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The deep inspiration breath hold (DIBH) technique is effective for heart dose reduction in patients with left-sided breast cancer. In deep breathing, some women breathe in thoracic respiration; and others, in abdominal respiration. This study evaluated differences in dose reduction in organs at risk (OAR) and reproducibilities of the target and OAR between thoracic DIBH (T-DIBH) and abdominal DIBH (A-DIBH). Fourteen patients with left-sided breast cancer who had planned to receive whole-breast irradiation were included. Computed tomography (CT) was performed in free breathing (FB), T-DIBH, and A-DIBH, and the dosimetric indexes of the target and OAR for three treatment plans were compared. In T-DIBH and A-DIBH, two series CTs were taken in each breathing method and the displacements of the target and heart were calculated. The averaged mean heart doses (MHDs) were 1.5 Gy and 1.6 Gy in T-DIBH and A-DIBH, respectively, significantly lower than 2.7 Gy in FB (p

BACKGROUND: Despite advances, blood oxygen level–dependent (BOLD) cardiac MRI for myocardial perfusion is limited by inadequate spatial coverage, imaging speed, multiple breath holds, and imaging artifacts, particularly at 3.0 T. PURPOSE: To develop and validate a robust, contrast agent–unenhanced, free-breathing three-dimensional (3D) cardiac MRI approach for reliably examining changes in myocardial perfusion between rest and adenosine stress. MATERIALS AND METHODS: A heart rate–independent, free-breathing 3D T2 mapping technique at 3.0 T that can be completed within the period of adenosine stress (≤4 minutes) was developed by using computer simulations, ex vivo heart preparations, and dogs. Studies in dogs were performed with and without coronary stenosis and validated with simultaneously acquired nitrogen 13 ((13)N) ammonia PET perfusion in a clinical PET/MRI system. The MRI approach was also prospectively evaluated in healthy human volunteers (from January 2017 to September 2017). Myocardial BOLD responses (MBRs) between normal and ischemic myocardium were compared with mixed model analysis. RESULTS: Dogs (n = 10; weight range, 20–25 kg; mongrel dogs) and healthy human volunteers (n = 10; age range, 22–53 years; seven men) were evaluated. In healthy dogs, T2 MRI at adenosine stress was greater than at rest (mean rest vs stress, 38.7 msec ± 2.5 [standard deviation] vs 45.4 msec ± 3.3, respectively; MBR, 1.19 ± 0.08; both, P < .001). At the same conditions, mean rest versus stress PET perfusion was 1.1 mL/mg/min ± 0.11 versus 2.3 mL/mg/min ± 0.82, respectively (P < .001); myocardial perfusion reserve (MPR) was 2.4 ± 0.82 (P < .001). The BOLD response and PET MPR were positively correlated (R = 0.67; P < .001). In dogs with coronary stenosis, perfusion anomalies were detected on the basis of MBR (normal vs ischemic, 1.09 ± 0.05 vs 1.00 ± 0.04, respectively; P < .001) and MPR (normal vs ischemic, 2.7 ± 0.08 vs 1.7 ± 1.1, respectively; P < .001). Human volunteers showed increased myocardial T2 at stress (rest vs stress, 44.5 msec ± 2.6 vs 49.0 msec ± 5.5, respectively; P = .004; MBR, 1.1 msec ± 8.08). CONCLUSION: This three-dimensional cardiac blood oxygen level–dependent (BOLD) MRI approach overcame key limitations associated with conventional cardiac BOLD MRI by enabling whole-heart coverage within the standard duration of adenosine infusion, and increased the magnitude and reliability of BOLD contrast, which may be performed without requiring breath holds. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Almeida in this issue.

During breath holding after face immersion there develops an urge to breathe. The point that would initiate the termination of the breath hold, the “physiological breaking point,” is thought to be primarily due to changes in blood gases. However, we theorized that other factors, such as lung volume, also contributes significantly to terminating breath holds during face immersion. Accordingly, nine naïve subjects (controls) and seven underwater hockey players (divers) voluntarily initiated face immersions in room temperature water at Total Lung Capacity (TLC) and Functional Residual Capacity (FRC) after pre-breathing air, 100% O2, 15% O2 / 85% N2, or 5% CO2 / 95% O2. Heart rate (HR), arterial blood pressure (BP), end-tidal CO2 (etCO2), and breath hold durations (BHD) were monitored during all face immersions. The decrease in HR and increase in BP were not significantly different at the two lung volumes, although the increase in BP was usually greater at FRC. BHD was significantly longer at TLC (54 ± 2 s) than at FRC (30 ± 2 s). Also, with each pre-breathed gas BHD was always longer at TLC. We found no consistent etCO2 at which the breath holding terminated. BDHs were significantly longer in divers than in controls. We suggest that during breath holding with face immersion high lung volume acts directly within the brainstem to actively delay the attainment of the physiological breaking point, rather than acting indirectly as a sink to produce a slower build-up of PCO2.

