Quantitative analysis of fall risk using TUG test.

We examined falling risk among elderly using a wearable inertial sensor, which combines accelerometer and gyrosensors devices, applied during the Timed Up and Go (TUG) test. Subjects were categorised into two groups as low fall risk and high fall risk with 13.5 s duration taken to complete the TUG test as the threshold between them. One sensor was attached at the subject's waist dorsally, while acceleration and gyrosensor signals in three directions were extracted during the test. The analysis was carried out in phases: sit-bend, bend-stand, walking, turning, stand-bend and bend-sit. Comparisons between the two groups showed that time parameters along with root mean square (RMS) value, amplitude and other parameters could reveal the activities in each phase. Classification using RMS value of angular velocity parameters for sit-stand phase, RMS value of acceleration for walking phase and amplitude of angular velocity signal for turning phase along with time parameters suggests that this is an improved method in evaluating fall risk, which promises benefits in terms of improvement of elderly quality of life.

Visualizing in vivo brain neural structures using volume rendered feature spaces.

BACKGROUND: Dendrites of cortical neurons are widely spread across several layers of the cortex. Recently developed two-photon microscopy systems are capable of visualizing the morphology of neurons within deeper layers of the brain and generate large amounts of volumetric imaging data from living tissue. METHOD: For visual exploration of the three-dimensional (3D) structure of dendrites and the connectivity among neurons in the brain, we propose a visualization software and interface for 3D images based on a new transfer function design using volume rendered feature spaces. This software enables the visualization of multidimensional descriptors of shape and texture extracted from imaging data to characterize tissue. It also allows the efficient analysis and visualization of large data sets. RESULTS: We apply and demonstrate the software to two-photon microscopy images of a living mouse brain. By applying the developed visualization software and algorithms to two-photon microscope images of the mouse brain, we identified a set of feature values that distinguish characteristic structures such as soma, dendrites and apical dendrites in mouse brain. Also, the visualization interface was compared to conventional 1D/2D transfer function system. CONCLUSIONS: We have developed a visualization tool and interface that can represent 3D feature values as textures and shapes. This visualization system allows the analysis and characterization of the higher-dimensional feature values of living tissues at the micron level and will contribute to new discoveries in basic biology and clinical medicine.

Direct volume manipulation for visualizing intraoperative liver resection process.

This paper introduces a new design and application for direct volume manipulation for visualizing the intraoperative liver resection process. So far, interactive volume deformation and resection have been independently handled due to the difficulty of representing elastic behavior of volumetric objects. Our framework models global shape editing and discontinuous local deformation by merging proxy geometry encoding and displacement mapping. A local-frame-based elastic model is presented to allow stable editing of the liver shape including bending and twisting while preserving the volume. Several tests using clinical CT data have confirmed the developed software and interface can represent the intraoperative state of liver and produce local views of reference vascular structures, which provides a "road map of vessels" that are key features when approaching occluded tumors during surgery.

Volumetric surgical planning system for fibular transfer in mandibular reconstruction.

This presentation introduces a new software design for virtual preoperative planning for free fibular transfer in mandibular reconstructive surgery. Direct volume resection and manipulation of superimposed fibular segments allow interactive editing of the surgical plan without the need for a surface modeling process. We also introduce three shape indicators: volume ratio, contour error and maximum projection for evaluating the reconstruction plan from geometrical aspects. The indicators significantly quantify the difference between 2-segment and 3-segment cases, and suggest optimization of preoperative planning while satisfying appropriate placement margins for fibular segments.

Quantitative analysis of the fall-risk assessment test with wearable inertia sensors.

