Robust temporal alignment of multimodal cardiac sequences

Given the dynamic nature of cardiac function, correct temporal alignment of pre-operative models and intraoperative images is crucial for augmented reality in cardiac image-guided interventions. As such, the current study focuses on the development of an image-based strategy for temporal alignment of multimodal cardiac imaging sequences, such as cine Magnetic Resonance Imaging (MRI) or 3D Ultrasound (US). First, we derive a robust, modality-independent signal from the image sequences, estimated by computing the normalized crosscorrelation between each frame in the temporal sequence and the end-diastolic frame. This signal is a resembler for the left-ventricle (LV) volume curve over time, whose variation indicates di erent temporal landmarks of the cardiac cycle. We then perform the temporal alignment of these surrogate signals derived from MRI and US sequences of the same patient through Dynamic Time Warping (DTW), allowing to synchronize both sequences. The proposed framework was evaluated in 98 patients, which have undergone both 3D+t MRI and US scans. The end-systolic frame could be accurately estimated as the minimum of the image-derived surrogate signal, presenting a relative error of 1:6 1:9% and 4:0 4:2% for the MRI and US sequences, respectively, thus supporting its association with key temporal instants of the cardiac cycle. The use of DTW reduces the desynchronization of the cardiac events in MRI and US sequences, allowing to temporally align multimodal cardiac imaging sequences. Overall, a generic, fast and accurate method for temporal synchronization of MRI and US sequences of the same patient was introduced. This approach could be straightforwardly used for the correct temporal alignment of pre-operative MRI information and intra-operative US images.

Improving The Robustness Of Interventional 4D Ultrasound Segmentation Through The Use Of Personalized Shape Priors

While fluoroscopy is still the most widely used imaging modality to guide cardiac interventions, the fusion of pre-operative Magnetic Resonance Imaging (MRI) with real-time intra-operative ultrasound (US) is rapidly gaining clinical acceptance as a viable, radiation-free alternative. In order to improve the detection of the left ventricular (LV) surface in 4D ultrasound, we propose to take advantage of the pre-operative MRI scans to extract a realistic geometrical model representing the patients cardiac anatomy. This could serve as prior information in the interventional setting, allowing to increase the accuracy of the anatomy extraction step in US data. We have made use of a real-time 3D segmentation framework used in the recent past to solve the LV segmentation problem in MR and US data independently and we take advantage of this common link to introduce the prior information as a soft penalty term in the ultrasound segmentation algorithm. We tested the proposed algorithm in a clinical dataset of 38 patients undergoing both MR and US scans. The introduction of the personalized shape prior improves the accuracy and robustness of the LV segmentation, as supported by the error reduction when compared to core lab manual segmentation of the same US sequences.

Semi-automatic 3D Segmentation Of Costal Cartilage In CT Data From Pectus Excavatum Patients

One of the current frontiers in the clinical management of Pectus Excavatum (PE) patients is the prediction of the surgical outcome prior to the intervention. This can be done through computerized simulation of the Nuss procedure, which requires an anatomically correct representation of the costal cartilage. To this end, we take advantage of the costal cartilage tubular structure to detect it through multi-scale vesselness filtering. This information is then used in an interactive 2D initialization procedure which uses anatomical maximum intensity projections of 3D vesselness feature images to efficiently initialize the 3D segmentation process. We identify the cartilage tissue centerlines in these projected 2D images using a livewire approach. We finally refine the 3D cartilage surface through region-based sparse field level-sets. We have tested the proposed algorithm in 6 noncontrast CT datasets from PE patients. A good segmentation performance was found against reference manual contouring, with an average Dice coefficient of 0.75±0.04 and an average mean surface distance of 1.69±0.30mm. The proposed method requires roughly 1 minute for the interactive initialization step, which can positively contribute to an extended use of this tool in clinical practice, since current manual delineation of the costal cartilage can take up to an hour.