This article provides a first quantitative overview of the timing and volumerelated properties of breath holds in spontaneous conversations. Firstly, we investigate breath holds based on their position within the coinciding respiratory interval amplitude. Secondly, we investigate breath holds based on their timing within the respiratory intervals and in relation to communicative activity following breath holds. We hypothesise that breath holds occur in different regions of the lung capacity range and at different times during the respiratory phase, depending on the conversational and physiological activity following breath holds. The results suggest there is not only considerable variation in both the time and lung capacity scales, but detectable differences are also present in breath holding characteristics involving laughter and speech preparation, while breath holds coinciding with swallowing are difficult to separate from the rest of the data based on temporal and volume information alone. Kokkuvõte. Kätlin Aare, Marcin Włodarczak ja Mattias Heldner: Hinge kinni hoidmine spontaanses kõnes. Artikkel kirjeldab hinge kinni hoidmist spontaansetes vestlustes ajaliste ja kopsumahuga seotud omaduste kaudu. Hinge kinni hoidmist analüüsitakse esmalt selle põhjal, kus see käimasoleva hingamisfaasi kopsumahu ulatuse suhtes asub. Teine fookus on ajalisel faktoril: kus hoitakse hinge kinni käimasoleva hingamisfaasi alguse ja lõpu ning vestlustes sisalduva kõne vm suhtes. Hüpoteeside kohaselt peaks hinge kinni hoidmine ajalisel ja kopsumahuga seotud skaalal toimuma erinevas kohas sõltuvalt sellest, milline kontekst hinge kinni hoidmist vestluses ümbritseb. Tulemused näitavad, et kuigi hinge kinni hoidmine esineb suure varieeruvusega mõlemal skaalal, sisaldab andmestik mustreid, mis eristavad kõneplaneerimisega seotud hinge kinni hoidmist teistest alternatiividest. Tulemustest selgub ka, et neelatustega seotud hinge kinni hoidmist on keeruline muudest eristada vaid aja ja kopsumahuga seotud informatsiooni abil. Märksõnad: hinge kinni hoidmine, kõnehingamine, spontaanne kõne, vestlused kolme osalejaga

Blood oxygen level dependent (BOLD) fMRI is a common technique for measuring brain activation that could be affected by low-level carbon monoxide (CO) exposure from, e.g. smoking. This study aimed to probe the vulnerability of BOLD fMRI to CO and determine whether it may constitute a significant neuroimaging confound. Low-level (6 ppm exhaled) CO effects on BOLD response were assessed in 12 healthy never-smokers on two separate experimental days (CO and air control). fMRI tasks were breath-holds (hypercapnia), visual stimulation and fingertapping. BOLD fMRI response was lower during breath holds, visual stimulation and fingertapping in the CO protocol compared to the air control protocol. Behavioural and physiological measures remained unchanged. We conclude that BOLD fMRI might be vulnerable to changes in baseline CO, and suggest exercising caution when imaging populations exposed to elevated CO levels. Further work is required to fully elucidate the impact on CO on fMRI and its underlying mechanisms.

A method based on repeated freediving was developed to rescue subjects trapped in cars underwater – a scenario leading to 5–6 annual deaths in Sweden, and thousands globally. We determined rescue time and whether the divers were at risk of hypoxic blackout. Cars containing 5 kg negatively buoyant rescue-dummies strapped with seatbelts were placed on 5 m and 8 m depth. Eight freediving-instructors made 230 freedives, working in pairs with one diver always at the surface. For each rescue, two freedivers, equipped with mask, snorkel, fins, weight-belt, wetsuit and a buoy with belt-cutter and glass-breaker freedived alternating in turns between the divers. They accomplished a maximum of one of the following tasks per dive; (1) Finding the car; (2) Marking car with buoy; (3) Opening door/crushing window. (4) Opening/cutting belt; (5) Retrieving dummy to surface; (6) Transporting dummy to shore. Dummies were retrieved to shore from 5 m depth within a mean (SD) duration of 4 min 16 s (1 min 36 s) and from 8 m within 6 min 22 s (2 min 13 s; P < 0.05). Mean dive duration was 28(7)s (14–46 s), with 3 dives over 40 s duration. Freedivers arterial oxygen saturation (SaO2) levels were measured in dives of 30, 35, 40 and 45 s using pulse oximetry. Mean (SD) SaO2 at 20 s after surfacing was 90% for 45 s dives. This allows rapid recovery and gives a safety margin to the 50% SaO2 level when divers may risk blackout. We concluded that repeated freediving is efficient for rescuing victims trapped in cars underwater within their survival time, and following recommended methods and dive durations, rescue divers are not exposed to risk.

