Learning a living : a blueprint for high performance : a SCANS report for America 2000.

"April 1992"--Pt. 1.

SCANS blueprint for action : building community coalitions.

Shipping list no.: 91-697-P.

Dr. Elijah Drake (2 scans, front & back)

scanned front and back; front = 1of2, back = 2of2

Variability in Cobb angle measurements using reformatted computerized tomography scans

Study Design. Survey of intraobserver and interobserver measurement variability. Objective. To assess the use of reformatted computerized tomography (CT) images for manual measurement of coronal Cobb angles in idiopathic scoliosis. Summary of Background Data. Cobb angle measurements in idiopathic scoliosis are traditionally made from standing radiographs, whereas CT is often used for assessment of vertebral rotation. Correlating Cobb angles from standing radiographs with vertebral rotations from supine CT is problematic because the geometry of the spine changes significantly from standing to supine positions, and 2 different imaging methods are involved. Methods. We assessed the use of reformatted thoracolumbar CT images for Cobb angle measurement. Preoperative CT of 12 patients with idiopathic scoliosis were used to generate reformatted coronal images. Five observers measured coronal Cobb angles on 3 occasions from each of the images. Intraobserver and interobserver variability associated with Cobb measurement from reformatted CT scans was assessed and compared with previous studies of measurement variability using plain radiographs. Results. For major curves, 95% confidence intervals for intraobserver and interobserver variability were +/- 6.6 degrees and +/- 7.7 degrees, respectively. For minor curves, the intervals were +/- 7.5 degrees and +/- 8.2 degrees, respectively. Intraobserver and interobserver technical error of measurement was 2.4 degrees and 2.7 degrees, with reliability coefficients of 88% and 84%, respectively. There was no correlation between measurement variability and curve severity. Conclusions. Reformatted CT images may be used for manual measurement of coronal Cobb angles in idiopathic scoliosis with similar variability to manual measurement of plain radiographs.

Examination of the predictive value of structural magnetic resonance scans in bipolar disorder:a pattern classification approach

Background - Bipolar disorder (BD) is one of the leading causes of disability worldwide. Patients are further disadvantaged by delays in accurate diagnosis ranging between 5 and 10 years. We applied Gaussian process classifiers (GPCs) to structural magnetic resonance imaging (sMRI) data to evaluate the feasibility of using pattern recognition techniques for the diagnostic classification of patients with BD. Method - GPCs were applied to gray (GM) and white matter (WM) sMRI data derived from two independent samples of patients with BD (cohort 1: n = 26; cohort 2: n = 14). Within each cohort patients were matched on age, sex and IQ to an equal number of healthy controls. Results - The diagnostic accuracy of the GPC for GM was 73% in cohort 1 and 72% in cohort 2; the sensitivity and specificity of the GM classification were respectively 69% and 77% in cohort 1 and 64% and 99% in cohort 2. The diagnostic accuracy of the GPC for WM was 69% in cohort 1 and 78% in cohort 2; the sensitivity and specificity of the WM classification were both 69% in cohort 1 and 71% and 86% respectively in cohort 2. In both samples, GM and WM clusters discriminating between patients and controls were localized within cortical and subcortical structures implicated in BD. Conclusions - Our results demonstrate the predictive value of neuroanatomical data in discriminating patients with BD from healthy individuals. The overlap between discriminative networks and regions implicated in the pathophysiology of BD supports the biological plausibility of the classifiers.

An integrative approach to face and expression recognition from 3D scans

Biometrics is afield of study which pursues the association of a person's identity with his/her physiological or behavioral characteristics.^ As one aspect of biometrics, face recognition has attracted special attention because it is a natural and noninvasive means to identify individuals. Most of the previous studies in face recognition are based on two-dimensional (2D) intensity images. Face recognition based on 2D intensity images, however, is sensitive to environment illumination and subject orientation changes, affecting the recognition results. With the development of three-dimensional (3D) scanners, 3D face recognition is being explored as an alternative to the traditional 2D methods for face recognition.^ This dissertation proposes a method in which the expression and the identity of a face are determined in an integrated fashion from 3D scans. In this framework, there is a front end expression recognition module which sorts the incoming 3D face according to the expression detected in the 3D scans. Then, scans with neutral expressions are processed by a corresponding 3D neutral face recognition module. Alternatively, if a scan displays a non-neutral expression, e.g., a smiling expression, it will be routed to an appropriate specialized recognition module for smiling face recognition.^ The expression recognition method proposed in this dissertation is innovative in that it uses information from 3D scans to perform the classification task. A smiling face recognition module was developed, based on the statistical modeling of the variance between faces with neutral expression and faces with a smiling expression.^ The proposed expression and face recognition framework was tested with a database containing 120 3D scans from 30 subjects (Half are neutral faces and half are smiling faces). It is shown that the proposed framework achieves a recognition rate 10% higher than attempting the identification with only the neutral face recognition module.^

Radiation Dose to the Lens of the Eye from Computed Tomography Scans of the Head

While it is well known that exposure to radiation can result in cataract formation, questions still remain about the presence of a dose threshold in radiation cataractogenesis. Since the exposure history from diagnostic CT exams is well documented in a patient’s medical record, the population of patients chronically exposed to radiation from head CT exams may be an interesting area to explore for further research in this area. However, there are some challenges in estimating lens dose from head CT exams. An accurate lens dosimetry model would have to account for differences in imaging protocols, differences in head size, and the use of any dose reduction methods.

