Optimization of a customized simultaneous algebraic reconstruction technique algorithm for phase-contrast breast computed tomography.

Objective.To introduce the optimization of a customized GPU-based simultaneous algebraic reconstruction technique (cSART) in the field of phase-contrast breast computed tomography (bCT). The presented algorithm features a 3D bilateral regularization filter that can be tuned to yield optimal performance for clinical image visualization and tissues segmentation.Approach.Acquisitions of a dedicated test object and a breast specimen were performed at Elettra, the Italian synchrotron radiation (SR) facility (Trieste, Italy) using a large area CdTe single-photon counting detector. Tomographic images were obtained at 5 mGy of mean glandular dose, with a 32 keV monochromatic x-ray beam in the free-space propagation mode. Three independent algorithms parameters were optimized by using contrast-to-noise ratio (CNR), spatial resolution, and noise texture metrics. The results obtained with the cSART algorithm were compared with conventional SART and filtered back projection (FBP) reconstructions. Image segmentation was performed both with gray scale-based and supervised machine-learning approaches.Main results.Compared to conventional FBP reconstructions, results indicate that the proposed algorithm can yield images with a higher CNR (by 35% or more), retaining a high spatial resolution while preserving their textural properties. Alternatively, at the cost of an increased image 'patchiness', the cSART can be tuned to achieve a high-quality tissue segmentation, suggesting the possibility of performing an accurate glandularity estimation potentially of use in the realization of realistic 3D breast models starting from low radiation dose images.Significance.The study indicates that dedicated iterative reconstruction techniques could provide significant advantages in phase-contrast bCT imaging. The proposed algorithm offers great flexibility in terms of image reconstruction optimization, either toward diagnostic evaluation or image segmentation.

Towards breast tomography with synchrotron radiation at Elettra: first images.

The aim of the SYRMA-CT collaboration is to set-up the first clinical trial of phase-contrast breast CT with synchrotron radiation (SR). In order to combine high image quality and low delivered dose a number of innovative elements are merged: a CdTe single photon counting detector, state-of-the-art CT reconstruction and phase retrieval algorithms. To facilitate an accurate exam optimization, a Monte Carlo model was developed for dose calculation using GEANT4. In this study, high isotropic spatial resolution (120 µm)(3) CT scans of objects with dimensions and attenuation similar to a human breast were acquired, delivering mean glandular doses in the range of those delivered in clinical breast CT (5-25 mGy). Due to the spatial coherence of the SR beam and the long distance between sample and detector, the images contain, not only absorption, but also phase information from the samples. The application of a phase-retrieval procedure increases the contrast-to-noise ratio of the tomographic images, while the contrast remains almost constant. After applying the simultaneous algebraic reconstruction technique to low-dose phase-retrieved data sets (about 5 mGy) with a reduced number of projections, the spatial resolution was found to be equal to filtered back projection utilizing a four fold higher dose, while the contrast-to-noise ratio was reduced by 30%. These first results indicate the feasibility of clinical breast CT with SR.

P.R.L. platelet rich lipotransfert: our experience and current state of art in the combined use of fat and PRP.

The authors report their experience about the use of P.R.L. PLATELET RICH LIPOTRANSFERT method (platelet rich plasma mixed fat grafting) in 223 patients affected by soft tissue defects (ulcers, Romberg syndrome, Hemifacial atrophy, loss of substance, and signs of aging). This paper introduces the reader to PRP therapy and reviews the current literature on this emerging treatment modality, showing at the current clinical use of PRP in plastic and reconstructive surgery, with description of innovative methods and future prospects. This technique provides a promising alternative to surgery by promoting safe and natural healing. Here recent studies concerning the use of PRP in the treatment of chronic ulcers and soft tissue defect are reviewed.

Quantitative phase retrieval with picosecond X-ray pulses from the ATF Inverse Compton Scattering source.