Purpose To evaluate the effect of setup uncertainties including uncertainties between different breath holds (BH) and inter-fractional anatomical changes under CT-guided BH with intensity-modulated proton therapy (IMPT) in patients with liver cancer. Methods and materials This retrospective study considered 17 patients with liver tumors who underwent feedback-guided BH (FGBH) IMRT treatment with daily CT-on-rail imaging. Planning CT images were acquired at simulation using FGBH, and FGBH CT-on-rail images were also acquired prior to each treatment. Selective robust IMPT plans were generated using planning CT and re-calculated on each daily CT-on-rail image. Subsequently, the fractional doses were deformed and accumulated onto the planning CT according to the deformable image registration between daily and planning CTs. The doses to the target and organs at risk (OARs) were compared between IMRT, planned IMPT, and accumulated IMPT doses. Results For IMPT plans, the mean of D98% of CTV for all 17 patients was slightly reduced from the planned dose of 68.90 ± 1.61 Gy to 66.48 ± 1.67 Gy for the accumulated dose. The target coverage could be further improved by adjusting planning techniques. The dose–volume histograms of both planned and accumulated IMPT doses showed better sparing of OARs than that of the IMRT. Conclusions IMPT with FGBH and CT-on-rail guidance is a robust treatment approach for liver tumor cases.

Breath holding divers display extraordinary voluntary control over involuntary reactions during apneic episodes. After an initial easy phase to the breath hold, this voluntary control is applied against the increasing involuntary effort to inspire. We quantified an electromyographic (EMG) signal associated with respiratory movements derived from broad bandpass ECG recordings taken from experienced breath holding divers during prolonged dry breath holds. We sought to define their relationship to involuntary respiratory movements and compare these signals with what is known to occur in obstructive sleep apnea (OSA) and epileptic seizures. ECG and inductance plethysmography records from 14 competitive apneists (1 female) were analyzed. ECG records were analyzed for intervals and the EMG signal was extracted from a re‐filtered version of the original broad bandpass signal and ultimately enveloped with a Hilbert transform. EMG burst magnitude, quantified as an area measure, increased over the course of the struggle phase, correlated with inductance plethysmography measures, and corresponded to significant variance in heart rate variability. We conclude that an EMG signal extracted from the ECG can complement plethysmography during breath holds and may help quantify involuntary effort, as reported previously for obstructive sleep apnea. Further, given the resemblance between cardiac and respiratory features of the breath hold struggle phase to obstructive apnea that can occur during sleep or in association with epileptic seizure activity, the struggle phase may be a useful simulation of obstructive apnea for controlled experimentation that can help clarify aspects of acute and chronic apnea‐associated physiology., Breath holding divers display extraordinary voluntary control over involuntary reactions during apneic episodes. We show that an EMG signal extracted from the ECG can complement plethysmography as a measure of breath hold respiratory function and may help quantify involuntary effort, as reported previously for obstructive sleep apnea. Further, given the resemblance between cardiac and respiratory features of the breath hold struggle phase to obstructive apnea that can occur during sleep or in association with epileptic seizure activity, the struggle phase may be a useful simulation of obstructive apnea for controlled experimentation that can help clarify aspects of acute and chronic apnea‐associated physiology.

Background Clinical guidelines recommend the use of established T2 mapping sequences to detect and quantify myocarditis and edema, but T2 mapping is performed in two dimensions with limited coverage and repetitive breath holds. Purpose To assess the reproducibility of an accelerated free-breathing three-dimensional (3D) whole-heart T2 MRI mapping sequence in phantoms and participants without a history of cardiac disease and to investigate its clinical performance in participants with suspected myocarditis. Materials and Methods Eight participants (three women, mean age, 31 years ± 4 [standard deviation]; cohort 1) without a history of cardiac disease and 25 participants (nine women, mean age, 45 years ± 17; cohort 2) with clinically suspected myocarditis underwent accelerated free-breathing 3D whole-heart T2 mapping with 100% respiratory scanning efficiency at 1.5 T. The participants were enrolled from November 2018 to August 2020. Three repeated scans were performed on 2 separate days in cohort 1. Segmental variations in T2 relaxation times of the left ventricular myocardium were assessed, and intrasession and intersession reproducibility were measured. In cohort 2, segmental myocardial T2 values, detection of focal inflammation, and map quality were compared with those obtained from clinical breath-hold two-dimensional (2D) T2 mapping. Statistical differences were assessed using the nonparametric Mann-Whitney and Kruskal-Wallis tests, whereas the paired Wilcoxon signed-rank test was used to assess subjective scores. Results Whole-heart T2 maps were acquired in a mean time of 6 minutes 53 seconds ± 1 minute 5 seconds at 1.5 mm3 resolution. Breath-hold 2D and free-breathing 3D T2 mapping had similar intrasession (mean T2 change of 3.2% and 2.3% for 2D and 3D, respectively) and intersession (4.8% and 4.9%, respectively) reproducibility. The two T2 mapping sequences showed similar map quality (P = .23, cohort 2). Abnormal myocardial segments were identified with confidence (score 3) in 14 of 25 participants (56%) with 3D T2 mapping and only in 10 of 25 participants (40%) with 2D T2 mapping. Conclusion High-spatial-resolution three-dimensional (3D) whole-heart T2 mapping shows high intrasession and intersession reproducibility and helps provide T2 myocardial characterization in agreement with clinical two-dimensional reference, while enabling 3D assessment of focal disease with higher confidence. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Friedrich in this issue.

