Tales Santini

Comparison of human and electronic observation for the measurement of compliance with hand hygiene

BACKGROUND Monitoring of hand hygiene is an important part of the improvement of hospital quality indicators. METHODS This study was prospectively performed over a 14-week (electronic observer) period from December 3, 2013-March 9, 2014, to evaluate hand hygiene compliance in an adult step-down unit. We compared electronic handwash counters with the application of radiofrequency identification (RFID - ZigBee; i-Healthsys, São Carlos, Brazil) (electronic observer), which counts each activation of the alcohol gel dispenser to direct observation (human observer) using the iScrub application. RESULTS For the overall time period of simultaneous electronic and human observation, we found that the electronic observer identified 414 hand hygiene episodes, whereas the human observers identified 448 episodes. Therefore, we found 92% (95% confidence interval [CI], 90%-95%) overall concordance (414/448), with an intraclass correlation coefficient of .87 (95% CI, 0.77-0.92). CONCLUSION Our RFID (ZigBee) system showed good accuracy (92%) and is a useful method to monitor hand hygiene compliance.

Experimental and numerical analysis of B1+ field and SAR with a new transmit array design for 7 T breast MRI

Developing a radiofrequency (RF) coil system that produces a uniform B1(+) field (circularly polarized component of the transverse magnetic field responsible for excitation) and low specific absorption rate (SAR) is critical for high performance ultrahigh field human imaging. In this study, we provide the design of a new eight channel radiofrequency (RF) transmit (Tx) array for breast MRI at 7T. A numerical analysis utilizing an in-house finite difference time domain (FDTD) package was carried out in (1) four breast models, (2) homogeneous spherical model and (3) full body model to calculate the B1(+) intensity (μT) and homogeneity represented by coefficient of variation (CoV=standard deviation/mean) in the proposed RF array design. The numerical results were compared with that measured in breast phantom (Bphantom) and homogeneous spherical phantom at 7T MRI and showed very good agreement. Average and peak SARs were also calculated in the four breast models and the temperature rises due to the operation of the RF array were also measured in the Bphantom. The proposed RF array; which can operate in a single or multi transmit modes, demonstrates homogeneous RF field excitation with acceptable local/average SAR levels for breast MRI at 7T.

Design and fabrication of a realistic anthropomorphic heterogeneous head phantom for MR purposes

Objective The purpose of this study is to design an anthropomorphic heterogeneous head phantom that can be used for MRI and other electromagnetic applications. Materials and methods An eight compartment, physical anthropomorphic head phantom was developed from a 3T MRI dataset of a healthy male. The designed phantom was successfully built and preliminarily evaluated through an application that involves electromagnetic-tissue interactions: MRI (due to it being an available resource). The developed phantom was filled with media possessing electromagnetic constitutive parameters that correspond to biological tissues at ~297 MHz. A preliminary comparison between an in-vivo human volunteer (based on whom the anthropomorphic head phantom was created) and various phantoms types, one being the anthropomorphic heterogeneous head phantom, were performed using a 7 Tesla human MRI scanner. Results Echo planar imaging was performed and minimal ghosting and fluctuations were observed using the proposed anthropomorphic phantom. The magnetic field distributions (during MRI experiments at 7 Tesla) and the scattering parameter (measured using a network analyzer) were most comparable between the anthropomorphic heterogeneous head phantom and an in-vivo human volunteer. Conclusion The developed anthropomorphic heterogeneous head phantom can be used as a resource to various researchers in applications that involve electromagnetic-biological tissue interactions such as MRI.

Development of a 7 T RF coil system for breast imaging

In ultrahigh‐field MRI, such as 7 T, the signal‐to‐noise ratio (SNR) increases while transmit (Tx) field (B1+) can be degraded due to inhomogeneity and elevated specific absorption rate (SAR). By applying new array coil concepts to both Tx and receive (Rx) coils, the B1+ homogeneity and SNR can be improved. In this study, we developed and tested in vivo a new RF coil system for 7 T breast MRI.

Ultra‐high‐field RF coil development for evaluating upper extremity imaging applications

The purpose of this study is to develop and evaluate a custom‐designed 7 T MRI coil and explore its use for upper extremity applications.

Ultra-high field upper extremity peripheral nerve and non-contrast enhanced vascular imaging

