Pre-operative CT angiography and three-dimensional image post processing for deep inferior epigastric perforator flap breast reconstructive surgery.

Autologous breast reconstructive surgery with deep inferior epigastric artery (DIEA) perforator flaps has become the mainstay for breast reconstructive surgery. CT angiography and three-dimensional image post processing can depict the number, size, course and location of the DIEA perforating arteries for the pre-operative selection of the best artery to use for the tissue flap. Knowledge of the location and selection of the optimal perforating artery shortens operative times and decreases patient morbidity.

SU-E-I-50: The ACR CT Dose Index Registry: Implementation Challenges and Preliminary Data.

PURPOSE: To successfully register our institution into the American College of Ragiology (ACR) CT Dose Index Registry (DIR), to discuss the technical and implementation challenges of doing so, and to review preliminary results. METHODS: TRIAD is the American College of Radiology Imaging Network's (ACRIN) image acquisition and management software, with the purpose of receiving and then transmitting DICOM structured dose report files from institutional CT scanners around the country. TRIAD was installed onto a virtual machine server at our institution so that anonymized and encrypted DICOM structured dose report files from our 6 CT scanners could be sent to the TRIAD Application Server at ACR. Doing so required collaboration between ACR and IT, PACS personnel and the physicist on site. Implementation involved several challenges, such as software installation and data transmission consistency problems. Since numerous institutions are involved, the ACR required an exam mapping process via the Radlex playbook to unify the protocol classification. These challenges have been overcome and data is being successfully transmitted to and analyzed by the ACR. RESULTS: The first report comparing dose data (CTDI and DLP by examination and by scan) between our site and others around the region and country was made available recently. For each exam, the report includes boxplots and histogram data for a variety of standard protocols. For example, for a CT head exam, our median CTDIvol and DLP were 44 mGy and 736 mGy-cm compared with 64 mGy and 844 mGy-cm respectively, for all other facilities registered in the DIR. CONCLUSIONS: The ACR CT DIR registry is a useful tool for dose data mining and will eventually establish national benchmarks for CT dose indices. Our experience will allow others to anticipate these challenges and have potential solutions available for when they do arise.

Lineage differentiation of canine lymphoma/leukemias and aberrant expression of CD molecules.

Multiparameter flow cytometry analysis and specific cluster differentiation (CD) molecules were used to determine the expression profiles of B- and T-cell antigens on lymph node preparations from 59 dogs with generalized or multisystemic lymphoma. Lymph node samples from 11 healthy dogs were labeled to validate the specificity of antibodies and to formulate guidelines for interpretation of the results obtained from lymphoma samples. In normal lymph nodes, T-lymphocytes expressing CD3, CD4, or CD8 beta represented 59+/-11%, 43+/-8%, or 16+/-5% of the total cells, whereas B-lymphocytes expressing either CD21 or surface IgM (IgM) represented 37+/-9% or 14+/-5%, respectively. Small lymphocytes could be distinguished from large lymphocytes by forward light scatter. Of the patient samples 29 different breeds were represented with Golden and Labrador retriever being the most common. The lymphoma samples segregated into three groups based on CD antigen expression. Thirty cases predominantly expressed one or more combinations of CD79a, IgM, and CD21 representing a B-cell lineage. Three B-cell cases also expressed the stem cell antigen, CD34. Sixteen cases expressed one or more combinations of CD3, CD4, and CD8 consistent with a T-cell lineage and CD3+CD4+CD8--phenotype was the most common. Thirteen cases showed a mixed expression profile for T- and B-cell antigens and in three cases CD14 was highly expressed. Clinical response was poorest for T-cell lymphomas. Leukemic states occurred in all three phenotypes; but mixed cell cases had the greatest proportion. Dual immunofluorescence staining confirmed co-expression of T-cell (CD3) and B-cell antigens (CD79a or CD21) on neoplastic lymphocytes of six mixed cell cases. In one mixed cell case, dual immunostaining identified lymphocyte populations that stained mutually exclusive for CD79a and CD3. Six mixed cell lymphomas tested by PCR showed clonality for rearranged antigen receptor. Four cases that were CD79a+CD3+ had TCRgamma chain gene rearrangements, whereas two cases that were CD3+CD8+CD21+ had Ig heavy chain rearrangement. One case expressing multiple CD molecules (CD3+CD8+CD21+CD14+) was PCR negative for both Ig and TCRgamma gene rearrangement and could not be classified into a B- or T-cell lineage. We show for the first time co-expression of B- and T-cell markers on lymphoma cells that had specific T- or B-cell gene rearrangements. These findings suggest that aberrant CD molecule expression is not an uncommon finding in canine lymphomas and is a useful diagnostic marker for malignancy.

Simultaneous flow cytometric analysis of phagocytosis and oxidative burst activity in equine leukocytes.

This paper describes a method for simultaneously measuring phagocytosis and oxidative burst activity in equine peripheral blood leukocytes by flow cytometry. Opsonized propidium iodide-labelled Staphylococcus aureus (PI-Sa) was used to measure the uptake of bacteria by equine phacocytes and the oxidative burst activity by oxidation of dihydrorhodamine 123. The requirements to achieve optimal activity of phagocytosis and oxidative burst are described. The advantage of the simultaneous technique is that it provides both independent and comparative values for phagocytosis and the oxidative burst, for the detection of impaired mechanisms of microbial destruction. Furthermore, the technique allows evaluation of opsonization activity in this context.