Deep Learning-Enabled Detection of Pneumoperitoneum in Supine and Erect Abdominal Radiography: Modeling Using Transfer Learning and Semi-Supervised Learning.

OBJECTIVE: Detection of pneumoperitoneum using abdominal radiography, particularly in the supine position, is often challenging. This study aimed to develop and externally validate a deep learning model for the detection of pneumoperitoneum using supine and erect abdominal radiography. MATERIALS AND METHODS: A model that can utilize "pneumoperitoneum" and "non-pneumoperitoneum" classes was developed through knowledge distillation. To train the proposed model with limited training data and weak labels, it was trained using a recently proposed semi-supervised learning method called distillation for self-supervised and self-train learning (DISTL), which leverages the Vision Transformer. The proposed model was first pre-trained with chest radiographs to utilize common knowledge between modalities, fine-tuned, and self-trained on labeled and unlabeled abdominal radiographs. The proposed model was trained using data from supine and erect abdominal radiographs. In total, 191212 chest radiographs (CheXpert data) were used for pre-training, and 5518 labeled and 16671 unlabeled abdominal radiographs were used for fine-tuning and self-supervised learning, respectively. The proposed model was internally validated on 389 abdominal radiographs and externally validated on 475 and 798 abdominal radiographs from the two institutions. We evaluated the performance in diagnosing pneumoperitoneum using the area under the receiver operating characteristic curve (AUC) and compared it with that of radiologists. RESULTS: In the internal validation, the proposed model had an AUC, sensitivity, and specificity of 0.881, 85.4%, and 73.3% and 0.968, 91.1, and 95.0 for supine and erect positions, respectively. In the external validation at the two institutions, the AUCs were 0.835 and 0.852 for the supine position and 0.909 and 0.944 for the erect position. In the reader study, the readers' performances improved with the assistance of the proposed model. CONCLUSION: The proposed model trained with the DISTL method can accurately detect pneumoperitoneum on abdominal radiography in both the supine and erect positions.

Absolute response of a proton detector composed of a microchannel plate assembly and a charge-coupled device to laser-accelerated multi-MeV protons.

The absolute response of a real-time proton detector, composed of a microchannel plate (MCP) assembly, an imaging lens, and a charge-coupled device (CCD) camera, is calibrated for the spectral characterization of laser-accelerated protons, using a Thomson parabola spectrometer (TPS). A slotted CR-39 plate was used as an absolute particle-counting detector in the TPS, simultaneously with the MCP-CCD detector to obtain a calibration factor (count/proton). In order to obtain the calibration factor as a function of proton energy for a wide range of proton numbers, the absolute response was investigated for different operation parameters of the MCP-CCD detector, such as MCP voltage, phosphor voltage, and CCD gain. A theoretical calculation for the net response of the MCP was in good agreement with the calibrated response of the MCP-CCD detector, and allows us to extend the response to higher proton energies. The response varies in two orders of magnitude, showing an exponential increase with the MCP voltage and almost linear increase with the phosphor voltage and the CCD gain. The calibrated detector enabled characterization of a proton energy spectrum in a wide dynamic range of proton numbers. Moreover, two MCP assemblies having different structures of MCP, phosphor screen, and optical output window have been calibrated, and the difference in the absolute response was highlighted. The highly-sensitive detector operated with maximum values of the parameters enables measuring a single proton particle and evaluating an absolute spectrum at high proton energies in a single laser shot. The absolute calibrations can be applied for the spectral measurement of protons using different operating voltages and gains for optimized response in a large range of proton energy and number.

Wavefront-corrected post-compression of a 100-TW Ti:sapphire laser.

We analyzed and corrected the wavefront distortion induced during the post-compression of a 100-TW Ti:Sapphire laser and achieved the intensity enhancement. In the post-compression, the spectral broadening of the laser was obtained by propagating through three 0.5 mm-thick fused silica plates and the laser pulse duration was post-compressed from 24 fs to 11 fs using a set of chirped mirrors. We measured the wavefront aberrations due to the intensity-dependent nonlinear process during the post-compression of femtosecond high-power laser pulses. By compensating for the wavefront aberrations with an adaptive optics system, the Strehl ratio of the post-compressed beam was improved from 0.37 to 0.52 and the focused intensity of the post-compressed beam could be enhanced by a factor of 1.5, while the enhancement without the wavefront correction was only a factor of 1.1 in spite of the peak-power enhancement by a factor of 1.8.

Comparison of spin-echo echo-planar imaging magnetic resonance elastography with gradient-recalled echo magnetic resonance elastography and their correlation with transient elastography.