A-scan ultrasound system for real-time puncture safety assessment during percutaneous nephrolithotomy

Background: Kidney stone is a major universal health problem, affecting 10% of the population worldwide. Percutaneous nephrolithotomy is a first-line and established procedure for disintegration and removal of renal stones. Its surgical success depends on the precise needle puncture of renal calyces, which remains the most challenging task for surgeons. This work describes and tests a new ultrasound based system to alert the surgeon when undesirable anatomical structures are in between the puncture path defined through a tracked needle. Methods: Two circular ultrasound transducers were built with a single 3.3-MHz piezoelectric ceramic PZT SN8, 25.4 mm of radius and resin-epoxy matching and backing layers. One matching layer was designed with a concave curvature to work as an acoustic lens with long focusing. The A-scan signals were filtered and processed to automatically detect reflected echoes. Results: The transducers were mapped in water tank and tested in a study involving 45 phantoms. Each phantom mimics different needle insertion trajectories with a percutaneous path length between 80 and 150 mm. Results showed that the beam cross-sectional area oscillates around the ceramics radius and it was possible to automatically detect echo signals in phantoms with length higher than 80 mm. Conclusions: This new solution may alert the surgeon about anatomical tissues changes during needle insertion, which may decrease the need of X-Ray radiation exposure and ultrasound image evaluation during percutaneous puncture.

Validation of percutaneous puncture trajectory during renal access using 4D ultrasound reconstruction

Background: An accurate percutaneous puncture is essential for disintegration and removal of renal stones. Although this procedure has proven to be safe, some organs surrounding the renal target might be accidentally perforated. This work describes a new intraoperative framework where tracked surgical tools are superimposed within 4D ultrasound imaging for security assessment of the percutaneous puncture trajectory (PPT). Methods: A PPT is first generated from the skin puncture site towards an anatomical target, using the information retrieved by electromagnetic motion tracking sensors coupled to surgical tools. Then, 2D ultrasound images acquired with a tracked probe are used to reconstruct a 4D ultrasound around the PPT under GPU processing. Volume hole-filling was performed in different processing time intervals by a tri-linear interpolation method. At spaced time intervals, the volume of the anatomical structures was segmented to ascertain if any vital structure is in between PPT and might compromise the surgical success. To enhance the volume visualization of the reconstructed structures, different render transfer functions were used. Results: Real-time US volume reconstruction and rendering with more than 25 frames/s was only possible when rendering only three orthogonal slice views. When using the whole reconstructed volume one achieved 8-15 frames/s. 3 frames/s were reached when one introduce the segmentation and detection if some structure intersected the PPT. Conclusions: The proposed framework creates a virtual and intuitive platform that can be used to identify and validate a PPT to safely and accurately perform the puncture in percutaneous nephrolithotomy.

Computer-aided recognition of dental implants in X-ray images

Dental implant recognition in patients without available records is a time-consuming and not straightforward task. The traditional method is a complete user-dependent process, where the expert compares a 2D X-ray image of the dental implant with a generic database. Due to the high number of implants available and the similarity between them, automatic/semi-automatic frameworks to aide implant model detection are essential. In this study, a novel computer-aided framework for dental implant recognition is suggested. The proposed method relies on image processing concepts, namely: (i) a segmentation strategy for semi-automatic implant delineation; and (ii) a machine learning approach for implant model recognition. Although the segmentation technique is the main focus of the current study, preliminary details of the machine learning approach are also reported. Two different scenarios are used to validate the framework: (1) comparison of the semi-automatic contours against implant’s manual contours of 125 X-ray images; and (2) classification of 11 known implants using a large reference database of 601 implants. Regarding experiment 1, 0.97±0.01, 2.24±0.85 pixels and 11.12±6 pixels of dice metric, mean absolute distance and Hausdorff distance were obtained, respectively. In experiment 2, 91% of the implants were successfully recognized while reducing the reference database to 5% of its original size. Overall, the segmentation technique achieved accurate implant contours. Although the preliminary classification results prove the concept of the current work, more features and an extended database should be used in a future work.

Sistema para formação e avaliação dos operadores das máquinas de inspeção ótica automática