Objective: Breast cancer radiotherapy is increasingly delivered supine with multiple, short breath-holds. There may be heart and lung sparing advantages for locoregional breast cancer of both prone treatment and in a single breath-hold. We test here whether single prolonged breath-holds are possible in the prone, front crawl position. Methods: 19 healthy volunteers were trained to deliver supine, single prolonged breath-holds with pre-oxygenation and hypocapnia. We tested whether all could achieve the same durations in the prone, front crawl position. Results: 19 healthy volunteers achieved supine, single prolonged breath-holds for mean of 6.2 ± 0.3 min. All were able to hold safely for the same duration while prone (6.1 ± 0.2 min ns. by paired ANOVA). With prone, the increased weight on the chest did not impede chest inflation, nor the ability to hold air in the chest. Thus, the rate of chest deflation (mean anteroposterior deflation movement of three craniocaudally arranged surface markers on the spinal cord) was the same (1.2 ± 0.2, 2.0 ± 0.4 and 1.2 ± 0.4 mm/min) as found previously during supine prolonged breath-holds. No leakage of carbon dioxide or air was detectable into the facemask. Conclusion: Single prolonged (>5 min) breath-holds are equally possible in the prone, front crawl position. Advances in knowledge: Prolonged breath-holds in the front crawl position are possible and have the same durations as in the supine position. Such training would therefore be feasible for some patients with breast cancer requiring loco-regional irradiation. It would have obvious advantages for hypofractionation.

Purpose: Current cardiovascular magnetic resonance (CMR) examinations require expert planning, multiple breath holds, and 2D imaging. To address this, we sought to develop and validate a comprehensive free -breathing 3D cine function and flow CMR examination using a steady-state free precession (SSFP) sequence to depict anatomy fused with a spatially registered phase contrast (PC) sequence for blood flow analysis.Methods: In a prospective study, 25 patients underwent a CMR examination which included a 3D cine SSFP sequence and a 3D cine PC (also known as 4D flow) sequence acquired during free-breathing and after the administration of a gadolinium-based contrast agent. Both 3D sequences covered the heart and mediastinum, and used retrospective vectorcardiogram gating (20 phases/beat interpolated to 30 phases/beat) and prospective respiratory motion compensation confining data acquisition to end-expiration. Cardiovascular measurements derived from the 3D cine SSFP and PC images were then compared with those from standard 2D imaging.Results: All 3D cine SSFP and PC acquisitions were completed successfully. The mean time for the 3D cine sequences including prescription was shorter than that for the corresponding 2D sequences (21 min vs. 36 min, P-value < 0.001). Left and right ventricular end-diastolic volumes and stroke volumes by 3D cine SSFP were slightly smaller than those from 2D cine SSFP (all biases

Ten subjects were tested on a cycle ergometer to exhaustion with intensity corresponding to 150 % of their peak power output (TF150) under three conditions [C: base line measurement; PRE: after five repeated breath hold maneuvers (BH); and POST: after 5BH, preceded by two weeks of BH training]. Respiratory and blood measurements were carried out. Upon cessation of 5BH, subjects compared to C condition started TF150 with reduced arterialized blood pH (C:7.428±0.023, PRE:7.419±0.016, POST:7.398±0.021) and elevated bicarbonate concentration (mmol/l), ventilation (l/min) and oxygen uptake (ml/min) (C:28.4±1.5, PRE:29.9±1.2, POST:30.0±1.8; C:10.4±2.5, PRE:13.3±3.3, POST:15.6±5.6; C:333.0±113.8, PRE:550.1±131.1, POST:585.1±192.8, respectively). After TF150, subjects had significantly reduced pH and elevated ventilation, and oxygen uptake in PRE and POST, in comparison to the C condition. TF150 (sec) significantly improved after 5BH without being further affected by BH training (C:44.8±8.1, PRE:49.2±4.8, POST:49.3±8.2). Priming breath holds prior to middle-distance racing may improve performance.