PURPOSE This study aimed to assess the agreement between liver stiffness (LS) values obtained by the gradient-recalled echo (GRE) magnetic resonance elastography (MRE) and spin-echo echo-planar imaging (SE-EPI) MRE with those of transient elastography (TE), respectively. METHODS We retrospectively included 48 participants who underwent liver MRE with both GRE and SE-EPI sequences in the same session and also TE within 1 year. We obtained LS values for MRE by drawing free-hand region of interest, and TE was performed using a FibroScan device. We assessed the relationship between the mean LS values obtained by each MRE sequence and TE using the correlation coefficients and Bland-Altman plots, respectively. We also compared LS values and technical failure rates of measured values from MRE between SE-EPI and GRE sequences using the paired t-test and McNemar's test. The MRE failure was defined as the absence of pixel value with a confidence index above 95%. RESULTS The LS values from SE-EPI and GRE sequences strongly correlated with those from TE (GRE; r = 0.73, P < .001 vs. SE-EPI; r = 0.79, P < .001). In addition, the LS values from the 2 MRE sequences showed excellent relationship (intraclass correlation coefficient, 0.94 [0.89-0.97], P < .001). The LS values from SE-EPI and GRE MRE were not significantly different (4.14 kPa vs. 3.88 kPa, P = .19). Furthermore, the technical success rate of SE-EPI MRE was superior to that of GRE (100% vs. 83.8%, P = .031). CONCLUSION The measured LS values obtained using TE correlated strongly with those obtained using GRE and SE-EPI MRE techniques, even though SE-EPI-MRE resulted a higher technical success rate than GRE-MRE. Therefore, we believe that TE, GRE, and SE-EPI MR elastography techniques may complement each other according to the appropriate individual situation.

Nanoparticle-insertion scheme to decouple electron injection from laser evolution in laser wakefield acceleration.

A localized nanoparticle insertion scheme is developed to decouple electron injection from laser evolution in laser wakefield acceleration. Here we report the experimental realization of a controllable electron injection by the nanoparticle insertion method into a plasma medium, where the injection position is localized within the short range of 100 µm. Nanoparticles were generated by the laser ablation process of a copper blade target using a 3-ns 532-nm laser pulse with fluence above 100 J/cm2. The produced electron bunches with a beam charge above 300 pC and divergence of around 12 mrad show the injection probability over 90% after optimizing the ablation laser energy and the temporal delay between the ablation and the main laser pulses. Since this nanoparticle insertion method can avoid the disturbing effects of electron injection process on laser evolution, the stable high-charge injection method can provide a suitable electron injector for multi-GeV electron sources from low-density plasmas.

Sub-10 fs pulse generation by post-compression for peak-power enhancement of a 100-TW Ti:Sapphire laser.

We demonstrated sub-10 fs pulse generation by the post-compression of a 100 TW Ti:Sapphire laser to enhance the peak-power. In the post-compression, the laser spectrum was widely broadened by self-phase modulation in thin fused silica plate(s), and the induced spectral phase was compensated with a set of chirped mirrors. A spatial filter stage, consisting of two cylindrical lenses and a spherical lens, was employed to reduce the intensity modulation existing in the laser beam, which effectively suppressed intensity spikes induced by self-focusing. The laser beam was post-compressed from 23 fs to 9.7 fs after propagating through a 1.5 mm fused silica plate, resulting in the peak-power enhancement by a factor of 2.1.

Treatment failure after rotational atherectomy and balloon angioplasty in recurrent cystic adventitial disease of the popliteal artery: a case report.

Cystic adventitial disease (CAD), which usually affects the popliteal artery, is a rare vascular condition in which fluid accumulates in the sub-adventitial layer, compressing the lumen. Historically, surgical treatment is preferred over endovascular or minimally invasive techniques, due to its lower recurrence rates. Here, the case of a 67-year-old male patient, in whom rotational atherectomy was performed for recurrent CAD following surgical cyst excision and patch angioplasty is reported. The patient's symptoms recurred one day after the rotational atherectomy procedure and repeat computed tomography angiography showed recurrence of the disease. Due to gradual worsening of the condition during 8 months of follow-up, left distal femoral artery to popliteal artery (below-the-knee) bypass surgery was performed using an ipsilateral reversed great saphenous vein graft. Follow-up has continued for 2 years without complications or requirement of additional treatment. This novel case is the first report of atherectomy attempted for recurrent CAD that led to an early recurrence. Our experience emphasises that additional surgical approaches should be selected over endovascular procedures for treating recurrent CAD.

Single-shot spatiotemporal characterization of a multi-PW laser using a multispectral wavefront sensing method.