The overall objective of this dissertation was to develop a comprehensive method to estimate radiation dose to the lens of the eye for patients receiving CT scans of the head. This research is comprised of a physics component, in which a lens dosimetry model was derived for head CT, and a clinical component, which involved the application of that dosimetry model to patient data.

The physics component includes experiments related to the physical measurement of the radiation dose to the lens by various types of dosimeters placed within anthropomorphic phantoms. These dosimeters include high-sensitivity MOSFETs, TLDs, and radiochromic film. The six anthropomorphic phantoms used in these experiments range in age from newborn to adult.

First, the lens dose from five clinically relevant head CT protocols was measured in the anthropomorphic phantoms with MOSFET dosimeters on two state-of-the-art CT scanners. The volume CT dose index (CTDIvol), which is a standard CT output index, was compared to the measured lens doses. Phantom age-specific CTDIvol-to-lens dose conversion factors were derived using linear regression analysis. Since head size can vary among individuals of the same age, a method was derived to estimate the CTDIvol-to-lens dose conversion factor using the effective head diameter. These conversion factors were derived for each scanner individually, but also were derived with the combined data from the two scanners as a means to investigate the feasibility of a scanner-independent method. Using the scanner-independent method to derive the CTDIvol-to-lens dose conversion factor from the effective head diameter, most of the fitted lens dose values fell within 10-15% of the measured values from the phantom study, suggesting that this is a fairly accurate method of estimating lens dose from the CTDIvol with knowledge of the patient’s head size.

Second, the dose reduction potential of organ-based tube current modulation (OB-TCM) and its effect on the CTDIvol-to-lens dose estimation method was investigated. The lens dose was measured with MOSFET dosimeters placed within the same six anthropomorphic phantoms. The phantoms were scanned with the five clinical head CT protocols with OB-TCM enabled on the one scanner model at our institution equipped with this software. The average decrease in lens dose with OB-TCM ranged from 13.5 to 26.0%. Using the size-specific method to derive the CTDIvol-to-lens dose conversion factor from the effective head diameter for protocols with OB-TCM, the majority of the fitted lens dose values fell within 15-18% of the measured values from the phantom study.

Third, the effect of gantry angulation on lens dose was investigated by measuring the lens dose with TLDs placed within the six anthropomorphic phantoms. The 2-dimensional spatial distribution of dose within the areas of the phantoms containing the orbit was measured with radiochromic film. A method was derived to determine the CTDIvol-to-lens dose conversion factor based upon distance from the primary beam scan range to the lens. The average dose to the lens region decreased substantially for almost all the phantoms (ranging from 67 to 92%) when the orbit was exposed to scattered radiation compared to the primary beam. The effectiveness of this method to reduce lens dose is highly dependent upon the shape and size of the head, which influences whether or not the angled scan range coverage can include the entire brain volume and still avoid the orbit.

The clinical component of this dissertation involved performing retrospective patient studies in the pediatric and adult populations, and reconstructing the lens doses from head CT examinations with the methods derived in the physics component. The cumulative lens doses in the patients selected for the retrospective study ranged from 40 to 1020 mGy in the pediatric group, and 53 to 2900 mGy in the adult group.

This dissertation represents a comprehensive approach to lens of the eye dosimetry in CT imaging of the head. The collected data and derived formulas can be used in future studies on radiation-induced cataracts from repeated CT imaging of the head. Additionally, it can be used in the areas of personalized patient dose management, and protocol optimization and clinician training.

Data-Driven Motion Detection and Characterization in PET Brain Scans Using List Mode

Head motion during a Positron Emission Tomography (PET) brain scan can considerably degrade image quality. External motion-tracking devices have proven successful in minimizing this effect, but the associated time, maintenance, and workflow changes inhibit their widespread clinical use. List-mode PET acquisition allows for the retroactive analysis of coincidence events on any time scale throughout a scan, and therefore potentially offers a data-driven motion detection and characterization technique. An algorithm was developed to parse list-mode data, divide the full acquisition into short scan intervals, and calculate the line-of-response (LOR) midpoint average for each interval. These LOR midpoint averages, known as “radioactivity centroids,” were presumed to represent the center of the radioactivity distribution in the scanner, and it was thought that changes in this metric over time would correspond to intra-scan motion.

