Keith S. White

The volume of lung parenchyma as a function of age: a review of 1050 normal CT scans of the chest with three-dimensional volumetric reconstruction of the pulmonary system.

Study Design. An Institutional Review Board-approved retrospective review of 3400 sequential CT scans of the thorax obtained at a single institution over a 3-year period from 2000 to 2003 was performed Objectives. We determined values for the volume of the right lung, left lung, and total lung volume and plot these data as a function of age and sex Summary of Background Data. To our knowledge, no normative data on CT determined lung volume as a function of age have been published Methods. All examinations with a report of a normal CT scan of the chest (1050 examinations) were identified. The volume of lung parenchyma in each normal examination was determined by performing a three-dimensional reconstruction of the pulmonary system Results. Predicted increases in pulmonary volume with age for the third to 97th percentiles of male and female children were calculated Conclusions. Normal values for the volume of lung parenchyma as a function of age and sex increase the clinical utility of a standard CT scan of the thorax in evaluating children with complex spinal deformities. They are a useful adjunct to pulmonary function testing. These data can be used in the pre- and postoperative evaluation of patients who are at risk of thoracic insufficiency syndrome, particularly in patients younger than 5 years of age, when standard pulmonary function testing cannot be accomplished. The effects of nonoperative treatment, early spinal fusion, and new techniques for the fusionless management of spinal deformity on lung volume can be quantified and compared to normal values.

Intra-arterial thrombolysis in a 2-year-old with cardioembolic stroke.

Recombinant tissue plasminogen activator, although the standard of care for the management of acute ischemic stroke in adults, is used infrequently in children. The authors describe the use of intra-arterial recombinant tissue plasminogen activator in a young child with embolic stroke. Thrombolysis restored flow to the affected middle cerebral artery and appeared to limit the extent of the infarction and the severity of the subsequent neurologic deficits.

Speech recognition implementation in radiology

Continuous speech recognition (SR) is an emerging technology that allows direct digital transcription of dictated radiology reports. The SR systems are being widely deployed in the radiology community. This is a review of technical and practical issues that should be considered when implementing an SR system.

Three Dimensional Reconstruction of Vascular Beds

This chapter discusses the mathematics and computer processing required to generate three dimensional representations of vascular beds from multiple digital angiographic projections. In order to compensate for the deficiencies of conventional reconstruction techniques, a method is presented which directly reconstructs a vascular tree structure. This method appears to take good advantage of vessel characteristics such as connectivity and uniform internal density. Direct reconstruction takes full advantage of the information contained in multiple images, using a dynamic programming technique to determine the vessel centerline, edges, and densitometric profiles in each of the views. With the knowledge of the artery locations from each projection, reconstruction of the arterial tree centerline is overdetermined and averaging or least squares techniques can be used. The vessel lumen geometry may be estimated using the edge information and attenuation profile. The lumen geometry can then be refined by densitometric reprojection of the vascular tree and comparison with original profiles. Examples of direct reconstruction and perspective display of a pig heart coronary artery cast are given.

Developing a multi-institutional PACS archive and designing processes to manage the shift from a film to a digital-based archive

The Quality Assurance Review Center (QARC) works to improve the standards of care in treating cancer by improving the quality of clinical trials medicine. QARC operates as a data management and review center providing quality assurance services for multiple external groups including cooperative groups and pharmaceutical companies. As the medical world migrates from analog film to digital files, QARC has developed an innovative and unique digital imaging management system to accommodate this trend. As QARC acquires electronic data from institutions across six continents, the system is continually developed to accommodate Digital Imaging and Communications in Medicine (DICOM) imaging originating from a wide variety of Picture Archival and Communications System (PACS) manufacturers, thus creating one of the largest and most diverse multi-institutional imaging archives in the cancer research community.

Extracranial relapse of an anaplastic oligodendroglioma in an adolescent: case report and review of the literature.

Oligodendroglioma is an uncommon childhood tumor and is more chemosensitive than other malignant glial neoplasms. Treatment involves gross total resection, and if anaplastic, radiation and chemotherapy. Distinct genetic alterations are associated with improved prognosis. We report a child with a low-grade oligodendroglioma that recurred as a high-grade oligodendroglioma and ultimately as extraneural systemic relapse. It was initially responsive to temozolomide, cyclophosphamide, etoposide, and carboplatin, perhaps predicted by combined loss of heterozygosity at 1p and 19q. This chemotherapy may be promising in treating malignant oligodendroglioma. However, he succumbed to progressive systemic disease. Positron emission spectroscopy scan was useful in sequentially assessing his disease.

Development of a Queriable Database for Oncology Outcome Analysis

Clinical trials and oncology data management have undergone considerable change in the past decade. Imaging has become a key tool for clinical trials management and a biomarker for clinical trial validation as imaging technologies improve and become more precise. Images have become extremely helpful in determining staging/eligibility, treatment response, and outcome determination including disease recurrence and progression. In modern protocols, images are often reviewed in real time to validate these points in order to improve compliance to study requirements and create uniform patient populations for clinical trials analysis. Data acquisition and management systems are currently in use to acquire and display images in electronic digital formats for view by both on site and off site radiology reviewers. As clinical trials become more global in focus, the ability for databases to accommodate diverse imaging acquisition strategies will become increasingly important for information review.

Fetus in fetu: unexpected cause of an abdominal mass.

Although abdominal masses are commonly encountered in pediatric oncology, the finding of a vertebrate fetus within the body of its normal twin host is certainly unexpected. This condition, termed fetus in fetu, is thought to occur when a monozygotic, diamniotic twin is incorporated into the body of its sibling early in embryonic development. The result is a differentiated mass that, in contrast to a teratoma, has a discrete spinal column and synchronous organ development (1). We report a case of fetus in fetu and highlight important features of this unusual disorder.

Quality Assurance of Clinical Trials in the Management of Cancer in the Head and Neck

Integrating tissue analysis and imaging strategies in clinical trial objectives is an important area of clinical translational research. Clinical trial designs that incorporate clear guidelines for clinical trial execution, definitions of data submission pathways and study deviations, and integration of real time and adaptive quality assurance will provide uniformity of study populations for clinical trial analysis. Essential to clinical trials management is a robust, validated informatics platform to display data and imaging in a uniform manner acquired from diverse platforms and re-presented for both on site and distributed review in a uniform file format. The Quality Assurance Review Center (QARC) uses a robust informatics platform to provide protocol development, site credentialing, data acquisition, case management, capable of both real time and retrospective review of objects, data transfer to clinical trial sponsor and/or industry partner and data archiving. As a member of the Virtual Imaging Evaluation Workspace (VIEW) and the Advanced Technology Quality Assurance (QA) Consortium (ATC), QARC collaborates in the development, sharing and implementation of credentialing tools, digital acquisition and review tools and processes, a common platform for data storage for radiotherapy and imaging with emphasis on compliance to caBIG and 21 CFR Part 11. Recent evidence demonstrates that compliance to study guidelines may have significant influence on study and patient outcome. Head and neck cancer is a very good area to study biopharmacology of treatment response and the quality assurance process is a vehicle for adaptive clinical trial and patient management.