The single-shot spatiotemporal characterization of an ultrahigh intensity laser pulse was performed using a multispectral wavefront sensor. For the measurement of the spatio-spectral electric field, a femtosecond laser pulse was spectrally modulated and separated by a Fabry-Perot etalon coupled with a grating pair, and its spatio-spectral electric field was measured with a wavefront sensor. The spatiotemporal electric field was reconstructed from the measured spatio-spectral electric field of a multi-PW laser pulse. We found that the spatiotemporal distortion could reduce the focused laser intensity by 15%, compared to the case of a diffraction-limited and transform-limited laser pulse.

Calibration of radiochromic EBT3 film using laser-accelerated protons.

We present a proof of principle for onsite calibration of a radiochromic film (EBT3) using CR-39 as an absolute proton-counting detector and laser-accelerated protons as a calibration source. A special detector assembly composed of aluminum range filters, an EBT3 film, and a CR-39 detector is used to expose the EBT3 film with protons in an energy range of 3.65 MeV-5.85 MeV. In our design, the proton beam is divided into small beamlets and their projection images are taken on the EBT3 film and the CR-39 detector by maintaining a certain distance between the two detectors. Owing to the geometrical factor of the configuration and scattering inside the EBT3, the areal number density of protons was kept below the saturation level of the CR-39 detector. We also present a method to relate the number of protons detected on the CR-39 in a narrow energy range to protons with a broad energy spectrum that contribute to the dose deposited in the EBT3 film. The energy spectrum of protons emitted along the target normal direction is simultaneously measured using another CR-39 detector installed in a Thomson parabola spectrometer. The calibration curves for the EBT3 film were obtained in the optical density range of 0.01-0.25 for low dose values of 0.1 Gy-3.0 Gy. Our results are in good agreement with the calibrations of the EBT3 film that are traditionally carried out using conventional accelerators. The method presented here can be further extended for onsite calibration of radiochromic films of other types and for a higher range of dose values.

Sonoelastography for Pelvic Metastatic Malignant Pheochromocytoma: A Case Report.

INTRODUCTION: Pheochromocytoma are tumors arising from the chromaffin tissue located in the adrenal medulla, associated with typical symptoms and signs. CASE PRESENTATION: Occasionally, metastasis, defined as the presence of tumor cells at sites other than the original site, secondary to pheochromocytoma have been reported. Pelvic metastatic malignant pheochromocytoma has rarely been reported in English literature. CONCLUSION: Here, we have reported a very rare case of pelvic metastatic malignant pheochromocytoma, with a particular focus on sonoelastographic features.

Analysis of angular dispersion induced by wavefront rotation in nanosecond optical parametric chirped pulse amplification.

Angular dispersion observed in a nanosecond optical parametric chirped-pulse amplification (ns-OPCPA) amplifier adopted in the frontend of a multi-PW laser was analyzed. The theory on the angular dispersion, extended by including the wavefront rotation and the pulse front tilt of a strongly chirped laser pulse, revealed that the wavefront rotation is a major contributor to the angular dispersion, as compared to the pulse front tilt, in a ns-OPCPA amplifier. It was also shown that the wavefront rotation could be introduced by the phase mismatch and the noncollinear propagation angle in the noncollinear ns-OPCPA amplifier. The theoretical prediction was experimentally verified by measuring the angular dispersion of the ns-OPCPA frontend installed in the 20-fs, 4-PW Ti:Sapphire laser. We emphasize the importance of the proper characterization and control of the angular dispersion in the ns-OPCPA amplifier since the focus intensity of an ultrahigh power laser could be significantly reduced due to the spatiotemporal effect even for small induced angular dispersion.

Achieving the laser intensity of 5.5×1022 W/cm2 with a wavefront-corrected multi-PW laser.

The generation of ultrahigh intensity laser pulses was investigated by tightly focusing a wavefront-corrected multi-petawatt Ti:sapphire laser. For the wavefront correction of the PW laser, two stages of deformable mirrors were employed. The multi-PW laser beam was tightly focused by an f/1.6 off-axis parabolic mirror and the focal spot profile was measured. After the wavefront correction, the Strehl ratio was about 0.4, and the spot size in full width at half maximum was 1.5×1.8 µm2, close to the diffraction-limited value. The measured peak intensity was 5.5×1022 W/cm2, achieving the highest laser intensity ever reached.

Spectral shaping of an OPCPA preamplifier for a sub-20-fs multi-PW laser.

