Imaging of pulmonary embolism and t-PA therapy effects using MDCT and liposomal iohexol blood pool agent – preliminary results in a rabbit model

Hypothesis and Objectives PEGylated liposomal blood pool contrast agents maintain contrast enhancement over several hours. This study aimed to evaluate (long-term) imaging of pulmonary arteries, comparing conventional iodinated contrast with a liposomal blood pool contrast agent. Secondly, visualization of the (real-time) therapeutic effects of tissue-Plasminogen Activator (t-PA) on pulmonary embolism (PE) was attempted. Materials and Methods Six rabbits (approximate 4 kg weight) had autologous blood clots injected through the superior vena cava. Imaging was performed using conventional contrast (iohexol, 350 mg I/ml, GE HealthCare, Princeton, NJ) at a dose of 1400 mgI per animal and after wash-out, animals were imaged using an iodinated liposomal blood pool agent (88 mg I/mL, dose 900 mgI/animal). Subsequently, five animals were injected with 2mg t-PA and imaging continued for up to 4 ½ hours. Results Both contrast agents identified PE in the pulmonary trunk and main pulmonary arteries in all rabbits. Liposomal blood pool agent yielded uniform enhancement, which remained relatively constant throughout the experiments. Conventional agents exhibited non uniform opacification and rapid clearance post injection. Three out of six rabbits had mistimed bolus injections, requiring repeat injections. Following t-PA, Pulmonary embolus volume (central to segmental) decreased in four of five treated rabbits (range 10–57%, mean 42%). One animal showed no response to t-PA. Conclusions Liposomal blood pool agents effectively identified acute PE without need for re-injection. PE resolution following t-PA was quantifiable over several hours. Blood pool agents offer the potential for repeated imaging procedures without need for repeated (nephrotoxic) contrast injections

NEW TOOLS FOR MONITORING GAMMA CAMERA UNIFORMITY

Detector uniformity is a fundamental performance characteristic of all modern gamma camera systems, and ensuring a stable, uniform detector response is critical for maintaining clinical images that are free of artifact. For these reasons, the assessment of detector uniformity is one of the most common activities associated with a successful clinical quality assurance program in gamma camera imaging. The evaluation of this parameter, however, is often unclear because it is highly dependent upon acquisition conditions, reviewer expertise, and the application of somewhat arbitrary limits that do not characterize the spatial location of the non-uniformities. Furthermore, as the goal of any robust quality control program is the determination of significant deviations from standard or baseline conditions, clinicians and vendors often neglect the temporal nature of detector degradation (1). This thesis describes the development and testing of new methods for monitoring detector uniformity. These techniques provide more quantitative, sensitive, and specific feedback to the reviewer so that he or she may be better equipped to identify performance degradation prior to its manifestation in clinical images. The methods exploit the temporal nature of detector degradation and spatially segment distinct regions-of-non-uniformity using multi-resolution decomposition. These techniques were tested on synthetic phantom data using different degradation functions, as well as on experimentally acquired time series floods with induced, progressively worsening defects present within the field-of-view. The sensitivity of conventional, global figures-of-merit for detecting changes in uniformity was evaluated and compared to these new image-space techniques. The image-space algorithms provide a reproducible means of detecting regions-of-non-uniformity prior to any single flood image’s having a NEMA uniformity value in excess of 5%. The sensitivity of these image-space algorithms was found to depend on the size and magnitude of the non-uniformities, as well as on the nature of the cause of the non-uniform region. A trend analysis of the conventional figures-of-merit demonstrated their sensitivity to shifts in detector uniformity. The image-space algorithms are computationally efficient. Therefore, the image-space algorithms should be used concomitantly with the trending of the global figures-of-merit in order to provide the reviewer with a richer assessment of gamma camera detector uniformity characteristics.

