Gerard Bashein

3D ULTRASONIC IMAGE FEATURE LOCALIZATION BASED ON MAGNETIC SCANHEAD TRACKING: IN VITRO CALIBRATION AND VALIDATION

The basis of a three-dimensional (3D) ultrasound imaging system was constructed from a commercially available magnetometer-based position and orientation measurement (POM) device, a standard B-Mode ultrasound instrument and a personal computer. To evaluate the systems performance, a novel method was devised using an iterative, least-squares technique to simultaneously determine the systems calibration parameters and measure its precision in locating points in three-dimensional space. When tested separately, the POM system located single points with a root mean squared (RMS) uncertainty of from 1.4 mm to 3.2 mm over the 610 mm working radius of the system. When combined with the ultrasound instrument, the RMS uncertainty in locating point targets varied from 2.1 mm to 3.5 mm. These results establish the lower limits of variability to be expected from this system when locating fiducial anatomical landmarks for repeated examinations of the same region of the body, and when making numerical 3D reconstructions from multiple planar images.

Three-dimensional echocardiographic assessment of annular shape changes in the normal and regurgitant mitral valve

OBJECTIVES To compare mitral annular shape and motion throughout the cardiac cycle in patients with normal hearts versus those with functional mitral regurgitation (FMR). BACKGROUND The causes of mitral regurgitation without valvular disease are unclear, but the condition is associated with changes in annular shape and dynamics. Three-dimensional (3D) imaging provides a more comprehensive view of annular structure and allows accurate reconstructions at high spatial and temporal resolution. METHODS Nine normal subjects and 8 patients with FMR undergoing surgery underwent rotationally scanned transesophageal echocardiography. At every video frame of 1 sinus beat, the mitral annulus was manually traced and reconstructed in 3D by Fourier series. Annular projected area, nonplanarity, eccentricity, perimeter length, and interpeak and intervalley spans were determined at 10 time points in systole and 10 points in diastole. RESULTS The mitral annulus in patients with FMR had a larger area, perimeter, and interpeak span than in normal subjects (P <.001 for all). At mid-systole in normal annuli, area and perimeter reach a minimum, nonplanarity is greatest, and projected shape is least circular. These cyclic variations were not significant in patients with FMR. Annular area change closely paralleled perimeter change in all patients (mean r = 0.96 +/- 0.07). CONCLUSIONS FMR is associated with annular dilation and reduced cyclic variation in annular shape and area. Normal mitral valve function may depend on normal annular 3D shape and dimensions as well as annular plasticity. These observations may have implications for design and selection of mitral annular prostheses.

Surgical Suite Utilization and Capacity Planning: A Minimal Cost Analysis Model

In this paper, we are concerned with cost reduction, operating suite utilization, and capacity planning in surgical services. We studied 58,251 computerized surgical records from a teaching hospital to determine a model for measuring operating suite utilization, analyzing the quality of surgical schedules, and allocating surgical suite budgets (capacity planning). The classical definition of operating suite (OR) utilization, encountered in the literature is the ratio of the total OR time used to the total OR time allocated or budgeted. To create a better measure of utilization, we measured underutilization and overutilization providing a more complete description of the overall use of resources. Because the costs of under and overutilization of operating suites are high, they are attractive potential targets for cost minimization and the magnitude of the potential savings are such that attempts to measure and eliminate this inefficiency could be financially rewarding.

Matched filter identification of left-ventricular endocardial borders in transesophageal echocardiograms

The use of one-dimensional spatial matched filtering for identifying the left ventricular endocardial borders in human transesophageal echocardiograms recorded during surgery is investigated. A maximum-likelihood method was used to choose the endocardial intensity profiles centered within the ventricle. The computer-generated border points were compared to those identified by an experienced ultrasonographer. A 16-pixel step template located 63.2% of the border points within 2 mm of the manual border. Median prefiltering of the images reduced detection accuracy by 3% to 6%. No statistically significant difference in accuracy was found between longer and shorter templates or between data-derived and step templates. Compared to manual estimates, computer generated cross-sectional area determinations were correlated with a coefficient of 0.93. Matched filtering executes rapidly, does not require prefiltering, and performs as well as other reported methods in estimating ventricular area.

Ventricular volume measurement from a multiplanar transesophageal ultrasonic imaging system: an in vitro study

A system to assess the feasibility of using multiple transesophageal ultrasonic images to measure left-ventricular volume is discussed. The system includes a special transesophageal probe with a micromanipulator for acquiring cardiac images in multiple planes with known interplanar spatial relationship and an offline processing system to compute the volume. In vitro studies with the probe demonstrated that the distance between two targets in space can be identified within 2 mm ( sigma =0.4 mm) for points in the imaging plane and 3.4 mm ( sigma =0.5 mm) for points not lying in the imaging plane. This gives an average accuracy of +or-6.5% for distances greater than 4.5 cm. Comparison of ultrasonic measurements of the volume of water-filled balloons and excised hearts to the volume required to fill them revealed a correlation coefficient of 0.992, a regression line with a slope of 1.0 and an ordinate intercept at 0.2 mL, and a standard error of the estimate of 8 mL.<<ETX>>

Three-Dimensional Measurement of the Mitral Annulus by Multiplane Transesophageal Echocardiography: In Vitro Validation and In Vivo Demonstration

Ten phantoms were scanned with a multiplane transesophageal echocardiographic probe in a water bath to assess a new method for three-dimensional modeling of the mitral annulus. The annulus was reconstructed from manually outlined borders with Fourier series in each of the three spatial coordinates. Comparisons with direct measurements by least-squares linear regression gave coefficients of determination of 0.99 for annular height, area, and circumference. Expressed as a percentage of their true values, the mean +/- SD of the errors were -0.1% +/- 3.0% for annular height, -2.8% +/- 3.1% for area, and -0.2% +/- 1.7% for circumference. The mean residual error length for phantoms was 0.64 mm compared with 1.21 mm in nine patients studied during general anesthesia. This method gives accurate and precise measurements of the mitral annulus in vitro and should be valuable for studying its morphology and dynamics in vivo.