Quantitative phase retrieval is experimentally demonstrated using the Inverse Compton Scattering X-ray source available at the Accelerator Test Facility (ATF) in the Brookhaven National Laboratory. Phase-contrast images are collected using in-line geometry, with a single X-ray pulse of approximate duration of one picosecond. The projected thickness of homogeneous samples of various polymers is recovered quantitatively from the time-averaged intensity of transmitted X-rays. The data are in good agreement with the expectations showing that ATF Inverse Compton Scattering source is suitable for performing phase-sensitive quantitative X-ray imaging on the picosecond scale. The method shows promise for quantitative imaging of fast dynamic phenomena.

Characterization of a mammographic system based on single photon counting pixel arrays coupled to GaAs x-ray detectors.

The authors report on the imaging capabilities of a mammographic system demonstrator based on GaAs pixel detectors operating in single photon counting (SPC) mode. The system imaging performances have been assessed by means of the transfer functions: The modulation transfer function (MTF), the normalized noise power spectrum, and the detective quantum efficiency (DQE) have been measured following the guidelines of the IEC 62220-1-2 protocol. The transfer function analysis has shown the high spatial resolution capabilities of the GaAs detectors. The MTF calculated at the Nyquist frequency (2.94 cycles/mm) is indeed 60%. The DQE, measured with a standard mammographic beam setup (Mo/Mo, 28 kVp, with 4 mm Al added filter) and calculated at zero frequency, is 46%. Aiming to further improve the system's image quality, the authors investigate the DQE limiting factors and show that they are mainly related to system engineering. For example, the authors show that optimization of the image equalization procedure increases the DQE(0) up to 74%, which is better than the DQE(0) of most clinical mammographic systems. The authors show how the high detection efficiency of GaAs detectors and the noise discrimination associated with the SPC technology allow optimizing the image quality in mammography. In conclusion, the authors propose technological solutions to exploit to the utmost the potentiality of GaAs detectors coupled to SPC electronics.

MAGIC-5: an Italian mammographic database of digitised images for research.

The implementation of a database of digitised mammograms is discussed. The digitised images were collected beginning in 1999 by a community of physicists in collaboration with radiologists in several Italian hospitals as a first step in developing and implementing a computer-aided detection (CAD) system. All 3,369 mammograms were collected from 967 patients and classified according to lesion type and morphology, breast tissue and pathology type. A dedicated graphical user interface was developed to visualise and process mammograms to support the medical diagnosis directly on a high-resolution screen. The database has been the starting point for developing other medical imaging applications, such as a breast CAD, currently being upgraded and optimised for use in a distributed environment with grid services, in the framework of the Instituto Nazionale di Fisicia Nucleare (INFN)-funded Medical Applications on a Grid Infrastructure Connection (MAGIC)-5 project.

A pixel detector-based single photon-counting system as fast spectrometer for diagnostic X-ray beams.

Recent advances in semiconductor pixel detectors and read-out electronics allowed to build the first prototypes of single photon-counting imaging systems that represent the last frontier of digital radiography. Among the advantages with respect to commercially available digital imaging systems, there are direct conversion of photon energy into electrical charge and the effective rejection of electronic noise by means of a thresholding process. These features allow the photon-counting systems to achieve high imaging performances in terms of spatial and contrast resolution. Moreover, the now available deep integration techniques allow the reduction of the pixel size and the improvement of the functionality of the single cell and the read-out speed so as to cope with the high fluxes found in diagnostic radiology. In particular, the single photon-counting system presented in this paper is based on a 300-microm thick silicon pixel detector bump-bonded to the Medipix2 read-out chip to form an assembly of 256 x 256 square pixels at a pitch of 55 microm. Each cell comprises a low-noise preamplifier, two pulse height discriminators and a 14-bit counter. The maximum counting rate per pixel is 1 MHz. The chip can operate in two modalities: it records the events with energy above a threshold (single mode) or between two energy thresholds (window mode). Exploiting this latter feature, a possible application of such a system as a fast spectrometer is presented to study the energy spectrum of diagnostic beams produced by X-ray tubes.