We developed an OPCPA preamplifier with an actively shaped output spectrum to obtain a sub-20-fs-duration pulse for a 4-PW laser. The active spectral shaping was facilitated by controlling the temporal profile of a pump pulse in the OPCPA preamplifier. By optimizing the output spectrum of the OPCPA to compensate for the gain-depletion effect in the 4-PW laser, a final laser pulse with a broad spectrum of 101-nm in width (FWHM), resulting in a short pulse duration of 17 fs, was achieved.

4.2 PW, 20 fs Ti:sapphire laser at 0.1 Hz.

We demonstrated the generation of 4.2 PW laser pulses at 0.1 Hz from a chirped-pulse amplification Ti:sapphire laser. The cross-polarized wave generation and the optical parametric chirped-pulse amplification stages were installed for the prevention of the gain narrowing and for the compensation of the spectral narrowing in the amplifiers, obtaining the spectral width of amplified laser pulses of 84 nm (FWHM), and enhancing the temporal contrast. The amplified laser pulses of 112 J after the final booster amplifier were compressed to the pulses with 83 J at 19.4 fs with a shot-to-shot energy stability of 1.5% (RMS). This 4.2 PW laser will be a workhorse for exploring high field science.

Relativistic frequency upshift to the extreme ultraviolet regime using self-induced oscillatory flying mirrors.

Coherent short-wavelength radiation from laser-plasma interactions is of increasing interest in disciplines including ultrafast biomolecular imaging and attosecond physics. Using solid targets instead of atomic gases could enable the generation of coherent extreme ultraviolet radiation with higher energy and more energetic photons. Here we present the generation of extreme ultraviolet radiation through coherent high-harmonic generation from self-induced oscillatory flying mirrors--a new-generation mechanism established in a long underdense plasma on a solid target. Using a 30-fs, 100-TW Ti:sapphire laser, we obtain wavelengths as short as 4.9 nm for an optimized level of amplified spontaneous emission. Particle-in-cell simulations show that oscillatory flying electron nanosheets form in a long underdense plasma, and suggest that the high-harmonic generation is caused by reflection of the laser pulse from electron nanosheets. We expect this extreme ultraviolet radiation to be valuable in realizing a compact X-ray instrument for research in biomolecular imaging and attosecond physics.

Generation of high-contrast, 30 fs, 1.5 PW laser pulses from chirped-pulse amplification Ti:sapphire laser.

High-contrast, 30 fs, 1.5 PW laser pulses are generated from a chirped-pulse amplification (CPA) Ti:sapphire laser system at 0.1 Hz repetition rate. The maximum output energy of 60.2 J is obtained, at a pump energy of 120 J, from a booster amplifier that is pumped by four frenquency-doubled Nd:glass laser systems. During amplification, parasitic lasing is suppressed by index matching fluid with absorption dye and the careful manipulation of the time delay between the seed and pump pulses. An amplified pulse passes through a pulse compressor consisting of four gold-coated gratings. After compression, the measured pulse duration is 30 fs, and the output energy is 44.5 J, yielding a peak power of about 1.5 PW. The output energy of 44.5 J and output power of 1.5-PW are the highest values ever achieved from the femtosecond CPA Ti:sapphire laser system. To maintain a sufficiently high temporal contrast, a saturable absorber is installed in the front-end system with two ultrafast Pockels cells in order to minimize the amplified spontaneous emission (ASE) and pre-pulse intensity. An adaptive optics system is implemented for PW laser pulses and a focused intensity of about 1 × 10(22) W/cm(2) can be obtained when an f/3 optic is used.

A case of aortopulmonary fistula caused by a huge thoracic aortic aneurysm.

Aortopulmonary fistula is an uncommon but often fatal condition resulting as a late complication of an aortic aneurysm. The most common cause is erosion of a false aneurysm of the descending thoracic aorta into the pulmonary artery, resulting in the development of a left-to-right shunt and leading to acute pulmonary edema and right heart failure. We report an our experience with aortopulmonary fistula as a rare complication associated with thoracic aortic aneurysm and high output heart failure.

A case of right atrial aneurysm incidentally found in old age.

Right atrial aneurysm is a rare abnormality of unknown origin. Approximately half of patients with right atrial aneurysm show no symptoms. Right atrial aneurysm is usually detected by chance at any time between fetal and adult life and can be associated with atrial arrhythmia and systemic embolism. The diagnosis of right atrial aneurysm can be established with echocardiography, computed tomography (CT) or magnetic resonance imaging (MRI). Because of thromboembolic risk, aneurysmectomy is usually recommended. We review the case report of a 69-year-wold woman with right atrial appendiceal aneurysm, whose diagnosis was established by echocardiography and CT angiography.