Eva Monclús

Abdominothoracic Mechanisms of Functional Abdominal Distension and Correction by Biofeedback

BACKGROUND & AIMS In patients with functional gut disorders, abdominal distension has been associated with descent of the diaphragm and protrusion of the anterior abdominal wall. We investigated mechanisms of abdominal distension in these patients. METHODS We performed a prospective study of 45 patients (42 women, 24-71 years old) with functional intestinal disorders (27 with irritable bowel syndrome with constipation, 15 with functional bloating, and 3 with irritable bowel syndrome with alternating bowel habits) and discrete episodes of visible abdominal distension. Subjects were assessed by abdominothoracic computed tomography (n = 39) and electromyography (EMG) of the abdominothoracic wall (n = 32) during basal conditions (without abdominal distension) and during episodes of severe abdominal distension. Fifteen patients received a median of 2 sessions (range, 1-3 sessions) of EMG-guided, respiratory-targeted biofeedback treatment; 11 received 1 control session before treatment. RESULTS Episodes of abdominal distension were associated with diaphragm contraction (19% ± 3% increase in EMG score and 12 ± 2 mm descent; P < .001 vs basal values) and intercostal contraction (14% ± 3% increase in EMG scores and 6 ± 1 mm increase in thoracic antero-posterior diameter; P < .001 vs basal values). They were also associated with increases in lung volume (501 ± 93 mL; P < .001 vs basal value) and anterior abdominal wall protrusion (32 ± 3 mm increase in girth; P < .001 vs basal). Biofeedback treatment, but not control sessions, reduced the activity of the intercostal muscles (by 19% ± 2%) and the diaphragm (by 18% ± 4%), activated the internal oblique muscles (by 52% ± 13%), and reduced girth (by 25 ± 3 mm) (P ≤ .009 vs pretreatment for all). CONCLUSIONS In patients with functional gut disorders, abdominal distension is a behavioral response that involves activity of the abdominothoracic wall. This distension can be reduced with EMG-guided, respiratory-targeted biofeedback therapy.

Representative Views and Paths for Volume Models

Volume data models are becoming larger and larger as the capture technology improves. Thus, their visualization requires high computational power. The automatic presentation of volume models through representative images and/or exploration paths becomes more and more useful. Representative views are also useful for document illustration, fast data quality evaluation, or model libraries documentation. Exploration paths are also useful for video demonstrations and previsualization of captured data. In this paper we present a fast, adaptive method for the selection of representative views and the automatic generation of exploration paths for volume models. Our algorithm is based on multi-scale entropy and algorithmic complexity. These views and paths reveal informative parts of a model given a certain transfer function. We show that our method is simple and easy to incorporate in medical visualization tools.

The virtual magic lantern: an interaction metaphor for enhanced medical data inspection

In Volume Rendering, it is difficult to simultaneously visualize interior and exterior structures. Several approaches have been developed to solve this problem, such as cut-away or exploded views. Nevertheless, in most cases, those algorithms usually require either a preprocess of the data, or an accurate determination of the region of interest, previous to data inspection. In this paper we present the Virtual Magic Lantern (VML), an interaction tool tailored to facilitate volumetric data inspection. It behaves like a lantern whose virtual illumination cone provides the focal region which is visualized using a secondary transfer function or different rendering style. This may be used for simple visual inspection, surgery planning, or injure diagnosis. The VML is a particularly friendly and intuitive interaction tool suitable for an immersive Virtual Reality setup with a large screen, where the user moves a Wanda device, like a lantern pointing to the model. We show that this inspection metaphor can be efficiently and easily adapted to a GPU ray casting volume visualization algorithm. We also present the Virtual Magic Window (VMW) metaphor as an efficient collateral implementation of the VML, that can be seen as a restricted case where the lantern illuminates following the viewing direction, through a virtual window created as the intersection of the virtual lantern (guided by the Wanda device) and the bounding box of the volume.

Intestinal gas content and distribution in health and in patients with functional gut symptoms

The precise relation of intestinal gas to symptoms, particularly abdominal bloating and distension remains incompletely elucidated. Our aim was to define the normal values of intestinal gas volume and distribution and to identify abnormalities in relation to functional‐type symptoms.

Adaptive Cross-sections of Anatomical Models

Medical illustrations have been used for a long time for teaching and communicating information for diagnosis or surgery planning. Illustrative visualization systems create methods and tools that adapt traditional illustration techniques to enhance the result of renderings. Clipping the volume is a popular operation in volume rendering for inspecting the inner parts, though it may remove some information of the context that is worth preserving. In this paper we present a new editing technique based on the use of clipping planes, direct structure extrusion, and illustrative methods, which preserves the context by adapting the extruded region to the structures of interest of the volumetric model. We will show that users may interactively modify the clipping plane and edit the structures to highlight, in order to easily create the desired result. Our approach works with segmented volume models and non‐segmented ones. In the last case, a local segmentation is performed on‐the‐fly. We will demonstrate the efficiency and utility of our method.

Colonic content: effect of diet, meals, and defecation

The metabolic activity of colonic microbiota is influenced by diet; however, the relationship between metabolism and colonic content is not known. Our aim was to determine the effect of meals, defecation, and diet on colonic content.

MTCut: GPU-based Marching Tetra Cuts

Isosurface construction and rendering based on tetrahedral grids has been adequately implemented on programmable graphics hardware. In this paper we present MTCut: a volume cutting algorithm that is able to cut isosurfaces obtained by a Marching Tetrahedra algorithm on volume data. It does not require a tetrahedal representation and runs in real time for complex meshes of up to 1.8M triangles. Our algorithm takes as input the isosurface to be cut, and produces the cut geometry in response to the user interaction with a haptic device. The result is a watertight manifold model that can be interactively recovered back to CPU upon user request.

Colonic content in health and its relation to functional gut symptoms

Gut content may be determinant in the generation of digestive symptoms, particularly in patients with impaired gut function and hypersensitivity. Since the relation of intraluminal gas to symptoms is only partial, we hypothesized that non‐gaseous component may play a decisive role.

Efficient Selection of Representative Views and Navigation Paths for Volume Data Exploration

The visualization of volumetric datasets, quite common in medical image processing, has started to receive attention fromother communities such as scientific and engineering. The main reason is that it allows the scientists to gain important insights into the data. While the datasets are becoming larger and larger, the computational power does not always go hand to hand, because the requirements of using low-end PCs or mobile phones increase. As a consequence, the selection of an optimal viewpoint that improves user comprehension of the datasets is challenged with time consuming trial and error tasks. In order to facilitate the exploration process, informative viewpoints together with camera paths showing representative information on the model can be determined. In this paper we present amethod for representative viewselection and path construction, togetherwith some accelerations that make this process extremely fast on a modern GPU.

Ventricular Puncture Trainer

The learning process in neurosurgery is a large and difficult task based on experimentation, being ventriculostomy not an exception. We have developed a virtual reality system to help training novel surgeons on this kind of operation. The system consists of the simulation of the surgery using a haptic device and a subsequent 3D visual inspection of the surgical trajectory. Our main objective was to proof that the tactile sensation produced by our system was enough realistic for the surgeons. We carried out a demonstration session in a medical workshop where all surgeons attending the workshop used the system with a very enthusiastic response about the perception experimented through the system.