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  • 1
    Language: English
    In: Journal of Biomechanics, 03 March 2010, Vol.43(4), pp.652-657
    Description: There is no published data about mask features that impact skin contact pressure during mask ventilation. To investigate the physical factors of skin contact pressure formation. We measured masks with original and reduced air cushion size and recorded contact pressure. We determined cushion contact and mask areas by planimetric measurements. Contact pressures necessary to prevent air leakage during inspiration exceed inspiratory pressure by 1.01±0.41 hPa independent of cushion size. Contact area, ventilator pressure and mask area during inspiration and expiration impact contact pressure. Mask contact pressures are higher during expiration. The contact pressure increases with increase in inspiratory pressures independent of the ventilator cycle. During expiration, the contact pressure will increase in proportion to the expiratory pressure reduction of the ventilator. The mask with reduced air cushion size developed higher contact pressures. Contact pressure can be reduced by selecting masks with a small mask area in combination with a large mask cushion.
    Keywords: Non-Invasive Ventilation ; Mask Ventilation ; Complications ; Skin Ulcer ; Medicine ; Engineering ; Anatomy & Physiology
    ISSN: 0021-9290
    E-ISSN: 1873-2380
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  • 2
    Language: English
    In: Journal of Cardiology Cases, April 2013, Vol.7(4), pp.e97-e100
    Description: We present the case of a 69-year-old female surviving an extensive dissecting thoracic aortic aneurysm. Due to the initial presentation with angina and epigastric pain the first working diagnosis was acute coronary syndrome. However, on transthoracic and transesophageal echocardiography (TEE), the dissecting aneurysm (type Stanford A) could be detected. Our article stresses the importance of imaging for the rapid and accurate diagnosis of thoracic aortic aneurysms with dissection. In our case, TEE detected the intimal flap separating true and false lumen, and the consecutive hemodynamically relevant aortic valve regurgitation, in addition to the aneurysm extent. The patient underwent surgical repair with aortic arch replacement and recovered without sequelae. 〈 In patients with severe hypertension and coronary artery disease presenting with atypical chest pain, ECG and troponin T assessment should be complemented by imaging of the heart and the ascending aorta to rule out aortic dissection.〉
    Keywords: Thoracic Aortic Aneurysm ; Transesophageal Echocardiogram ; Dissecting Aortic Aneurysm ; Medicine
    ISSN: 1878-5409
    E-ISSN: 1878-5409
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  • 3
    Language: English
    In: European Radiology, 2011, Vol.21(9), pp.1895-1903
    Description: Byline: J. Matthias Kerl (1,2), U. Joseph Schoepf (1,3), Peter L. Zwerner (1,3), Ralf W. Bauer (1,2), Joseph A. Abro (1), Christian Thilo (1,3), Thomas J. Vogl (2), Christopher Herzog (1,2) Keywords: Computed Tomography (CT), cardiac; Computed Tomography (CT), multidetector-row technology; Coronary artery stenosis; Atherosclerosis; Conventional coronary angiography; Sensitivity and specificity Abstract: Objective To prospectively compare the accuracy of coronary CT angiography (CCTA) and conventional coronary angiography (CCA) for stenosis detection using composite findings from both tests as an enhanced reference standard. Methods One hundred thirteen patients underwent CCTA and CCA. Per-segment and per-patient accuracy of CCTA compared with initial CCA interpretation were determined. Angiographers were then unblinded to the CCTA results and re-evaluation of the CCA studies was performed with knowledge of CCTA findings, which was used as an enhanced reference standard to compare the diagnostic accuracy of CCTA versus CCA. Results When using the enhanced reference standard instead of initial CCA interpretation, CCTA accuracy for identifying segments (patients) with aY=50% stenosis increased from 97.7% (96.5%) to 98.1% (98.2%), sensitivity from 90.5% (100%) to 90.8% (100%), and specificity from 98.4% (94.3%) to 98.9% (97.1%). CCTA identified six segments and two patients with stenoses aY=50% missed on initial CCA interpretation. Compared with the enhanced reference standard the accuracies of CCTA and of initial CCA interpretation were not different (p=0.87). Conclusion CCTA compares favourably with CCA for stenosis detection. Use of a composite reference standard combining findings from both tests can control for the effect of false-negative CCA results when evaluating the accuracy of CCTA. Author Affiliation: (1) Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29401, USA (2) Department of Diagnostic and Interventional Radiology, University of Frankfurt, Frankfurt, Germany (3) Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA Article History: Registration Date: 21/04/2011 Received Date: 20/12/2010 Accepted Date: 23/03/2011 Online Date: 01/05/2011