Objective The purpose of this study was to explore the efficacy of Ultra-high field [UHF] 7 Tesla [T] MRI as compared to 3T MRI in non-contrast enhanced [nCE] imaging of structural anatomy in the elbow, forearm, and hand [upper extremity]. Materials and method A wide range of sequences including T1 weighted [T1] volumetric interpolate breath-hold exam [VIBE], T2 weighted [T2] double-echo steady state [DESS], susceptibility weighted imaging [SWI], time-of-flight [TOF], diffusion tensor imaging [DTI], and diffusion spectrum imaging [DSI] were optimized and incorporated with a radiofrequency [RF] coil system composed of a transverse electromagnetic [TEM] transmit coil combined with an 8-channel receive-only array for 7T upper extremity [UE] imaging. In addition, Siemens optimized protocol/sequences were used on a 3T scanner and the resulting images from T1 VIBE and T2 DESS were compared to that obtained at 7T qualitatively and quantitatively [SWI was only qualitatively compared]. DSI studio was utilized to identify nerves based on analysis of diffusion weighted derived fractional anisotropy images. Images of forearm vasculature were extracted using a paint grow manual segmentation method based on MIPAV [Medical Image Processing, Analysis, and Visualization]. Results High resolution and high quality signal-to-noise ratio [SNR] and contrast-to-noise ratio [CNR]—images of the hand, forearm, and elbow were acquired with nearly homogeneous 7T excitation. Measured [performed on the T1 VIBE and T2 DESS sequences] SNR and CNR values were almost doubled at 7T vs. 3T. Cartilage, synovial fluid and tendon structures could be seen with higher clarity in the 7T T1 and T2 weighted images. SWI allowed high resolution and better quality imaging of large and medium sized arteries and veins, capillary networks and arteriovenous anastomoses at 7T when compared to 3T. 7T diffusion weighted sequence [not performed at 3T] demonstrates that the forearm nerves are clearly delineated by fiber tractography. The proper digital palmar arteries and superficial palmar arch could also be clearly visualized using TOF nCE 7T MRI. Conclusion Ultra-high resolution neurovascular imaging in upper extremities is possible at 7T without use of renal toxic intravenous contrast. 7T MRI can provide superior peripheral nerve [based on fiber anisotropy and diffusion coefficient parameters derived from diffusion tensor/spectrum imaging] and vascular [nCE MRA and vessel segmentation] imaging.

Correction: Design and fabrication of a realistic anthropomorphic heterogeneous head phantom for MR purposes

[This corrects the article DOI: 10.1371/journal.pone.0183168.].

A new RF transmit coil for foot and ankle imaging at 7T MRI

A four-channel Tic-Tac-Toe (TTT) transmit RF coil was designed and constructed for foot and ankle imaging at 7T MRI. Numerical simulations using an in-house developed FDTD package and experimental analyses using a homogenous phantom show an excellent agreement in terms of B1+ field distribution and s-parameters. Simulations performed on an anatomically detailed human lower leg model demonstrated an B1+ field distribution with a coefficient of variation (CV) of 23.9%/15.6%/28.8% and average B1+ of 0.33μT/0.56μT/0.43μT for 1W input power (i.e., 0.25W per channel) in the ankle/calcaneus/mid foot respectively. In-vivo B1+ mapping shows an average B1+ of 0.29μT over the entire foot/ankle. This newly developed RF coil also presents acceptable levels of average SAR (0.07W/kg for 10g per 1W of input power) and peak SAR (0.34W/kg for 10g per 1W of input power) over the whole lower leg. Preliminary in-vivo images in the foot/ankle were acquired using the T2-DESS MRI sequence without the use of a dedicated receive-only array.

Association of Hippocampal Substructure Resting-State Functional Connectivity with Memory Performance in Older Adults

OBJECTIVES Hippocampal hyperactivation marks preclinical dementia pathophysiology, potentially due to differences in the connectivity of specific medial temporal lobe structures. Our aims were to characterize the resting-state functional connectivity of medial temporal lobe sub-structures in older adults, and evaluate whether specific substructural (rather than global) functional connectivity relates to memory function. METHODS In 15 adults (mean age: 69 years), we evaluated the resting state functional connectivity of medial temporal lobe substructures: dentate/Cornu Ammonis (CA) 4, CA1, CA2/3, subiculum, the molecular layer, entorhinal cortex, and parahippocampus. We used 7-Tesla susceptibility weighted imaging and magnetization-prepared rapid gradient echo sequences to segment substructures of the hippocampus, which were used as structural seeds for examining functional connectivity in a resting BOLD sequence. We then assessed correlations between functional connectivity with memory performance (short and long delay free recall on the California Verbal Learning Test [CVLT]). RESULTS All the seed regions had significant connectivity within the temporal lobe (including the fusiform, temporal, and lingual gyri). The left CA1 was the only seed with significant functional connectivity to the amygdala. The left entorhinal cortex was the only seed to have significant functional connectivity with frontal cortex (anterior cingulate and superior frontal gyrus). Only higher left dentate-left lingual connectivity was associated with poorer CVLT performance (Spearman r = -0.81, p = 0.0003, Benjamini-Hochberg false discovery rate: 0.01) after multiple comparison correction. CONCLUSIONS Rather than global hyper-connectivity of the medial temporal lobe, left dentate-lingual connectivity may provide a specific assay of medial temporal lobe hyper-connectivity relevant to memory in aging.

Dynamic Bayesian Network Modeling of Hippocampal Subfields Connectivity with 7T fMRI: A Case Study.

The development of high resolution structural and functional magnetic resonance imaging, along with the new automatic segmentation procedures for identifying brain regions with high precision and level of detail, has made possible new studies on functional connectivity in the medial temporal lobe and hippocampal subfields, with important applications in the understanding of human memory and psychiatric disorders. Many previous analyses using high resolution data have focused on undirected measures between these subfields. Our work expands this by presenting Dynamic Bayesian Network (DBN) models as an useful tool for mapping directed functional connectivity in the hippocampal subfields. Besides revealing directional connections, DBNs use a model-free approach which also exclude indirect connections between nodes of a graph by means of conditional probability distribution. They also relax the constraint of acyclicity imposed by traditional Bayesian networks (BNs) by considering nodes at different time points through a Markovianity assumption. We apply the GlobalMIT DBN learning algorithm to one subject with fMRI time-series obtained from three regions: the cornu ammonis (CA), dentate gyrus (DG) and entorhinal cortex (ERC), and find an initial network structure, which can be further expanded with the inclusion of new regions and analyzed with a group analysis method.