Lung nodule detection in low-dose and thin-slice computed tomography.

A computer-aided detection (CAD) system for the identification of small pulmonary nodules in low-dose and thin-slice CT scans has been developed. The automated procedure for selecting the nodule candidates is mainly based on a filter enhancing spherical-shaped objects. A neural approach based on the classification of each single voxel of a nodule candidate has been purposely developed and implemented to reduce the amount of false-positive findings per scan. The CAD system has been trained to be sensitive to small internal and sub-pleural pulmonary nodules collected in a database of low-dose and thin-slice CT scans. The system performance has been evaluated on a data set of 39 CT containing 75 internal and 27 sub-pleural nodules. The FROC curve obtained on this data set shows high values of sensitivity to lung nodules (80-85% range) at an acceptable level of false positive findings per patient (10-13 FP/scan).

A CAD system for nodule detection in low-dose lung CTs based on region growing and a new active contour model.

A computer-aided detection (CAD) system for the selection of lung nodules in computer tomography (CT) images is presented. The system is based on region growing (RG) algorithms and a new active contour model (ACM), implementing a local convex hull, able to draw the correct contour of the lung parenchyma and to include the pleural nodules. The CAD consists of three steps: (1) the lung parenchymal volume is segmented by means of a RG algorithm; the pleural nodules are included through the new ACM technique; (2) a RG algorithm is iteratively applied to the previously segmented volume in order to detect the candidate nodules; (3) a double-threshold cut and a neural network are applied to reduce the false positives (FPs). After having set the parameters on a clinical CT, the system works on whole scans, without the need for any manual selection. The CT database was recorded at the Pisa center of the ITALUNG-CT trial, the first Italian randomized controlled trial for the screening of the lung cancer. The detection rate of the system is 88.5% with 6.6 FPs/CT on 15 CT scans (about 4700 sectional images) with 26 nodules: 15 internal and 11 pleural. A reduction to 2.47 FPs/CT is achieved at 80% efficiency.

Comparison of two portable solid state detectors with an improved collimation and alignment device for mammographic x-ray spectroscopy.

We describe a portable system for mammographic x-ray spectroscopy, based on a 2 X 2 X 1 mm3 cadmium telluride (CdTe) solid state detector, that is greatly improved over a similar system based on a 3 X 3 X 2 mm3 cadmium zinc telluride (CZT) solid state detector evaluated in an earlier work. The CdTe system utilized new pinhole collimators and an alignment device that facilitated measurement of mammographic x-ray spectra. Mammographic x-ray spectra acquired by each system were comparable. Half value layer measurements obtained using an ion chamber agreed closely with those derived from the x-ray spectra measured by either detector. The faster electronics and other features of the CdTe detector allowed its use with a larger pinhole collimator than could be used with the CZT detector. Additionally, the improved pinhole collimator and alignment features of the apparatus permitted much more rapid setup for acquisition of x-ray spectra than was possible on the system described in the earlier work. These improvements in detector technology, collimation and ease of alignment, as well as low cost, make this apparatus attractive as a tool for both laboratory research and advanced mammography quality control.

GPCALMA: a Grid-based tool for mammographic screening.

OBJECTIVES: The next generation of high energy physics (HEP) experiments requires a GRID approach to a distributed computing system: the key concept is the Virtual ORGANISATION (VO), a group of distributed users with a common goal and the will to share their resources. METHODS: A similar approach, applied to a group of hospitals that joined the GPCALMA project (Grid Platform for Computer Assisted Library for MAmmography), will allow common screening programs for early diagnosis of breast and, in the future, lung cancer. The application code makes use of neural networks for the image analysis and is useful in improving the radiologists' diagnostic performance. GRID services allow remote image analysis and interactive online diagnosis, with a potential for a relevant reduction of the delays presently associated with screening programs. RESULTS AND CONCLUSIONS: A prototype of the system, based on AliEn GRID Services [1], is already available, with a central server running common services [2] and several clients connecting to it. Mammograms can be acquired in any location; the related information required to select and access them at any time is stored in a common service called Data Catalogue, which can be queried by any client. Thanks to the PROOF facility [3], the result of a query can be used as input for analysis algorithms, which are executed on the nodes where the input images are stored,. The selected approach avoids data transfers for all the images with a negative diagnosis and allows an almost real time diagnosis for the set of images with high cancer probability.

