Voice quality in relation to voice complaints and vocal fold condition during the screening of female student teachers.

OBJECTIVES: The purpose of this study was to compare the perceptual examination of voice quality with the condition of the vocal folds and voice complaints during voice screening in female student teachers. METHODS: This research was a cross-sectional study in 214 starting student teachers using the four-point grade scale of the GRBAS and laryngostroboscopic assessment of the vocal folds. The voice quality was assessed by speech pathologists using the ordinal 4-point G-scale (overall dysphonia) of the GRBAS method in a running speech sample. Glottal closure and vocal fold lesions were recorded. A questionnaire was used for assessing voice complaints. RESULTS: More students with an insufficient glottal closure (89%) were rated dysphonic compared with students with sufficient glottal closure (80%). Students with sufficient glottal closure had a significantly lower mean G-score (1.21) compared with the group with insufficient glottal closure (1.52) (P = 0.038). This study showed a larger percentage of students with vocal fold lesions (96%) labeled a dysphonic voice compared to students with no vocal fold problems (81%). Students with no vocal fold lesions had a significantly lower mean G-score (1.20) compared with the group with vocal fold lesions (2.05) (P=0.002). A dysphonic voice (G≥1) was rated in 76% of the students without voice complaints compared with 86% of the students with voice complaints. Students with no voice complaints had a lower mean G-score (1.07) compared with the group with voice complaints (1.41) (P=0.090). CONCLUSION: The present study showed that perceptual assessment of the voice and voice complaints is not sufficient to check if the future professional is at risk. Therefore, preventive measures are needed to detect students at risk early in their education and this depends on broader assessment: on the one hand, assessing voice quality and voice complaints and on the other hand, examination of the vocal folds of all starting students.

Biopsychosocial impact of the voice in relation to the psychological features in female student teachers.

OBJECTIVE: The aim of the study was to assess biopsychosocial impact of the voice in relation to the psychological features in female student teachers. METHODS: This research was a cross-sectional study in 755 student teachers using general questionnaires, the Voice Handicap Inventory (VHI), Type D Scale-16, Symptom Check List (SCL-90), and Utrecht Coping List (UCL). Student teachers with a relative high score on the VHI (>75th percentile) and students with a relative low score (<25th percentile) were compared. RESULTS: Type D student teachers had a 4x greater risk of a high VHI-score (OR 4.23) than the non-type-D group. The student teachers with relative high VHI scores scored significantly higher (P<.001) on the SCL-90 total and all subscales, compared to the student teachers with relative low VHI scores. Furthermore, the students with a relative high VHI score had significant high scores on the subscales passive attitude (P<.001), palliative reactions (P<.001), avoidance and a waiting attitude (P<.001), and expression of emotions (P=.003) of the UCL. CONCLUSION: This study showed that a relative high biopsychosocial impact of the voice is related to the personality trait Type D, psychosomatic well-being and coping strategies in female student teachers. These features should be implemented in screening and training programs for students for a voice demanding profession. The students have to be prepared to cope with psychological, physical and vocal demands of the teaching profession. The speech therapist (of the vocational university) has to be aware of an important role in coaching the students into a more active coping attitude.

Relationship between image quality and ultrasound exposure level in diagnostic US devices.

Ultrasonographic B-mode images were obtained at various exposure levels with three real-time diagnostic scanners. Adult human and tissue-equivalent phantom images were compared in terms of diagnostic content and depth of penetration. For the exposure level settings used, spatial-peak pulse-average intensities ranged from approximately 10 to 500 W/cm2. At the 3.50-3.75-MHz nominal frequencies used in the study, images of the human abdomen showed little discernible change in quality with varying exposure levels. However, phantom tests confirmed that depth of penetration is a function of exposure level. The results suggest that a judicious use of exposure level and receiver gain controls can be a practical means for minimizing patient exposure to ultrasound without sacrifice of diagnostic effectiveness.

Pulmonary hamartoma: CT findings.

Forty-seven patients with a proved (n = 31) or presumed (n = 16) diagnosis of pulmonary hamartoma were studied prospectively by thin-section computed tomography (CT). CT criteria for hamartoma included a diameter of 2.5 cm or less, a smooth edge, and focal collections of fat or fat alternating with areas of calcification. No case of cancer (n = 283) or metastatic disease (n = 72) fulfilled these criteria. Seventeen hamartomas with no detectable calcium or fat were not diagnosed by means of CT. Two other lesions contained diffuse calcium deposits. In 28 lesions, a CT diagnosis of hamartoma was based on the detection of fat (n = 18) or calcium plus fat (n = 10). Twelve such cases were proved histologically by means of thoracotomy or needle biopsy; the remainder, including eight in asymptomatic patients aged 65 years or older, were managed with conservative follow-up.

Solitary pulmonary nodules: CT assessment.