We performed a quantitative analysis of the fall-risk assessment test using a wearable inertia sensor focusing on two tests: the time up and go (TUG) test and the four square step test (FSST). These tests consist of various daily activities, such as sitting, standing, walking, stepping, and turning. The TUG test was performed by subjects at low and high fall risk, while FSST was performed by healthy elderly and hemiplegic patients with high fall risk. In general, the total performance time of activities was evaluated. Clinically, it is important to evaluate each activity for further training and management. The wearable sensor consisted of an accelerometer and angular velocity sensor. The angular velocity and angle of pitch direction were used for TUG evaluation, and those in the pitch and yaw directions at the thigh were used for FSST. Using the threshold of the angular velocity signal, we classified the phase corresponding to each activity. We then observed the characteristics of each activity and recommended suitable training and management. The wearable sensor can be used for more detailed evaluation in fall risk management. The wearable sensor can be used more detailed evaluation for fall-risk management test.

Cardiovascular modeling of congenital heart disease based on neonatal echocardiographic images.

This paper proposes a 3-D cardiovascular modeling system based on neonatal echocardiographic images. With the system, medical doctors can interactively construct patient-specific cardiovascular models, and share the complex topology and the shape information. For the construction of cardiovascular models with a variety of congenital heart diseases, we propose a set of algorithms and interface that enable editing of the topology and shape of the 3-D models. In order to facilitate interactivity, the centerline and radius of the vessels are used to edit the surface of the heart vessels. This forms a skeleton where the centerlines of blood vessel serve as the nodes and edges, while the radius of the blood vessel is given as an attribute value to each node. Moreover, parent-child relationships are given to each skeleton. They are expressed as the directed acyclic graph, where the skeletons are viewed as graph nodes and the connecting points are graph edges. The cardiovascular models generated from some patient data confirmed that the developed technique is capable of constructing cardiovascular disease models in a tolerable timeframe. It is successful in representing the important structures of the patient-specific heart vessels for better understanding in preoperative planning and electric medical recording of the congenital heart disease.

Background-incorporated volumetric model for patient-specific surgical simulation: a segmentation-free, modeling-free framework.

PURPOSE: Patient-specific surgical simulation imposes both practical and technical challenges. We propose a segmentation-free, modeling-free framework that creates medical volumetric models for intuitive volume deformation and manipulation in patient-specific surgical simulation. METHODS: The proposed framework creates a volumetric model based upon a new form of mesh structure, a Volume Proxy Mesh (VPM). The model can be generated in two phases: the vertex placement phase and mesh improvement phase. Vertices of a VPM are assigned to an initial location by curvature-based vertex placement method, and followed by mesh improvement performed by Particle Swarm Optimization (PSO). RESULTS: The framework is applied to several kidney CT volume data. Using the framework, the resulting models are closely tailored to the detailed features of the datasets. Moreover, the resulting VPM meshes can support broader spectrum deformation between the manipulated organ and its surrounding tissues. Progress in the mesh quality of the final mesh also shows that PSO is feasible for mesh improvement. CONCLUSION: The framework was applied to several kidney CT volume datasets. Using the framework, the resulting models are closely tailored to the detailed features of the datasets. Moreover, the resulting VPM meshes can support broader spectrum deformation between the manipulated organ and its surrounding tissues. Evaluation of final mesh quality shows that PSO is feasible for mesh improvement.

Sensitivity of kinetic macro parameters to changes in dopamine synthesis, storage, and metabolism: a simulation study for [¹8F]FDOPA PET by a model with detailed dopamine pathway.

Quantitative interpretation of brain [¹8F]FDOPA PET data has been made possible by several kinetic modeling approaches, which are based on different assumptions about complex [¹8F]FDOPA metabolic pathways in brain tissue. Simple kinetic macro parameters are often utilized to quantitatively evaluate metabolic and physiological processes of interest, which may include DDC activity, vesicular storage, and catabolism from (18) F-labeled dopamine to DOPAC and HVA. A macro parameter most sensitive to the changes of these processes would be potentially beneficial to identify impaired processes in a neurodegenerative disorder such as Parkinson's disease. The purpose of this study is a systematic comparison of several [¹8F]FDOPA macro parameters in terms of sensitivities to process-specific changes in simulated time-activity curve (TAC) data of [¹8F]FDOPA PET. We introduced a multiple-compartment kinetic model to simulate PET TACs with physiological changes in the dopamine pathway. TACs in the alteration of dopamine synthesis, storage, and metabolism were simulated with a plasma input function obtained by a non-human primate [¹8F]FDOPA PET study. Kinetic macro parameters were calculated using three conventional linear approaches (Gjedde-Patlak, Logan, and Kumakura methods). For simulated changes in dopamine storage and metabolism, the slow clearance rate (k(loss) ) as calculated by the Kumakura method showed the highest sensitivity to these changes. Although k(loss) performed well at typical ROI noise levels, there was large bias at high noise level. In contrast, for simulated changes in DDC activity it was found that K(i) and V(T), estimated by Gjedde-Patlak and Logan method respectively, have better performance than k(loss).