[Application of a computer-aided detection (CAD) system to digitalized mammograms for identifying microcalcifications]. / Applicazione di un sistema di Computer Aided Detection (CAD) a mammografie digitalizzate nell-individuazione di microcalcificazioni.

PURPOSE: It is estimated that during mammographic screening programs radiologists fail to detect approximately 25% of breast cancers visible on retrospective review; this percentage rises to 50% if minimal signs are considered. Independent double reading is now strongly recommended as it allows to reduce the rate of false negative examinations by 5-15%. Recent technological progress has allowed to develop a number of computer-aided detection (CAD) systems. The aim of CAD is to help radiologists interpret lesions by serving as a second reader. In this study the authors developed and applied a CAD system to measure its ability to microcalcifications detect and compare its performance with that of a human observer. MATERIAL AND METHODS: The study was performed as part of the CALMA (computer-aided library for mammography) project of the Pisa section of the National Institute of Nuclear Physics. The aim of this project is to set up a large database of digital mammograms and to develop a CAD system. Our study series consisted of 802 mammograms - corresponding to 213 patients - digitalized between March and June 2000. We performed traditional mammography and then digitalized the mammograms using a CCD linear scanner (pixel size of 85 x 85 microm2, 12 bits). The images were evaluated by two radiologists with similar experience and then by the CAD system. This CAD system searches for microcalcifications by using ad hoc algorithms and an artificial neural network (Sanger type). RESULTS: The number of clusters in our database was 141 corresponding to 140 images; 692 images were non pathological. The CAD system identified a variable number of clusters depending on the threshold values. The threshold value is a number over which the probability of finding a lesion is highest. With thresholds of 0.13 and 0.14 the CAD system identified 140/141 clusters (99.3%); with a threshold of 0.15 it identified 139/141 clusters (98.6%); with a threshold of 0.16, 137/141 (97.2%); with a threshold of 0.18, 133/141 (94.3%); with thresholds of 0.18 and 0.20, 130/141 (92.2%). With threshold values of 0.13, 0.14, 0.15, 0.16 and 0.17 the system's sensitivity was greater than 82%, whereas with values of 0.18 and 0.20 it was greater than 80%. The number of false positive region of interest (ROI) / image was greater with low threshold values: in particular, thresholds of 0.13 and 0.14 yielded 16 false positives /image, thresholds of 0.15 and 0.16 yielded 9 and 7 false positives/image, and both 0.18 and 0.20 only 5/image. DISCUSSION: ROC curve shows how the use of high threshold values determined a very high specificity despite very low sensitivity rates. Conversely, low threshold values allowed to have a high sensitivity and a very low specificity. The best performance of our CAD system was obtained with threshold values at 0.15 and 0.16. In fact these thresholds resulted in a high sensitivity (greater than 82%) with an acceptable number of false positives/image, 9 and 7/image, respectively. It is not yet known how radiologists can deal with large numbers of false positives in screening programmes but in our opinion the most important feature of a good CAD system is a high sensitivity. CONCLUSIONS: In the near future the use of CAD systems will be widespread and easier to apply to everyday practice above all in centers where digital mammography is performed. Mammograms could be directly shown to radiologists after the CAD system has selected the ROI and analysed the images. Thanks to its high sensitivity and despite its low specificity CAD represents a concrete aid for radiologists.