Previous reports suggested the existence of direct somatic motor control over heart rate (fH) responses during diving in some marine mammals, as the result of a cognitive and/or learning process rather than being a reflexive response. This would be beneficial for O2storage management, but would also allow ventilation-perfusion matching for selective gas exchange, where O2and CO2can be exchanged with minimal exchange of N2. Such a mechanism explains how air breathing marine vertebrates avoid diving related gas bubble formation during repeated dives, and how stress could interrupt this mechanism and cause excessive N2exchange. To investigate the conditioned response, we measured thefH-response before and during static breath-holds in three bottlenose dolphins (Tursiops truncatus) when shown a visual symbol to perform either a long (LONG) or short (SHORT) breath-hold, or during a spontaneous breath-hold without a symbol (NS). The averagefH(ifHstart), and the rate of change infH(difH/dt) during the first 20 s of the breath-hold differed between breath-hold types. In addition, the minimum instantaneousfH(ifHmin), and the average instantaneousfHduring the last 10 s (ifHend) also differed between breath-hold types. The difH/dt was greater, and the ifHstart, ifHmin, and ifHendwere lower during a LONG as compared with either a SHORT, or an NS breath-hold (P< 0.05). Even though the NS breath-hold dives were longer in duration as compared with SHORT breath-hold dives, the difH/dt was greater and the ifHstart, ifHmin, and ifHendwere lower during the latter (P< 0.05). In addition, when the dolphin determined the breath-hold duration (NS), thefHwas more variable within and between individuals and trials, suggesting a conditioned capacity to adjust thefH-response. These results suggest that dolphins have the capacity to selectively alter thefH-response during diving and provide evidence for significant cardiovascular plasticity in dolphins.

Background Respiratory motion management with breath hold for patients with hepatobiliary cancers remain a challenge in the precise positioning for radiotherapy. We compared different image-guided alignment markers for estimating positional errors, and investigated the factors associated with positional errors under breath-hold control. Methods Spirometric motion management system (SDX) for breath holds was used in 44 patients with hepatobiliary tumor. Among them, 28 patients had a stent or embolized materials (lipiodol) as alignment markers. Cone-beam computed tomography (CBCT) and kV-orthogonal images were compared for accuracy between different alignment references. Breath-hold level (BHL) was practiced, and BHL variation (ΔBHL) was defined as the standard deviation in differences between actual BHLs and baseline BHL. Mean BHL, ΔBHL, and body-related factors were analyzed for the association with positional errors. Results Using the reference CBCT, the correlations of positional errors were significantly higher in those with stent/lipiodol than when the vertebral bone was used for alignment in three dimensions. Patients with mean BHL > 1.4 L were significantly taller (167.6 cm vs. 161.6 cm, p = 0.03) and heavier (67.1 kg vs. 57.4 kg, p = 0.02), and had different positional error in the craniocaudal direction (− 0.26 cm [caudally] vs. + 0.09 cm [cranially], p = 0.01) than those with mean BHL 0.03 L. Conclusion Under rigorous breath-hold respiratory control, BHL correlated with body weight and height. With more accurate alignment reference by stent/lipiodol, actual BHL but not breath-hold variation was associated with craniocaudal positional errors.

Breathing in conversation (VR 2014-1072) Hidden events in turn-taking (MAW 2017.0034)

T1ρ relaxation imaging is a quantitative imaging technique that has been used to assess cartilage integrity, liver fibrosis, tumors, cardiac infarction, and Alzheimer's disease. T1 , T2 , and T1ρ relaxation time constants have each demonstrated different degrees of sensitivity to several markers of fibrosis and inflammation, allowing for a potential multi-parametric approach to tissue quantification. Traditional magnetic resonance fingerprinting (MRF) has been shown to provide quick, quantitative mapping of T1 and T2 relaxation time constants. In this study, T1ρ relaxation is added to the MRF framework using spin lock preparations. An MRF sequence involving an RF-spoiled sequence with TR , flip angle, T1ρ , and T2 preparation variation is described. The sequence is then calibrated against conventional T1 , T2 , and T1ρ relaxation mapping techniques in agar phantoms and the abdomens of four healthy volunteers. Strong intraclass correlation coefficients (ICC > 0.9) were found between conventional and MRF sequences in phantoms and also in healthy volunteers (ICC > 0.8). The highest ICC correlation values were seen in T1 , followed by T1ρ and then T2 . In this study, T1ρ relaxation has been incorporated into the MRF framework by using spin lock preparations, while still fitting for T1 and T2 relaxation time constants. The acquisition of these parameters within a single breath hold in the abdomen alleviates the issues of movement between breath holds in conventional techniques.