    Keywords: Computed Tomography (CT), cardiac ; Computed Tomography (CT), multidetector-row technology ; Coronary artery stenosis ; Atherosclerosis ; Conventional coronary angiography ; Sensitivity and specificity
    ISSN: 0938-7994
    E-ISSN: 1432-1084
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  • 4
    Language: English
    In: European Radiology, 2011, Vol.21(3), pp.530-537
    Description: Byline: J. Matthias Kerl (1,3), Ralf W. Bauer (1,3), Tobias B. Maurer (1,3), Rene Aschenbach (1,3), Huedayi Korkusuz (1,3), Thomas Lehnert (1,3), Simon Deseive (1,3), Hanns Ackermann (2,3), Thomas J. Vogl (1,3) Keywords: Cardiac CT; Dual energy CT; Computed tomography; Dual source CT; Coronary CT angiography Abstract: Purpose To compare the dose estimates and image quality of Dual Energy CT (DECT), Dual Source CT (DSCT) and 16-slice CT for coronary CT angiography (cCTA). Methods Sixty-eight patients were examined with 16 - slice MDCT (group 1), 68 patients with DSCT (group 2) and 68 patients using DSCT in dual energy mode (DECT group 3). CT dose index volume, dose length product, effective dose, signal-to-noise, and contrast-to-noise ratio were compared. Subjective image quality was rated by two observers, blinded to technique. Results The mean estimated radiation dose of all patients investigated on a 16 - slice MDCT was 12+-3.59 mSv, for DSCT in single energy 9.8+-4.77 mSv and for DECT 4.54+-1.87 mSv. Dose for CTA was significantly lower in group 3 compared to group 1 and 2. The image noise was significantly lower in Group 2 in comparison to group 1 and group 3. There was no significant difference in diagnostic image quality comparing DECT and DSCT. Conclusion cCTA shows better dose levels at both DECT and DSCT compared to 16-slice CT. Further, DECT delivers significantly less dose than regular DSCT or single source single energy cCTA while maintaining diagnostic image quality. Author Affiliation: (1) Department of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University, Theodor Stern Kai 7, 60590, Frankfurt, Germany (2) Department of Department of Biomathematics, Johann Wolfgang Goethe-University, Theodor Stern Kai 7, 60590, Frankfurt, Germany (3) Department of Diagnostic and Interventional Radiology and Neuroradiology, HELIOS Clinics Erfurt, Nordhauser Strasse 74, 99089, Erfurt, Germany Article History: Registration Date: 09/09/2010 Received Date: 05/02/2010 Accepted Date: 16/07/2010 Online Date: 23/09/2010
    Keywords: Cardiac CT ; Dual energy CT ; Computed tomography ; Dual source CT ; Coronary CT angiography
    ISSN: 0938-7994
    E-ISSN: 1432-1084
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  • 5
    Language: English
    In: AJR. American journal of roentgenology, November 2012, Vol.199(5), pp.W646-50
    Description: The purpose of this study was to evaluate the efficiency of automatic bone removal in dual-energy CT angiography (CTA) of the trunk. Nineteen patients underwent dual-energy CTA of the trunk (tube A, 140 kV; tube B, 100 kV). In addition to the dual-energy dataset, an image equivalent to that of a standard 120-kV single-energy examination was generated with both tubes. Automated bone segmentation was performed on both datasets, and the results were analyzed. The time required for and subjective image quality of the maximum intensity projections (MIPs) generated were evaluated. Errors in bone segmentation were found for 1.5% of bones on dual-energy images and 12.4% of bones on single-energy images (p 〈 0.01). The most important differences were found in the rib cage, sternum, and pelvis. The times required for postprocessing of MIPs were similar for the dual-energy (113.5 seconds) and single-energy (106.8 seconds) techniques. The subjective image quality of the arteries was considered better for dual-energy CTA (4.5 points) than for single-energy CTA (4.1 points) owing to false cutoff of vessels during the bone removal process on the single-energy images (p = 0.026). For CTA of the trunk, the dual-energy postprocessing capabilities for 3D visualization are superior to the threshold-based bone removal of single-energy CT. Dual-energy CTA can generate boneless MIP images of substantial quality.