A montagem de circuitos eletrónicos é um processo extremamente complexo, e como tal muito difícil de controlar. Ao longo do processo produtivo, é colocada solda no PCB (printed circuit board), seguidamente são colocados os componentes eletrónicos que serão depois soldados através de um sistema de convecção, sendo por fim inspecionados todos os componentes, com o intuito de detetar eventuais falhas no circuito. Esta inspeção é efetuada por uma máquina designada por AOI (automatic optical inspection), que através da captura de várias imagens do PCB, analisa cada uma, utilizando algoritmos de processamento de imagem como forma de verificar a presença, colocação e soldadura de todos os componentes. Um dos grandes problemas na classificação dos defeitos relaciona-se com a quantidade de defeitos mal classificados que passam para os processos seguintes, por análise errada por parte dos operadores. Assim, apenas com uma formação adequada, realizada continuamente, é possível garantir uma menor taxa de falhas por parte dos operadores e consequentemente um aumento na qualidade dos produtos. Através da implementação da metodologia Gage R&R para atributos, que é parte integrante da estratégia “six sigma” foi possível analisar a aptidão dos operadores, com base na repetição aleatória de várias imagens. Foi desenvolvido um software que implementa esta metodologia na formação dos operadores das máquinas AOI, de forma a verificar a sua aptidão, tendo como objetivo a melhoria do seu desempenho futuro, através da medição e quantificação das dificuldades de cada pessoa. Com esta nova sistemática foi mais fácil entender a necessidade de formação de cada operador, pois com a constante evolução dos componentes eletrónicos e com o surgimento de novos componentes, estão implícitas novas dificuldades para os operadores neste tipo de tarefa. Foi também possível reduzir o número de defeitos mal classificados de forma significativa, através da aposta na formação com o auxílio do software desenvolvido.

IDEA MANAGEMENT SYSTEM - AN ESSENTIAL COMPONENT IN THE CONTINUOUS IMPROVEMENT OF QUALITY AND INNOVATION

It is known the power of ideas is tremendous. But there are employees in many companies who have good ideas but not put them into practice. On the other hand, there are many others who have good ideas and are encouraged to contribute their ideas for innovation in the company. This study attempts to identify factors that contribute to success in managing ideas and consequent business innovation. The method used was the case study applied to two companies. During the investigation, factors considered essential for the success of an idea management program were identified, of which we highlight, among others, evidences the results, involvement of the top management, establishment of goals and objectives; recognition; dissemination of good results. Companies with these implemented systems, capture the best ideas from their collaborators and apply them internally. This study intends to contribute to business innovation in enterprises through creation and idea management, mainly through collecting the best ideas of their own employees. The results of this study can be used to help improving deployed suggestions systems, as well as, all managers who wish to implement suggestions systems/ideas management systems.

Multi-centre validation of an automatic algorithm for fast 4D myocardial segmentation in cine CMR datasets

Quantitative analysis of cine cardiac magnetic resonance (CMR) images for the assessment of global left ventricular morphology and function remains a routine task in clinical cardiology practice. To date, this process requires user interaction and therefore prolongs the examination (i.e. cost) and introduces observer variability. In this study, we sought to validate the feasibility, accuracy, and time efficiency of a novel framework for automatic quantification of left ventricular global function in a clinical setting.

Assessment of Laparoscopic Skills Performance: 2D Versus 3D Vision and Classic Instrument Versus New Hand-Held Robotic Device for Laparoscopy

Introduction and Objectives. Laparoscopic surgery has undeniable advantages, such as reduced postoperative pain, smaller incisions, and faster recovery. However, to improve surgeons’ performance, ergonomic adaptations of the laparoscopic instruments and introduction of robotic technology are needed. The aim of this study was to ascertain the influence of a new hand-held robotic device for laparoscopy (HHRDL) and 3D vision on laparoscopic skills performance of 2 different groups, naïve and expert. Materials and Methods. Each participant performed 3 laparoscopic tasks—Peg transfer, Wire chaser, Knot—in 4 different ways. With random sequencing we assigned the execution order of the tasks based on the first type of visualization and laparoscopic instrument. Time to complete each laparoscopic task was recorded and analyzed with one-way analysis of variance. Results. Eleven experts and 15 naïve participants were included. Three-dimensional video helps the naïve group to get better performance in Peg transfer, Wire chaser 2 hands, and Knot; the new device improved the execution of all laparoscopic tasks (P < .05). For expert group, the 3D video system benefited them in Peg transfer and Wire chaser 1 hand, and the robotic device in Peg transfer, Wire chaser 1 hand, and Wire chaser 2 hands (P < .05). Conclusion. The HHRDL helps the execution of difficult laparoscopic tasks, such as Knot, in the naïve group. Three-dimensional vision makes the laparoscopic performance of the participants without laparoscopic experience easier, unlike those with experience in laparoscopic procedures.