PURPOSE To demonstrate the feasibility of compressed sensing (CS) to accelerate the acquisition of hyperpolarized (HP) 129 Xe multi-b diffusion MRI for quantitative assessments of lung microstructural morphometry. METHODS Six healthy subjects and six chronic obstructive pulmonary disease (COPD) subjects underwent HP 129 Xe multi-b diffusion MRI (b = 0, 10, 20, 30, and 40 s/cm2 ). First, a fully sampled (FS) acquisition of HP 129 Xe multi-b diffusion MRI was conducted in one healthy subject. The acquired FS dataset was retrospectively undersampled in the phase encoding direction, and an optimal twofold undersampled pattern was then obtained by minimizing mean absolute error (MAE) between retrospective CS (rCS) and FS MR images. Next, the FS and CS acquisitions during separate breath holds were performed on five healthy subjects (including the above one). Additionally, the FS and CS synchronous acquisitions during a single breath hold were performed on the sixth healthy subject and one COPD subject. However, only CS acquisitions were conducted in the rest of the five COPD subjects. Finally, all the acquired FS, rCS and CS MR images were used to obtain morphometric parameters, including acinar duct radius (R), acinar lumen radius (r), alveolar sleeve depth (h), mean linear intercept (Lm ), and surface-to-volume ratio (SVR). The Wilcoxon signed-rank test and the Bland-Altman plot were employed to assess the fidelity of the CS reconstruction. Moreover, the t-test was used to demonstrate the effectiveness of the multi-b diffusion MRI with CS in clinical applications. RESULTS The retrospective results demonstrated that there was no statistically significant difference between rCS and FS measurements using the Wilcoxon signed-rank test (P > 0.05). Good agreement between measurements obtained with the CS and FS acquisitions during separate breath holds was demonstrated in Bland-Altman plots of slice differences. Specifically, the mean biases of the R, r, h, Lm , and SVR between the CS and FS acquisitions were 1.0%, 2.6%, -0.03%, 1.5%, and -5.5%, respectively. Good agreement between measurements with the CS and FS acquisitions was also observed during the single breath-hold experiments. Furthermore, there were significant differences between the morphometric parameters for the healthy and COPD subjects (P

PURPOSE/OBJECTIVE(S) Motion management is crucial to safe and efficacious treatment for abdominal stereotactic body radiotherapy (SBRT). Expiratory breath hold (EBH) treatment is attractive as it does not require sophisticated gating technologies and minimizes abdominal target motion compared to inspiratory breath hold and abdominal compression; however, few patients can perform prolonged EBH to allow efficient treatment. We hypothesized that providing patients supplemental oxygen and controlling respiratory rate (RR) at the upper limit of normal would improve EBH times, increase the percentage of patients eligible for EBH treatment and decrease EBH treatment time. MATERIALS/METHODS Starting in 2020, we provided patients supplemental oxygen (50% O2 via Venturi mask) with synchronization to a RR of 18 breaths/min with a metronome at the time of CT simulation. Patients were eligible for EBH treatment if they were able to complete two consecutive 20 second EBH. Eligible patients were treated per standard institutional guidelines for abdominal SBRT with EBH. We retrospectively identified all completed EBH treatments with this new supplemented procedure (EBHsupp) from our departmental database. Historical controls treated with EBH prior to this new procedure (EBHRA, where RA = room air) were identified and matched 1:1 based on patient age, sex, RT prescription, number of treatment arcs, and comorbidities via individual matching. Individual patient EBH times, total treatment time, cone beam CT (CBCT) time, and treatment arc time were extracted from the treatment planning software. Statistical comparisons were made with chi-squared test for categorical variables and student's t-test for continuous variables. RESULTS We identified 8 patients that received 10 abdominal SBRT treatment plans with EBHsupp (two patients had two lesions requiring two separate treatment plans). There was no statistical difference between the EBHsupp and EBHRA groups with respect to patient characteristics. Eight of 11 (73%) screened EBHsupp patients were able to undergo EBH treatment compared to historical department standard of ∼30% with EBHRA. The EBHsupp group had a significant improvement in maximum (50.5 vs 30.9 s, P = 0.002) and median (24.0 vs 17.8 s, P = 0.016) EBH times compared to the EBHRA group and required less breath holds to complete their treatment (9.1 vs 13.9, P = 0.029). Time for CBCT was reduced with EBHsupp (6.5 vs 8.6 min, P = 0.004) and there was a trend towards decreased time for treatment arc completion (3.1 vs 4.0 min, P = 0,10) and overall treatment time (18.6 vs 21.7 min, P = 0.12). CONCLUSION Providing supplemental oxygen and controlling respiratory rate at 18 breaths/min significantly improves EBH time. This intervention is simple, inexpensive, safe, and may allow more patients to be treated with EBH while decreasing overall treatment time. AUTHOR DISCLOSURE C.S. Schneider: None. S. Shen: None. J.B.Fiveash: None. R. Jacob: None.