    Keywords: Whole Body Imaging ; Angiography, Digital Subtraction -- Methods ; Bone and Bones -- Diagnostic Imaging ; Tomography, X-Ray Computed -- Methods
    ISSN: 0361803X
    E-ISSN: 1546-3141
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  • 6
    Language: English
    In: Thoracic and Cardiovascular Surgeon, 2015, Vol.64(03)
    In: Thoracic and Cardiovascular Surgeon, 2016, Vol.64(03), pp.204-210
    Description:  Inferior vein graft patency after coronary artery bypass grafting (CABG) is attributed to various factors. Venous valves may limit flow, cause thrombus formation, and diminish diastolic backflow. The aim of our study was to compare clinical outcome and midterm patency rate of valvulotomized vein grafts and arterial grafts in patients undergoing CABG.  Between 2007 and 2010, valvulotomized saphenous vein segments were used to graft the right coronary artery (RCA) in 147 patients undergoing CABG with mean 2.8 ± 1 arterial and 1.5 ± 0.6 venous anastomoses. Outcome, reintervention, and reoperation were assessed after 4 ± 1.6 years. Intraoperative bypass flow rate was measured before and after valvulotomy of venous bypass grafts in 12 patients. Patency of the grafts was assessed by means of multislice computed tomography (MSCT) in 45 patients.  A total of 102 patients underwent isolated CABG and 45 had combined procedures. In-hospital mortality was 2%. At 4 years' clinical follow-up, 95% of the patients were asymptomatic. Five patients underwent recoronary angiography because of angina pectoris. The MSCT and reangiography patency rate of all valvulotomized saphenous vein grafts was 97.1 versus 95.8% of arterial grafts 18 ± 6 months postoperatively. Intraoperative measurements showed a significant increase (+20.2 mL/min; p = 0.01) of flow in the venous bypass grafts to the RCA after valvulotomy. There were no reoperations at the latest follow-up.  Patients with valvulotomized venous grafts had good clinical outcome. The one-year patency rate of those grafts is comparable to that of arterial grafts. However, long-term results and angiography studies will be needed to strengthen these findings.
    Keywords: Coronary artery bypass grafting ; Computed tomography ; Outcomes
    ISSN: 0171-6425
    E-ISSN: 1439-1902
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  • 7
    In: Journal of Thoracic Imaging, 2012, Vol.27(6), pp.376-381
    Description: PURPOSE:: To investigate pulmonary arterial (PA) enhancement, image noise, and artifacts related to breathing and heart motion in patients with suspected pulmonary embolism. MATERIALS AND METHODS:: Seventy-six consecutive patients underwent computed tomographic pulmonary angiography (CTPA) in dual-source high-pitch mode (pitch 3.0, 100 kV, 180 mAs, 50 mL contrast material) without breathing commands. PA enhancement, image noise, signal to noise ratio, overall image quality, incidence of total or partial interruption of the contrast column in the PAs, and heart motion-related and breathing-related artifacts of the diaphragm and pulmonary structures were recorded. RESULTS:: Mean central and peripheral PA attenuation was 404±104 and 453±119 HU; mean image noise was 11±2 HU; mean examination time was 0.67±0.09 s; and mean dose-length product was 142±31 mGy cm. There were no motion artifacts of the diaphragm or pulmonary vessels related to breathing or heart motion. There was no case of partial or total interruption of the contrast column in the PA tree. No examination was rated nondiagnostic. CONCLUSIONS:: High-pitch dual-source CTPA in freely breathing patients effectively produces images that are free of artifacts related to breathing and cardiac motion. Hence, Valsalva-related artifacts can be eliminated using this technique.