Computed tomography (CT) was used to examine 634 solitary pulmonary nodules (SPNs). Each lesion was assessed as benign or indeterminate on the basis of CT criteria. Benign nodules made up 44% of all SPNs and 58% of the 431 that were 2 cm or less in diameter. All malignant SPNs were assessed as indeterminate, and adenocarcinoma (42%) was the most common primary malignancy. A total of 176 (63% of benign SPNs) were correctly assessed as benign by CT. Ninety SPNs assessed as diffusely calcified were not so identified by conventional tomography at outside institutions. An SPN can be reliably assessed by CT as benign if it exhibits high attenuation values, exceeding a critical level and distributed diffusely throughout a CT section through the center of the lesion and a well-defined edge. Although 38 of 283 (13.4%) primary lung cancers contained localized calcification, there was no significant overlap with the diffuse calcification of benign lesions. Central carcinoid tumors may contain focal ossification, but such lesions may be recognized by noting the proximity of larger bronchi. Assessment of SPNs by CT is most effective for lesions 2.0 cm or less in diameter. For larger lesions, the frequency of benign disease was decreased (14.3% of 203), as was the percentage of benign SPNs correctly assessed as benign by CT (37.9%).

A standard phantom for quantitative CT analysis of pulmonary nodules.

The CT density of the same pulmonary nodule can vary significantly between scanners or with the same scanner because several independent factors besides partial volume averaging can affect its determination. Hence a single CT number cannot be used to distinguish calcified from noncalcified nodules, ruling out direct extrapolation of quantitative data between scanners. The authors designed a phantom that simulates CT measurements in patients and permits comparison of CT density of each nodule with a physical standard derived from clinical experience. Tests on 35 patients using a GE 8800 showed that no malignant nodules and 65% of benign lesions were more dense than the phantom nodule. This method is independent of inter- and intra-scanner variation and facilitates standardized quantitative analysis of pulmonary nodules with current scanners.

Factors influencing quantitative CT measurements of solitary pulmonary nodules.

Quantitative computed tomographic (CT) measurement of pulmonary nodules has not been widely applied despite favorable reports. Its usefulness has been questioned by some investigators. A series of experiments on six different scanners was undertaken to study the factors that affect the applicability of this technique. The type of reconstruction algorithm, the design of the CT system, the true slice thickness, and the beam kilovoltage were the most important factors identified. These factors can produce large variations in the CT numbers of pulmonary nodules, preventing direct comparison of results from scanner to scanner. Before undertaking studies of pulmonary nodules, the effect of these variables in each individual scanner should be evaluated. Despite the current lack of standardization, reliable CT number measurements using a specific kilovoltage and slice thickness should be possible on every modern scanner provided it is positionally uniform and gives a linear response to varying densities. We propose that the CT number above which a pulmonary nodule can be considered benign should be the representative CT number of a 1 cm diameter syringe filled with a hydrous calcium chloride solution of 40 mg/ml of water and scanned in air. A better understanding of the physics of lung nodule densitometry is necessary for the proper application of this technique in the management of patients with solitary pulmonary nodules.

CT of the solitary pulmonary nodule.

Computed tomography (CT) with thin sections (2-5 mm) was used to assess tissue density in 91 apparently noncalcified pulmonary nodules in 88 patients. The study included 45 primary lung malignancies and 13 metastases proven by subsequent lung biopsy or thoracotomy. There were 33 benign lesions of which 13 were biopsy proven. The other 20 nodules were presumed benign on the basis of serial radiography showing no growth. A representative CT number based on the 32 most dense voxels was calculated for each lesion. For the primary malignancies, the mean representative CT number was 92 H, with a standard deviation of 18 H. The highest representative CT number for any malignant lesion was 147 H. Of the 33 benign lesions, 20 had a representative CT number of 164 H or greater. It is presumed that nodules with representative CT numbers of 164 H are benign, and that diffuse calcification likely accounts for the higher CT number of some benign lesions. CT has proven to be more objective and more sensitive than standard tomography in assessing the density of pulmonary nodules.

In vitro computed tomography of the human placenta.

A plastic holding device has been devised to allow in vitro computed tomography of term human placentas. Graded dilutions of iodinated contrast medium have been injected into the fetal placental circulation and into the intervillous space of placental lobules perfused with normal saline solution. Computed tomography in different orientations has imaged Borell's "jets" on the maternal side and cotyledonary vascular "puffs" on the fetal side of the placenta. Attenuation coefficients, before and after injection of contrast medium may be used for quantitative investigation of the physiological placental circulation and possibly for diagnosing placental pathology.

In vitro computed tomography of the human heart.

In vitro computed tomography (CT) was performed on nine human hearts. Mean attenuation coefficients from a 2.5 X 2.5-cm area of the left ventricular wall were determined from a 160 X 160 computer printout before and after formalin fixation in five hearts. These values averaged 27.1 and 24.7 units, respectively (p less than 0.05). The absorption characteristics of normal human myocardium do not differ from those observed in animals and the potential of CT application to ischemic heart disease can be assessed by this mehtodology applied to postmortem hearts of patients with myocardial infarction of varying duration.