Purpose To assess the clinical feasibility of self-gated non-contrast-enhanced functional lung (SENCEFUL) magnetic resonance (MR) imaging for quantitative ventilation (QV) imaging in patients with cystic fibrosis (CF). Materials and Methods Twenty patients with CF and 20 matched healthy volunteers underwent functional 1.5-T lung MR imaging with the SENCEFUL imaging approach, in which a two-dimensional fast low-angle shot sequence is used with quasi-random sampling. The lungs were manually segmented on the ventilation-weighted images to obtain QV measurements, which were compared between groups. QV values of the patients were correlated with results of pulmonary function testing. Three radiologists rated the images for presence of ventilation deficits by means of visual inspection. Mann-Whitney U tests, receiver operating characteristic analyses, Spearman correlations, and Gwet agreement coefficient analyses were used for statistical analysis. Results QV of the entire lungs was lower for patients with CF than for control subjects (mean ± standard deviation, 0.09 mL/mL ± 0.03 vs 0.11 mL/mL ± 0.03, respectively; P = .007). QV ratios of upper to lower lung halves were lower in patients with CF than in control subjects (right, 0.84 ± 0.2 vs 1.16 ± 0.2, respectively [P.001]; left, 0.88 ± 0.3 vs 1.11 ± 0.1, respectively [P = .017]). Accordingly, ventilation differences between the groups were larger in the upper halves (Δ = 0.04 mL/mL, P ≤ .001-.002). QV values of patients with CF correlated with forced vital capacity (r = 0.7; 95% confidence interval [CI]: 0.21, 0.91), residual volume (static hyperinflation, r = -0.8; 95% CI: -0.94, 0.42), and forced expiratory volume in 1 second (airway obstruction, r = 0.7; 95% CI: 0.21, 0.91). Disseminated small ventilation deficits were the most frequent involvement pattern, present in 40% of the functional maps in CF versus 8% in the control subjects (P.001). Conclusion SENCEFUL MR imaging is feasible for QV assessment. Less QV, especially in upper lung parts, and correlation to vital capacity and to markers for hyperinflation and airway obstruction were found in patients with CF.

We hypothesized that dynamic perfluorinated gas MRI would sensitively detect mild cystic fibrosis (CF) lung disease. This cross-sectional study enrolled 20 healthy volunteers and 24 stable subjects with CF, including a subgroup of subjects with normal forced expiratory volume in the first second (FEV(1); >80% predicted, n = 9). Dynamic fluorine-19–enhanced MRI ((19)F MRI) were acquired during sequential breath holds while breathing perfluoropropane (PFP) and during gas wash-out. Outcomes included the fraction of lung without significant ventilation (ventilation defect percent, VDP) and time constants that described PFP wash-in and wash-out kinetics. VDP values (mean ± SD) of healthy controls (3.87% ± 2.7%) were statistically different from moderate CF subjects (19.5% ± 15.5%, P = 0.001) but not from mild CF subjects (10.4% ± 9.9%, P = 0.24). In contrast, the fractional lung volume with slow gas wash-out was elevated both in subjects with mild (9.61% ± 4.87%; P = 0.0066) and moderate CF (16.01% ± 5.01%; P = 0.0002) when compared with healthy controls (3.84% ± 2.16%) and distinguished mild from moderate CF (P = 0.006). (19)F MRI detected significant ventilation abnormalities in subjects with CF. The ability of gas wash-out kinetics to distinguish between healthy and mild CF lung disease subjects makes (19)F MRI a potentially valuable method for the characterization of early lung disease in CF. This study has been registered at ClinicalTrials.gov (NCT03489590).

We performed a dosimetric study to evaluate the benefits of using a flattening-filter-free (FFF) beam with the deep inspiration breath-hold (DIBH) method for left-breast cancer. We used data from 30 previous patients with treatment plans that included DIBH for left-breast cancer with a flattened beam. FFF beam plans were calculated from previous treatment plan images and compared to the original plans in terms of monitor units (MU), number of segments, beam-on time, and breath-holds. Beam-on time was calculated by adding the traveling time of 1.5 second between segments to the time calculated from the MU and dose rate. Breath-holds were calculated based on the beam-on time, assuming 15 s per hold. The FFF beam had increased MU in all cases (mean ± SD: flattened beam, 122.4 ± 9.8 MU; FFF beam, 160.2 ± 17.5 MU). Furthermore, the number of segments increased with the FFF beam in all cases (median [range]: flattened beam, 2 [1 to 3]; FFF beam, 5 [3 to 7]). However, in most cases, the beam-on time was reduced using the FFF beam (mean ± SD: flattened beam, 27.8 ± 7.4 seconds; FFF beam, 13.2 ± 1.7 seconds), although when a 6 MV flattened beam was used there was not a large increase. There were fewer breath-holds in most cases with the FFF beam. Cases using a 4 MV flattened beam also had fewer breath-holds; however, the number of breath-holds was consistent or increased in cases that used a 6 MV flattened beam (median [range]: flattened beam, 3 [1 to 3]; FFF beam, 1 [1 to 2]).