    Keywords: Adolescent–Analogs & Derivatives ; Adult–Diagnostic Imaging ; Aged–Diagnostic Imaging ; Aged, 80 and Over–Methods ; Artifacts–Methods ; Contrast Media–Methods ; Diagnosis, Differential–Methods ; Female–Methods ; Humans–Methods ; Iopamidol–Methods ; Male–Methods ; Middle Aged–Methods ; Observer Variation–Methods ; Pulmonary Artery–Methods ; Pulmonary Embolism–Methods ; Radiographic Image Enhancement–Methods ; Respiration–Methods ; Signal-To-Noise Ratio–Methods ; Tomography, X-Ray Computed–Methods ; Young Adult–Methods ; Contrast Media ; Iomeprol ; Iopamidol;
    ISSN: 0883-5993
    E-ISSN: 15360237
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  • 8
    In: Journal of Computer Assisted Tomography, 2015, Vol.39(2), pp.290-294
    Description: ABSTRACT: Sliding-gantry computed tomography offers an interesting variety of treatment options for emergency radiology and clinical routine. The Frankfurt 2-room installation provides an interdisciplinary, multifunctional, and cost-effective concept. It is based on a magnetically sealed rail system for the permanent movement of the gantry between 2 adjacent rooms with fixed-mounted tables. In case of emergency or intensive care patients, routine scanning can be performed in room 1 until computed tomography diagnosis is required in room 2 and can then be continued in room 1 again. Moreover, this concept allows the simultaneous handling of 2 emergency patients.
    Keywords: Tomography, X-Ray Computed -- Instrumentation;
    ISSN: 0363-8715
    E-ISSN: 15323145
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  • 9
    Language: English
    In: Acta Radiologica, May 2012, Vol.53(4), pp.435-440
    Description: Background Today's gold standard for diagnostic imaging of inflammatory diseases of the paranasal sinus is computed tomography (CT). Purpose To evaluate diagnostic sensitivity and radiation dose of an ultra-low dose dual-source CT technique. Material and Methods Paranasal sinuses of 14 cadaveric heads were independently evaluated by two readers using a modern dual-source CT with lowest reasonable dosage in high-pitch mode (100 kV, 10 mAs, collimation 0.6 mm, pitch value 3.0). Additionally the head part of an anthropomorphic Alderson-Rando phantom was equipped with thermoluminiscent detectors to measure radiation exposure to the eye lenses and thyroid gland. Results Diagnostic accuracy regarding sinusoidal fluid, nasal septum deviation, and mucosal swelling was 100%. Mastoid fluid was detected in 76% and 92%, respectively. In the phantom study, average measured eye lens dosage was 0.64 mGy; radiation exposure of the thyroid gland was 0.085 mGy. Conclusion Regarding evaluation of inflammatory diseases of the paranasal sinus this study indicates sufficient accuracy of the proposed CT protocol at a very low dosage level.
    Keywords: Radiation Dose ; Dual-Source Computed Tomography ; Paranasal Sinus ; Medicine
    ISSN: 0284-1851
    E-ISSN: 1600-0455
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  • 10
    In: Journal of Thoracic Imaging, 2012, Vol.27(6), pp.382-386
    Description: PURPOSE:: The purpose of this study was to objectively analyze motion artifacts on thoracic computed tomography (CT) with dual-source high-pitch and single-source techniques when using a no–breath-hold technique to examine patients who have difficulty complying with breath-holding instructions. MATERIALS AND METHODS:: A total of 120 patients who received CT of the thorax with a free-breathing technique in single-source (16 slices and 128 slices; pitch=1.2) and dual-source (pitch=3.0) manners were evaluated retrospectively. In each of the 3 study groups, movements of the diaphragm and pulsations of the aortic root and main pulmonary artery were analyzed for their number and severity (blurred distance). RESULTS:: No motion artifacts of the diaphragm were identified using a pitch of 3.0 (compared with n=14 for single-source CT using 128 slices and n=24 using 16-slice CT). In single-source examinations, the severity of artifacts was similar between 128-slice CT and 16-slice CT: blurring distance of the lung parenchyma due to diaphragm movements was 14 versus 16 mm, and double contours of the aorta were measured as 8 and 9 mm, respectively. CONCLUSIONS:: A high-pitch, dual-source mode is potentially advantageous for evaluating the lung parenchyma and vascular structures in patients who have difficulty complying with breath-holding instructions. Increasing from 16 to 128 slices can significantly reduce the number and severity of motion artifacts.
    Keywords: Artifacts–Methods ; Female–Methods ; Humans–Methods ; Male–Methods ; Middle Aged–Methods ; Motion–Methods ; Radiographic Image Interpretation, Computer-Assisted–Methods ; Radiography, Thoracic–Methods ; Respiration–Methods ; Retrospective Studies–Methods ; Thorax–Methods ; Tomography, X-Ray Computed–Methods;
    ISSN: 0883-5993
    E-ISSN: 15360237
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