DEVELOPMENT OF NOVEL METHODS TO MINIMIZE THE IMPACT OF SEQUENCING ERRORS IN THE NEXT-GENERATION SEQUENCING DATA ANALYSIS

Next-generation sequencing (NGS) technology has become a prominent tool in biological and biomedical research. However, NGS data analysis, such as de novo assembly, mapping and variants detection is far from maturity, and the high sequencing error-rate is one of the major problems. . To minimize the impact of sequencing errors, we developed a highly robust and efficient method, MTM, to correct the errors in NGS reads. We demonstrated the effectiveness of MTM on both single-cell data with highly non-uniform coverage and normal data with uniformly high coverage, reflecting that MTM’s performance does not rely on the coverage of the sequencing reads. MTM was also compared with Hammer and Quake, the best methods for correcting non-uniform and uniform data respectively. For non-uniform data, MTM outperformed both Hammer and Quake. For uniform data, MTM showed better performance than Quake and comparable results to Hammer. By making better error correction with MTM, the quality of downstream analysis, such as mapping and SNP detection, was improved. SNP calling is a major application of NGS technologies. However, the existence of sequencing errors complicates this process, especially for the low coverage (

Electron intensity modulation for mixed-beam radiation therapy with an x-ray multi-leaf collimator

The current standard treatment for head and neck cancer at our institution uses intensity-modulated x-ray therapy (IMRT), which improves target coverage and sparing of critical structures by delivering complex fluence patterns from a variety of beam directions to conform dose distributions to the shape of the target volume. The standard treatment for breast patients is field-in-field forward-planned IMRT, with initial tangential fields and additional reduced-weight tangents with blocking to minimize hot spots. For these treatment sites, the addition of electrons has the potential of improving target coverage and sparing of critical structures due to rapid dose falloff with depth and reduced exit dose. In this work, the use of mixed-beam therapy (MBT), i.e., combined intensity-modulated electron and x-ray beams using the x-ray multi-leaf collimator (MLC), was explored. The hypothesis of this study was that addition of intensity-modulated electron beams to existing clinical IMRT plans would produce MBT plans that were superior to the original IMRT plans for at least 50% of selected head and neck and 50% of breast cases. Dose calculations for electron beams collimated by the MLC were performed with Monte Carlo methods. An automation system was created to facilitate communication between the dose calculation engine and the treatment planning system. Energy and intensity modulation of the electron beams was accomplished by dividing the electron beams into 2x2-cm2 beamlets, which were then beam-weight optimized along with intensity-modulated x-ray beams. Treatment plans were optimized to obtain equivalent target dose coverage, and then compared with the original treatment plans. MBT treatment plans were evaluated by participating physicians with respect to target coverage, normal structure dose, and overall plan quality in comparison with original clinical plans. The physician evaluations did not support the hypothesis for either site, with MBT selected as superior in 1 out of the 15 head and neck cases (p=1) and 6 out of 18 breast cases (p=0.95). While MBT was not shown to be superior to IMRT, reductions were observed in doses to critical structures distal to the target along the electron beam direction and to non-target tissues, at the expense of target coverage and dose homogeneity. ^

Comparative virulence of enterotoxigenic non-Escherichia coli Enterobacteriaceae species from patients with travelers' diarrhea

Background: Family members of Enterobacteriaceae are found in small numbers associated with acute diarrhea. These species are sometimes mistaken for ETEC. ^ Methods: Forty-four non-E. coli species from travelers' diarrhea are compared to 30 strains of Escherichia coli (ETEC) and 30 strains of normal flora E. coli. Tissue culture supernatants were assayed by enzyme-linked immunosorbent assay for amounts of IL-8, IL-1, and IL-1ra. Amounts of heat-stable (ST) and heat-labile (LT) enterotoxins were assayed from cell culture supernatants by enzyme-linked immunoassay. PCR was use to determine which species was positive colonization factor antigens, CFA/I, CS3, and CS6. ^ Results: Normal flora E. coli significantly induced the production of more IL-8 than non- E. coli and ETEC. Normal E. coli also induced the production of more IL-1and IL-1ra than ETEC. Non-E. coli produced more ST than ETEC. A small percentage of enterotoxigenic non- E. coli gram negatives and ETEC were positive for CFA/I and CS6. None of the strains were positive for CS3. ^ Conclusions: Non-E. coli enterotoxigenic gram negatives were similar to ETEC in their virulence factors. Identification and further study of these non-E.coli strains is important for understanding their pathogenic role in acute diarrhea.^