Radiologist model for cardiac rest period determination based on fuzzy rule.

Image data acquisition for the coronary arteries is generally implemented during the diastole rest period, in order to suppress blurring due to cardiac movement. The purpose of this study is to improve the semi-automated application to determine the cardiac rest period based on fuzzy logic. The cardiac rest period from 25 subjects were determined based on their normalized cross-correlation of consecutive frame images as well as normalized frame number as the measured variables. The fuzzy set and membership are generated based on the measured variables from the radiologist's visual assessment. That visual assessment is also regarded as a gold standard for verification. The distance difference between the proposed method and visual assessment was analyzed. The fuzzy logic approach for cardiac rest period determination has no significant difference compared to the visual assessment (p>0.05) in terms of start frame and end frame. The algorithm could be extended easily in case of there are some necessary variables should be added to accommodate rest period definition from different radiologist.

A compact and high sensitivity positron detector using dual-layer thin GSO scintillators for a small animal PET blood sampling system.

For quantitative measurements of small animals such as mice or rats, a compact and high sensitivity continuous blood sampling detector is required because their blood sampling volume is limited. For this purpose we have developed and tested a new positron detector. The positron detector uses a pair of dual-layer thin gadolinium orthosilicate (GSO) scintillators with different decay times. The front layer detects the positron and the background gamma photons, and the back layer detects the background gamma photons. By subtracting the count rate of the latter from that of the former, the count rate of the positrons can be estimated. The GSO for the front layer has a Ce concentration of 1.5 mol% (decay time of 35 ns), and that for the back layer has a Ce concentration of 0.5 mol% (decay time of 60 ns). By using the pulse shape analysis, the count rate of these two GSOs can be discriminated. The thickness is 0.5 mm, which is thick enough to detect positrons while minimizing the detection of the background gamma photons. These two types of thin GSOs were optically coupled to each other and connected to a metal photomultiplier tube (PMT) through triangular light guides. The signal from the PMT was digitized by 100 MHz free-running A-D converters in the data acquisition system and digitally integrated at two different integration times for the pulse shape analysis. We obtained good separation of the pulse shape distributions of these two GSOs. The energy threshold level was decreased to 80 keV, increasing the sensitivity of the detector. The sensitivity of a small diameter plastic tube was 8.6% and 24% for the F-18 and C-11 positrons, respectively. The count rate performance was linear up to approximately 50 kcps. The background counts from the gamma photons could be precisely corrected. The time-activity curve (TAC) of the rat artery blood was successfully obtained and showed a good correlation with that measured using a well counter. With these results, we confirmed that the developed blood sampling detector is promising for quantitative measurement for an animal positron emission tomography system.

Interactive bone drilling using a 2D pointing device to support Microendoscopic Discectomy planning.

PURPOSE: To support preoperative planning of bone drilling for Microendoscopic Discectomy, we present a set of interactive bone-drilling methods using a general 2D pointing device. METHODS: Unlike the existing methods, our framework has the following features: (1) the user can directly cut away arbitrary 3D regions on the volumetrically rendered image, (2) in order to provide a simple interface to end-users, our algorithms make 3D drilling possible through only a general-purpose wheel mouse, (3) to reduce both over-drilling and unnatural drilling of an unintended region, we introduce a smart depth control to ensure the continuity of the cutting operation and (4) a GPU-based rendering scheme for high-quality shading of clipped boundaries. RESULTS: We applied our techniques to some CT data of specific patients. Several experiments confirmed that the user was able to directly drill a 3D complex region on a volumetrically rendered lumber spine through simple mouse operation. Also, our rendering scheme clearly visualizes time-varying drilled surfaces at interactive rates. By comparing simulation results to actual postoperative CT images, we confirmed the user interactively simulates similar cutting to that carried out in real surgery. CONCLUSION: We concluded our techniques perform mouse-based, direct drilling of complex 3D regions with high-quality rendering of drilled boundaries and contribute to preoperative planning of Microendoscopic Discectomy.