Several scans were taken of the 3D Hoffman brain phantom on a GE Discovery IQ PET/CT scanner to test the ability of the radioactivity to indicate intra-scan motion. Each scan incrementally surveyed motion in a different degree of freedom (2 translational and 2 rotational). The radioactivity centroids calculated from these scans correlated linearly to phantom positions/orientations. Centroid measurements over 1-second intervals performed on scans with ~1mCi of activity in the center of the field of view had standard deviations of 0.026 cm in the x- and y-dimensions and 0.020 cm in the z-dimension, which demonstrates high precision and repeatability in this metric. Radioactivity centroids are thus shown to successfully represent discrete motions on the submillimeter scale. It is also shown that while the radioactivity centroid can precisely indicate the amount of motion during an acquisition, it fails to distinguish what type of motion occurred.

Core scans and lithologic analysis of Subglacial Lake Whillans sediment cores

The hydrologic system beneath the Antarctic Ice Sheet is thought to influence both the dynamics and distribution of fast flowing ice streams, which discharge most of the ice lost by the ice sheet. Despite considerable interest in understanding this subglacial network and its affect on ice flow, in situ observations from the ice sheet bed are exceedingly rare. Here we describe the first sediment cores recovered from an active subglacial lake. The lake, known as Subglacial Lake Whillans, is part of a broader, dynamic hydrologic network beneath the Whillans Ice Stream in West Antarctica. Even though "floods" pass through the lake, the lake floor shows no evidence of erosion or deposition by flowing water. By inference, these floods must have insufficient energy to erode or transport significant volumes of sediment coarser than silt. Consequently, water flow beneath the region is probably incapable of incising continuous channels into the bed and instead follows preexisting subglacial topography and surface slope. Sediment on the lake floor consists of till deposited during intermittent grounding of the ice stream following flood events. The fabrics within the till are weaker than those thought to develop in thick deforming beds suggesting subglacial sediment fluxes across the ice plain are currently low and unlikely to have a large stabilizing effect on the ice stream's grounding zone.

effects of weight and injected dose in the liver’s Signal-to-Noise Ratio in patients submitted to PET/CT scans

The quality of the image of 18F-FDG PET/CT scans in overweight patients is commonly degraded. This study evaluates, retrospectively, the relation between SNR, weight and dose injected in 65 patients, with a range of weights from 35 to 120 kg, with scans performed using the Biograph mCT using a standardized protocol in the Nuclear Medicine Department at Radboud University Medical Centre in Nijmegen, The Netherlands. Five ROI’s were made in the liver, assumed to be an organ of homogenous metabolism, at the same location, in five consecutive slices of the PET/CT scans to obtain the mean uptake (signal) values and its standard deviation (noise). The ratio of both gave us the Signal-to- Noise Ratio in the liver. With the help of a spreadsheet, weight, height, SNR and Body Mass Index were calculated and graphs were designed in order to obtain the relation between these factors. The graphs showed that SNR decreases as the body weight and/or BMI increased and also showed that, even though the dose injected increased, the SNR also decreased. This is due to the fact that heavier patients receive higher dose and, as reported, heavier patients have less SNR. These findings suggest that the quality of the images, measured by SNR, that were acquired in heavier patients are worst than thinner patients, even though higher FDG doses are given. With all this taken in consideration, it was necessary to make a new formula to calculate a new dose to give to patients and having a good and constant SNR in every patient. Through mathematic calculations, it was possible to reach to two new equations (power and exponential), which would lead to a SNR from a scan made with a specific reference weight (86 kg was the considered one) which was independent of body mass. The study implies that with these new formulas, patients heavier than the reference weight will receive higher doses and lighter patients will receive less doses. With the median being 86 kg, the new dose and new SNR was calculated and concluded that the quality of the image remains almost constant as the weight increases and the quantity of the necessary FDG remains almost the same, without increasing the costs for the total amount of FDG used in all these patients.

Automatic detection of the inferior alveolar nerve in CT scans with CenterNet

The inferior alveolar nerve (IAN) lies within the mandibular canal, named inferior alveolar canal in literature. The detection of this nerve is important during maxillofacial surgeries or for creating dental implants. The poor quality of cone-beam computed tomography (CBCT) and computed tomography (CT) scans and/or bone gaps within the mandible increase the difficulty of this task, posing a challenge to human experts who are going to manually detect it and resulting in a time-consuming task.Therefore this thesis investigates two methods to automatically detect the IAN: a non-data driven technique and a deep-learning method. The latter tracks the IAN position at each frame leveraging detections obtained with the deep neural network CenterNet, fined-tuned for our task, and temporal and spatial information.