Measurement of left ventricular ejection fraction and volumes with three-dimensional reconstructed transesophageal ultrasound scans: comparison to radionuclide and thermal dilution measurements.

A transesophageal, ultrasonic cardiac imaging probe was built that incorporated a mechanism for changing the angle of the imaging plane of a conventional phased array in a precise and known manner. This probe was used to acquire an angular spatial sequence of two-dimensional images of the left ventricular cavity over a series of cardiac cycles by sweeping the imaging plane through it stepwise. The endocardial borders of these images were manually outlined off-line and the application of a three-dimensional reconstruction algorithm was then used to compute the left ventricular end-diastolic and end-systolic volumes and ejection fraction. A study was conducted with seven anesthesized dogs to compare ultrasonic determinations by this method with determinations and measurements made using radionuclide and thermal dilution methods. Comparison of 33 ejection fractions, measured by the ultrasonic volume method and by the gated blood pool radionuclide approach, yielded a correlation coefficient of 0.87 and a standard error of the estimate of 5.7% measured over a range of 10% to 58% (average, 40%). Comparison of the ultrasonically measured volumes with those calculated from stroke volume (derived from thermal dilution cardiac output measurement) and ejection fraction (measured by radionuclide technique) produced a correlation coefficient of 0.92 and a standard error of the estimate of 10.3 mL over a range of 18 to 130 mL (average, 56 mL). The accuracy of volume and ejection fraction measurements with this new ultrasonic method seems comparable to that of other currently used clinical approaches such as radionuclide and angiography.

Quantitative Three Dimensional Echocardiography: Methodology, Validation, and Clinical Applications

Three dimensional (3D) ultrasound imaging provides the most accurate measurement of the volume of the heart’s left ventricle. We have developed methods for acquiring and quantitatively analyzing 3D echocardiograms to measure the size, shape, and function not only of the left ventricle but also the mitral annulus and other structures in the mitral apparatus. These methods provide a powerful tool to investigate structure-function relationships, evaluate surgical procedures, and assess patient prognosis.

How positionally stable is a transesophageal echocardiographic probe? Implications for three-dimensional reconstruction.

Three-dimensional (3D) reconstruction from a single esophageal scanning position requires a stable relationship between the probe and the heart. The purpose of this study was to examine the movement of a transesophageal echocardiographic probe during 3D image acquisition. A new dual-axis multiplane probe was used that includes a miniature (6 x 6 x 9 mm) magnetic sensor in the tip. The sensor identifies the probes 3D position and 3D orientation in space with respect to the location of a magnetic field generator placed beneath the subject. In vivo 3D scanning was performed in five anesthetized, ventilated dogs, with positional determinations acquired every 66 msec. Probe movement was estimated by computing the deviations of each x, y, and z position and orientation determination, compared with the average values during each 3D scan or cardiac cycle. Ten 3D scans were analyzed, involving 263 cardiac cycles and 2328 determinations. The range and SD of the translational movement of the transducer were 2.3 and 0.8 mm, 1.7 and 0.5 mm, and 2.4 and 0.7 mm in x, y, and z directions, respectively, during 3D scanning. Translational movement was more dominant than was rotational movement. Misregistration of three-dimensional reconstructions may be due to subtle probe movement. The ability to monitor probe movement may be helpful in optimizing 3D data sets.

Clinical assessment of a flow-through fluorometric blood gas monitor

We performed an observational study to evaluate a flow-through fluorometric instrument (Gas-STAT) that continuously measures the carbon dioxide tension (PCO2), oxygen tension (PO2), and pH of blood in the cardiopulmonary bypass circuit. Setup and calibration of the instrument typically required 20 minutes. During bypass, 129 blood samples were drawn from 16 patients for comparison with conventional measurements obtained with a blood gas machine. Data for each variable, within each sensor, were analyzed by linear regression. The ranges of the standard errors of the estimate were 0.7 to 4.2 mm Hg forPCO2, 18.3 to 78.7 mm Hg for the highPO2 range, 1.4 to 7.1 mm Hg for the lowPO2 range, and 0.008 to 0.049 for pH. The regression lines differed from the identity line (P<0.05) in at least one variable in most patients, and large deviations from the line of identity in both slope and intercept were common. Among 58 sensors evaluated, failures occurred in 5 (2.9%) of the 174 optodes, and minor leakage occurred in 2 (3.4%) of the flow-through cells. We conclude that although this flow-through fluorometric instrument is an adequate monitor of trends in blood gases during cardiopulmonary bypass, it is not accurate enough to supplant conventional laboratory measurements.