Physics-based interactive volume manipulation for sharing surgical process.

This paper presents a new set of techniques by which surgeons can interactively manipulate patient-specific volumetric models for sharing surgical process. To handle physical interaction between the surgical tools and organs, we propose a simple surface-constraint-based manipulation algorithm to consistently simulate common surgical manipulations such as grasping, holding and retraction. Our computation model is capable of simulating soft-tissue deformation and incision in real time. We also present visualization techniques in order to rapidly visualize time-varying, volumetric information on the deformed image. This paper demonstrates the success of the proposed methods in enabling the simulation of surgical processes, and the ways in which this simulation facilitates preoperative planning and rehearsal.

Measurement of density and affinity for dopamine D(2) receptors by a single positron emission tomography scan with multiple injections of [(11)C]raclopride.

Positron emission tomography (PET) with [(11)C]raclopride has been used to investigate the density (B(max)) and affinity (K(d)) of dopamine D(2) receptors related to several neurological and psychiatric disorders. However, in assessing the B(max) and K(d), multiple PET scans are necessary under variable specific activities of administered [(11)C]raclopride, resulting in a long study period and unexpected physiological variations. In this paper, we have developed a method of multiple-injection graphical analysis (MI-GA) that provides the B(max) and K(d) values from a single PET scan with three sequential injections of [(11)C]raclopride, and we validated the proposed method by performing numerous simulations and PET studies on monkeys. In the simulations, the three-injection protocol was designed according to prior knowledge of the receptor kinetics, and the errors of B(max) and K(d) estimated by MI-GA were analyzed. Simulations showed that our method could support the calculation of B(max) and K(d), despite a slight overestimation compared with the true magnitudes. In monkey studies, we could calculate the B(max) and K(d) of diseased or normal striatum in a 150 mins scan with the three-injection protocol of [(11)C]raclopride. Estimated B(max) and K(d) values of D(2) receptors in normal or partially dopamine-depleted striatum were comparable to the previously reported values.

Quantitative evaluation of changes in binding potential with a simplified reference tissue model and multiple injections of [11C]raclopride.

Positron emission tomography (PET) with [(11)C]raclopride is widely used to investigate temporal changes in the dopamine D(2) receptor system attributed to the dopamine release. The simplified reference tissue model (SRTM) can be used to determine the binding potential (BP(ND)) value using the time-activity curve (TAC) of the reference region as input function. However, in assessing temporal changes in BP(ND) using the SRTM, multiple [(11)C]raclopride PET scans are required, and a second scan must be performed after the disappearance of the [(11)C]raclopride administered in the first scan. In this study, we have developed an extended multiple-injection SRTM to estimate the BP(ND) change, from a single PET scan with multiple injections of [(11)C]raclopride, and we have validated this approach by performing numerous simulations and studies on monkeys. In the computer simulations, TACs were generated for dual injections of [(11)C]raclopride, in which binding conditions changed during the scans, and the BP(ND) values before, and after, the second injection were estimated by the proposed method. As a result, the reduction in BP(ND) was correlated, either with the integral of released dopamine, or with the administered mass of raclopride. This method was applied to studies on monkeys, and was capable of determining two identical BP(ND) values when there were no changes in binding conditions. The BP(ND) after the second injection decreased when binding conditions changed due to an increase in administered raclopride. An advantage of the proposed method is the shortened scan period for the quantitative assessment of the BP(ND) change for neurotransmitter competition studies.