Conversion of bis(trichloromethyl) carbonate to phosgene and reactivity of triphosgene, diphosgene, and phosgene with methanol(1)

Triphosgene was decomposed quantitatively to phosgene by chloride ion. The reaction course was monitored by IR spectroscopy (React-IR), showing that diphosgene was an intermediate. The methanolysis of triphosgene in deuterated chloroform, monitored by proton NMR spectroscopy, gave methyl chloroformate and methyl 1,1, 1-trichloromethyl carbonate in about a 1:1 ratio, as primary products. The reaction carried out in the presence of large excess of methanol (0.3 M, 30 equiv) was a pseudo-first-order process with a k(obs) of 1.0 x 10(-)(4) s(-)(1). Under the same conditions, values of k(obs) of 0.9 x 10(-)(3) s(-)(1) and 1.7 x 10(-)(2) s(-)(1) for the methanolysis of diphosgene and phosgene, respectively, were determined. The experimental data suggest that, under these conditions, the maximum concentration of phosgene during the methanolysis of triphosgene and diphosgene was lower than 1 x 10(-)(5) M. Methyl 1,1,1-trichloromethyl carbonate was synthesized and characterized also by the APCI-MS technique.

[The evaluation of the size variations in alginate subjected to the sterilizing action of glutaraldehyde]. / Valutazione sulle variazioni dimensionali dell'alginato sottoposto all'azione sterilizzante della glutaraldeide.

The work takes into consideration the changes of dimension undergone by alginate submitted to the sterilizing action of aldehyde glutarate, after the impression. Trough the use of computerized analyser of images, samples of sterilized alginate have been compared with control samples. The results obtained can give a useful contribution to the prophylaxis of the crossed transmission of infection in the dental field.

The surgical management of childhood cholesteatoma.

The results of treatment of 124 cases of childhood cholesteatoma are reported in the present study and compared with an adult group of patients. Intact canal wall tympanoplasty was performed in over 90 per cent of cases in children and the procedure was staged in nearly 80 per cent of cases. The children had a 43.8 per cent incidence of residual cholesteatoma and an 8.8 per cent incidence of recurrent cholesteatoma in intact canal wall tympanoplasty cases. Intact canal wall tympanoplasty remains the technique of choice in our hands for the treatment of childhood cholesteatoma; pre-planned staging of the operation is mandatory for the detection and elimination of residual cholesteatoma which occurs more frequently in children.

Prevention of recurrent cholesteatoma in closed tympanoplasty.

Recurrent cholesteatoma in a series of 534 staged intact canal wall tympanoplasties performed over a 10-year period has been reviewed for the present study. Overall detected incidence of recurrent cholesteatoma is 5.2% (28 of 534 operated ears). A steady decrease of recurrent cholesteatoma was found, however, in the second period of our surgical experience (1978 to 1982) when prevention techniques were adopted in all operations, resulting in a 1.07% incidence (four of 373 operated ears). Our present policy for prevention of recurrent cholesteatoma in intact canal wall tympanoplasties with mastoidectomy includes the use of plastic sheeting with thick Silastic, the repair of bony sulcus defects with cartilage shavings, staging of the operation with preplanned reexploration of the middle ear and mastoid, and transtympanic ventilation tube insertion in cases of refractory tubal insufficiency.

Surgical treatment of brain herniation into the middle ear and mastoid.

A series of thirty-five patients operated on for brain herniation into the middle ear and mastoid is presented. The etiologic factor was felt to be previous surgery in twenty-six cases, head trauma in four cases, chronic otomastoiditis in four cases, congenital dehiscence of the tegmen in one case, and subdural empyema in one case. Diagnosis and treatment of brain herniation are discussed. The mastoid approach for repair of tegmen defects from below with the use of homologous cartilage or autologous cortical bone is advocated. A combined procedure using the transmastoid approach plus a mini-craniotomy of the temporalis squama is suggested as an alternative treatment to middle cranial fossa repair for larger cerebral hernias.