Targeting lactate transport suppresses in vivo breast tumour growth

Background: Most cancers, including breast cancer, have high rates of glucose consumption, associated with lactate production, a process referred as “Warburg effect”. Acidification of the tumour microenvironment by lactate extrusion, performed by lactate transporters (MCTs), is associated with higher cell proliferation, migration, invasion, angiogenesis and increased cell survival. Previously, we have described MCT1 up-regulation in breast carcinoma samples and demonstrated the importance of in vitro MCT inhibition. In this study, we performed siRNA knockdown of MCT1 and MCT4 in basal-like breast cancer cells in both normoxia and hypoxia conditions to validate the potential of lactate transport inhibition in breast cancer treatment. Results: The effect of MCT knockdown was evaluated on lactate efflux, proliferation, cell biomass, migration and invasion and induction of tumour xenografts in nude mice. MCT knockdown led to a decrease in in vitro tumour cell aggressiveness, with decreased lactate transport, cell proliferation, migration and invasion and, importantly, to an inhibition of in vivo tumour formation and growth. Conclusions: This work supports MCTs as promising targets in cancer therapy, demonstrates the contribution of MCTs to cancer cell aggressiveness and, more importantly, shows, for the first time, the disruption of in vivo breast tumour growth by targeting lactate transport.

Anotação ao Acórdão do Supremo Tribunal de Justiça (Português), de 25 de Janeiro de 2011 - a resolução e o contrato de franquia

is important to draw attention to potential differences between the franchise agreement and agency agreement with regard also to the resolution problem in more general terms or in more concrete terms; 1 - Summary of the Sentence of the Supreme Court of Justice, 25 of January of 2011; 2 - Complete text of the Sentence of the Supreme Court of Justice, 25 of January of 2011, Advising Judge Garcia CALEJO (Reporter), Advising Judge Hélder ROQUE and Advising Juiz Sebastião PÓVOAS: cfr. http://www.dgsi.pt , 21 of April of 2011; 3 - Notation; 3.1 - Introduction to the notation; 3.2 - The question of the resolution in general terms; 3.3 - The question of the resolution in the «atypical contract of franshise»; 4 - Conclusions;

Effects and determinants of household debt in Portugal

As the amount of debt has gradually increased, particularly in recent years, Portugal is currently one of the European countries exhibiting one of the highest levels of overall indebtedness, including in both sovereign and private sectors. Indeed, this condition is the outcome of increasing levels of debt assumed not only by the government, but also by companies and families, being the later mostly due to mortgage loans and due charges. This paper focuses on the study of borrowing by Portuguese households. The research has been made in respect to the notion of debt, the consequences of recent developments in debt, among other factors. In order to analyse the factors that are most associated with debt, a study was developed using two multiple regression models, one using a longer time series and another shorter, evaluating the effect of several variables, such as consumption, savings, unemployment, inflation and interest rates, in order to check whether they could be associated with a higher level of debt.

Financial Risk Analysis of Portuguese Textile and Tourism Companies

Textile and tourism sectors are two important industries in the Portuguese economy. However, its high exposure to both internal and international economic volatility make the companies operating in these economic sectors particularly vulnerable to economic crises, such as the ones which have been impacting Portugal and the European Union. The objective of this paper is to evaluate and understand the impact of size and age on the financial health of textile and tourism companies, measured by economic indices. An empirical based model is proposed. Its implications are derived and tested on a sample of 4061 Portuguese companies from textile and tourism sectors, during the period 2005-2009. The findings suggest that age has a major impact on the risk of failure, rather than size. Whereas the effect of age is generally positive regarding the financial health of the company, the effect of size is less clear and ultimately depends on the age of the company.

The impact of size and age of the company on assessing financial risk.

Textiles and tourism sectors are two important sectors in Portuguese economy. Its high exposure to both internal and international economy volatility transform the companies operating in these economic sectors especially vulnerable to recent economic crises in Portugal and European Union. The objective of this paper is to evaluate and understand the impact of size and age on the financial health of textile and tourism companies, measured by economic indices. An empirical based model is proposed. Its implications are derived and tested on a sample of 4061 Portuguese companies from textile and tourism sector, during the period 2005-2009. The results conclude that age has a stronger impact on the risk of failure than size. Whereas the effect of age is generally positive regarding the financial health of the company, the effect of size is less clear and depends on the age of the company.