Evaluation of utility of asymmetric index for count-based oxygen extraction fraction on dual-tracer autoradiographic method for chronic unilateral brain infarction.

OBJECTIVE: For diagnosing patients with ischemic cerebrovascular disease, non-invasive count-based method with (15)O(2) and H (2) (15) O positron-emission tomography (PET) data is widely used to measure asymmetric increases in oxygen extraction fraction (OEF). For shortening study time, we have proposed dual-tracer autoradiographic (DARG) protocol in which (15)O(2) gas and C(15)O(2) gas are sequentially administrated within short period. In this paper, we evaluated feasibility of the non-invasive count-based method with the DARG protocol. METHODS: Twenty-three patients [67.8 +/- 9.9 (mean +/- SD) years] with chronic unilateral brain infarction were examined by the use of measurements of asymmetric OEF elevation. As DARG protocol, (15)O(2) and C(15)O(2) gases were inhaled with 5-min interval and dynamic PET data were acquired for 8 min. Quantitative OEF (qOEF) image was computed with PET data and arterial input function. Ratio image of (15)O(2) and C(15)O(2) phases of PET data was computed as count-based OEF (cbOEF) image. The asymmetric indices (AI) of qOEF (qOEF-AI) and cbOEF (cbOEF-AI) were obtained from regions of interest symmetric placed on left and right sides of cerebral hemisphere. To optimize the summation time of PET data for the cbOEF image, qOEF and cbOEF images with various summation times were compared. RESULTS: Image quality of cbOEF image was better than that of qOEF image. The best correlation coefficient of 0.94 was obtained when the cbOEF image was calculated from 0 to 180 s of (15)O(2) summed image and 340 to 440 s of C(15)O(2) summed image. CONCLUSION: Using the appropriate summation time, we obtained the cbOEF image with good correlation with qOEF image, which suggests non-invasive cbOEF image can be used for evaluating the degree of misery perfusion in patients with chronic unilateral brain infarction. The count-based method with DARG protocol has a potential to dramatically reduce the examination time of (15)O PET study.

Influence of residual oxygen-15-labeled carbon monoxide radioactivity on cerebral blood flow and oxygen extraction fraction in a dual-tracer autoradiographic method.

OBJECTIVE: Cerebral blood flow (CBF), cerebral metabolic rate of oxygen (CMRO(2)), oxygen extraction fraction (OEF), and cerebral blood volume (CBV) are quantitatively measured with PET with (15)O gases. Kudomi et al. developed a dual tracer autoradiographic (DARG) protocol that enables the duration of a PET study to be shortened by sequentially administrating (15)O(2) and C(15)O(2) gases. In this protocol, before the sequential PET scan with (15)O(2) and C(15)O(2) gases ((15)O(2)-C(15)O(2) PET scan), a PET scan with C(15)O should be preceded to obtain CBV image. C(15)O has a high affinity for red blood cells and a very slow washout rate, and residual radioactivity from C(15)O might exist during a (15)O(2)-C(15)O(2) PET scan. As the current DARG method assumes no residual C(15)O radioactivity before scanning, we performed computer simulations to evaluate the influence of the residual C(15)O radioactivity on the accuracy of measured CBF and OEF values with DARG method and also proposed a subtraction technique to minimize the error due to the residual C(15)O radioactivity. METHODS: In the simulation, normal and ischemic conditions were considered. The (15)O(2) and C(15)O(2) PET count curves with the residual C(15)O PET counts were generated by the arterial input function with the residual C(15)O radioactivity. The amounts of residual C(15)O radioactivity were varied by changing the interval between the C(15)O PET scan and (15)O(2)-C(15)O(2) PET scan, and the absolute inhaled radioactivity of the C(15)O gas. Using the simulated input functions and the PET counts, the CBF and OEF were computed by the DARG method. Furthermore, we evaluated a subtraction method that subtracts the influence of the C(15)O gas in the input function and PET counts. RESULTS: Our simulations revealed that the CBF and OEF values were underestimated by the residual C(15)O radioactivity. The magnitude of this underestimation depended on the amount of C(15)O radioactivity and the physiological conditions. This underestimation was corrected by the subtraction method. CONCLUSIONS: This study showed the influence of C(15)O radioactivity in DARG protocol, and the magnitude of the influence was affected by several factors, such as the radioactivity of C(15)O, and the physiological condition.

