Monitoring of fatigue in radiologists during prolonged image interpretation using fNIRS.

PURPOSE: To determine whether functional near-infrared spectroscopy (fNIRS) allows monitoring fatigue in radiologists during prolonged image interpretation. MATERIALS AND METHODS: Nine radiologists participated as subjects in the present study and continuously interpreted medical images and generated reports for cases for more than 4 h under real clinical work conditions. We measured changes in oxygenated hemoglobin concentrations [oxy-Hb] in the prefrontal cortex using 16-channel fNIRS (OEG16ME, Spectratech) every hour during the Stroop task to evaluate fatigue of radiologists and recorded fatigue scale (FS) as a behavior data. RESULTS: Two subjects showed a subjective feeling of fatigue and an apparent decrease in brain activity after 4 h, so the experiment was completed in 4 h. The remaining seven subjects continued the experiment up to 5 h. FS decreased with time, and a significant reduction was observed between before and the end of image interpretation. Seven out of nine subjects showed a minimum [oxy-Hb] change at the end of prolonged image interpretation. The mean change of [oxy-Hb] at the end of all nine subjects was significantly less than the maximum during image interpretation. CONCLUSION: fNIRS using the change of [oxy-Hb] may be useful for monitoring fatigue in radiologists during image interpretation.

Liposome-Encapsulated Hemoglobin Improves Tumor Oxygenation as Detected by Near-Infrared Spectroscopy in Colon Carcinoma in Mice.

Liposome-encapsulated hemoglobin (LEH) with high (h-LEH, P50 O2  = 10 mm Hg) or low O2 affinity (l-LEH, P50 O2  = 40 mm Hg) may improve O2 delivery to sensitize tumor tissues for radiotherapy. A total of 10 mL/kg of h-LEH, l-LEH, red blood cells (RBCs), or saline was infused in mice transplanted with murine colon carcinoma with near-infrared spectroscopy (NIRS) detectors set at the tumor (right leg) and intact muscle (left leg). NIRS recorded changes in the amount of oxyhemoglobin (oxyHb), deoxyhemoglobin (deoxyHb), and their sum (tHb) with the animals spontaneously breathing room air (10 min), pure O2 (5 min), and then back to room air. The tumor was finally excised for histological examination. In mice treated with h-LEH, tHb significantly increased compared to mice receiving other solutions. The magnitude was significantly attenuated in the tumor compared to the intact muscle under room air. Reciprocal changes in oxyHb and deoxyHb between intact muscle and tumor in response to infused solutions allowed assumption of average tissue PO2 between 30 and 40 mm Hg in muscle and at around 10 mm Hg in tumor. While O2 respiration increased oxyHb and decreased deoxyHb both in muscle and tumor, their sum or tHb consistently decreased in muscle and increased in tumor regardless of preceding infusion. Such responses were totally reversed when mice were placed under hypoxia (10% O2 ), suggesting that a lack of physiological circulatory regulation in tumor may account for heavier immunohistochemical staining for human hemoglobin in tumors of mice treated with h-LEH than with l-LEH. The results suggest that h-LEH may cause significant tumor oxygenation compared to RBC, l-LEH, or saline probably due to its nanometer size (vs. RBC) and high O2 affinity (vs. l-LEH) without increasing O2 content in the intact tissue (vs. O2 respiration) probably due to a lack of physiological circulatory regulation.

Comparison of light intensity on the brain surface due to laser exposure during optical topography and solar irradiation.

Optical topography (OT), which is based on the near-infrared spectroscopy, is a powerful tool for observing brain activity noninvasively. To estimate the effect of laser exposure on the brain, photon-distribution profiles in bald heads of adults and neonates during the OT were calculated using the photon-diffusion equation. These calculations showed that although the absolute values of the intensity depend on details of the head model, the relative values of OT exposure to sunlight exposure were less sensitive to the model details. As an example, the light intensities on the brain surface during OT obtained by using a commercially available system were about 2% for adults and 3% for neonates of those values obtained under midday sunlight on a sunny day in midsummer. These values were obtained under the reasonable assumptions with a large safety factor.

Practicality of wavelength selection to improve signal-to-noise ratio in near-infrared spectroscopy.

Near-infrared spectroscopy (NIRS), which can be used to detect changes in the concentration of oxygenated hemoglobin (oxy-Hb) and deoxygenated hemoglobin (deoxy-Hb) in tissue by using illumination at two different wavelengths, is often applied to noninvasive measurements of human brain functions. It is common to use two wavelengths that are on opposite sides of the point where the optical absorptions of oxy- and deoxy-Hb are equal (about 800 nm) but an optimal wavelength pair has not yet been determined. In this study, we conducted simultaneous recordings at five wavelengths (678, 692, 750, 782, and 830 nm) to determine the best wavelength for pairing with 830 nm. A theory suggests that pairing a shorter wavelength with 830 nm can provide more sensitivity because of the larger difference in absorption coefficients of hemoglobin between two wavelengths. The changes measured in four cortical areas (frontal, occipital, parietal, and temporal) showed that the noise level when the 678-, 692-, and 750-nm wavelengths were paired with 830 nm was usually lower than when the 782-nm wavelength was paired with 830 nm, which is consistent with theoretical prediction. Moreover, the signal-to-noise ratios (S/Ns) and wavelength dependencies of the power detected in all areas and subjects together suggest that the 692-nm pairing had the highest S/N. This suggests that the optimal wavelengths depend on not only the difference in the absorption coefficients of hemoglobin but also on the optical properties in the measurement area, which affect the strength of the attenuation data. The 692-nm wavelength is thus a more optimal choice than wavelengths around 780 nm for pairing with 830 nm to measure Hb changes induced by cortical activation. The improved S/N enables more sensitive statistical analysis, which is essential to functional mapping with NIRS.

Successful resection of prostatic rhabdomyosarcoma by the posterior sagittal approach combined with preoperative chemotherapy.

The authors used a posterior sagittal approach to successfully remove a huge prostatic rhabdomyosarcoma from a 3-year-old boy after he had received intensive chemotherapy. This procedure enables safe removal of the prostatic rhabdomyosarcoma under direct vision and with minimal damage to other pelvic organs.

A rare case of Salmonella soft-tissue abscess.

A healthy 6-year-old boy had complained of fever and chest pain for 3 days. On admission, he had a mass on the sternum, 3.7 x 2.5 cm in size. Abnormal laboratory findings included a white blood cell count of 12,900/microl, erythrocyte sedimentation rate (ESR), 74 mm/h, and C-reactive protein (CRP), 9.7 mg/dl. Ultrasound examination of the chest revealed a hypoechoic lesion on the sternum that was 30 x 15 mm in size. Chest computed tomography (CT) scan showed no bone fracture or bone erosion. The patient received cefpirome, given intravenously at 60 mg/kg per day for 10 days. Incision and drainage was performed on the seventh day in the hospital, and we collected 0.5 ml of pus. Salmonella enteritidis was detected from the drainage. However, the patient had no gastrointestinal symptoms. He was discharged on the fourteenth hospital day, as he was asymptomatic. Results of all physical and laboratory examinations including blood and stool cultures and ultrasound examinations, were within the normal limits upon discharge.