Nanomanipulation and nanotechnology for future diagnostics.

Nanomanipulation is a technology to manipulate a small object sized in nanometer to submicron scale. Optical tweezers is one of nanomanipulation techniques, which can investigate pico-newton to femto-newton force exerted on microscopic objects. We have developed a cell palpation system by use of optical tweezers and performed palpation experiments on cells. With the cell palpation system, an operator manipulates a probe particle to touch a certain location of a cell and feels the strength of the cell by hand through a haptic device, which displays force calculated and generated by a computer. We expect this technique can be used in diagnostic purpose and utilized not only in research field but also in daily medicine.

Development of measuring system to measure standing pose of the foot using distributed triaxial force sensor.

The bottom of a person's foot grips the floor for balance, and the action force and action moment work at the foot bottom when he maintains posture and when he moves. They are important indices in the evaluation and the medical attention of standing pose balance and gait disturbances. A lot of equipments to measure the floor reaction force have been researched. However, no floor reaction force meter exists that can measure distribution information force in three directions. This paper aims at the development of a system that can measure the standing pose of the foot that exists from a measuring instrument and that can measure the standing pose of foot distributed 6times4 three axis force sensors and software that displays and preserves the output of the sensor element. A time change of force that worked at the foot bottom is sought as a vector by outputting each sensor element. Moreover, an action vector is three dimensionally displayed whose data can be intuitively understood. The results of experiments show that the measuring system can measure the action force of the foot bottom as distribution information on force in three directions.

An intra-operative positron probe with background rejection capability for FDG-guided surgery.

For radio-guided surgery on tumors using F-18-FDG, detection of annihilation gamma photons emanating from other parts of the body produces background radiation counts and limits its use in clinical situations. To overcome this limitation, we have developed an intra-operative positron probe with background-rejection capability. The positron probe uses a phoswich detector composed of a plastic scintillator and a bismuth germinate (BGO). A positron from a positron emitter such as F-18 is detected by the plastic scintillator and emits annihilation photons. The BGO detects one of the annihilation photons while a photo-multiplier tube (PMT) detects scintillation photons from both scintillators. The decay time differences of these two scintillators are used to distinguish whether the event is a true event where a positron and a following annihilation photon are detected simultaneously, or a background event. In this configuration, only positrons can be selectively detected, even in an environment of high background gamma photon flux. Spatial resolution was 11-mm full width at half maximum (FWHM) 5 mm from the detector surface. Measured sensitivity for the F-18 point source was 2.6 cps/kBq 5 mm from the detector surface. The background count rate was less than 0.5 cps for a 20-cm diameter cylindrical phantom containing 37 MBq of F-18 solution measured on the phantom surface, while the positron count rate was almost linear over a range of approximately 6 kcps. These results indicate that our developed intra-operative positron probe is valuable for radio-guided surgery on tumors using F-18-FDG in a high flux of background annihilation gamma photons.

Experimental and analytical investigations of motor unit location for the precise estimation of muscle force with surface electromyograms.

Surface motor unit action potential (SMUAP) is generated from a motor unit (MU) located at certain depth from the skin surface. The depth is referred to as MU location in the present papers. The MU location affects the amplitude of MUAP, and smoothed rectified electromyogram (SR EMG) is used to estimate for the muscle force. The aim of this study is to investigate MU locations in the short head of biceps brachii (BIC) and the first dorsal interosseous (FDI), experimentally and analytically with eight-channel surface EMGs (SEMGs) in isometric voluntary contractions. In order to estimate the MU location, profiles of peak SMUAP at each channel were compared with those of different MU locations obtained from the tripole current source model. From the result, MU locations of BIC distributed in a certain range, and those of FDI seemed to be identical. Our method was practical and useful for estimating the approximated MU location.