Accurate segmentation of heart structures imaged by cardiac MR is key for the quantitative analysis of pathology. High-resolution 3D MR sequences enable whole-heart structural imaging but are time-consuming, expensive to acquire and they often require long breath holds that are not suitable for patients. Consequently, multiplanar breath-hold 2D cine sequences are standard practice but are disadvantaged by lack of whole-heart coverage and low through-plane resolution. To address this, we propose a conditional variational autoencoder architecture able to learn a generative model of 3D high-resolution left ventricular (LV) segmentations which is conditioned on three 2D LV segmentations of one short-axis and two long-axis images. By only employing these three 2D segmentations, our model can efficiently reconstruct the 3D high-resolution LV segmentation of a subject. When evaluated on 400 unseen healthy volunteers, our model yielded an average Dice score of $87.92 \pm 0.15$ and outperformed competing architectures., Comment: Accepted in IEEE International Symposium on Biomedical Imaging (ISBI 2019)

The purpose of this study was to compare respiratory motion artifact and diagnostic image quality between end-inspiration and end-expiration breath-holding techniques on unenhanced and contrast-enhanced axial T1-weighted MRI of the liver.This retrospective observational study included 50 consecutive subjects undergoing axial T1-weighted liver MRI, with unenhanced images acquired with both end-inspiration and end-expiration breath-holding techniques, and with contrast-enhanced images acquired for 47 of the subjects with either the end-inspiration or the end-expiration breath-holding technique. Three radiologists performed blinded independent evaluations of each unenhanced sequence, contrast-enhanced sequence, and subtraction (contrast-enhanced minus unenhanced) image, using a scale ranging from 1 point (denoting nondiagnostic imaging) to 5 points (denoting no artifacts). Blinded side-by-side assessment of each pair of unenhanced sequences was also performed. Two-tailed Wilcoxon signed rank and Wilcoxon rank sum tests were used to assess statistical significance.A significant improvement in motion scores was noted for sequences acquired in end-expiration, compared with those acquired in end-inspiration, for unenhanced sequences (mean, 3.35 vs 2.80; p0.00001), contrast-enhanced sequences (mean, 4.02 vs 3.46; p = 0.0003), and subtraction images (mean, 3.67 vs 2.41; p0.00001). Severe degradation of image quality or nondiagnostic image quality was noted for 15% of unenhanced images (23/150), 0% of contrast-enhanced images, and 8% (5/63) of subtraction images acquired on end-expiration, whereas it was noted for 36% (54/150) of unenhanced images, 13% (10/78) of contrast-enhanced images, and 59% (46/78) of subtraction images acquired on end-inspiration. When side-by-side assessment of paired unenhanced sequences was performed, images acquired in end-expiration were significantly favored in 59% of paired sequences (88/150) (p0.00001), and no difference between images acquired with both breath-hold techniques was noted for 21% (32/150) of paired sequences.The end-expiration breath-holding technique leads to significant decreases in respiratory motion artifacts, compared with the end-inspiration technique, on unenhanced and contrast-enhanced T1-weighted liver MRI.

Purpose Contrary to what is commonly assumed, organs continue to move during breath-holding. We investigated the influence of lung volume on motion magnitude during breath-holding and changes in velocity over the duration of breath-holding. Materials and methods Sixteen healthy subjects performed 60-second inhalation breath-holds in room-air, with lung volumes of ∼100% and ∼70% of the inspiratory capacity, and exhalation breath-holds, with lung volumes of ∼30% and ∼0% of the inspiratory capacity. During breath-holding, we obtained dynamic single-slice magnetic-resonance images with a time-resolution of 0.6s. We used 2-dimensional image correlation to obtain the diaphragmatic and pancreatic velocity and displacement during breath-holding. Results Organ velocity was largest in the inferior–superior direction and was greatest during the first 10s of breath-holding, with diaphragm velocities of 0.41mm/s, 0.29mm/s, 0.16mm/s and 0.15mm/s during BH 100% , BH 70% , BH 30% and BH 0% , respectively. Organ motion magnitudes were larger during inhalation breath-holds (diaphragm moved 9.8 and 9.0mm during BH 100% and BH 70% , respectively) than during exhalation breath-holds (5.6 and 4.3mm during BH 30% and BH 0% , respectively). Conclusion Using exhalation breath-holds rather than inhalation breath-holds and delaying irradiation until after the first 10s of breath-holding may be advantageous for irradiation of abdominal tumors.

PURPOSE To present an image registration method for renal blood oxygen level-dependent (BOLD) measurements that enables semiautomatic assessment of parenchymal and medullary R2* changes under a functional challenge. METHODS In a series of breath-hold acquisitions, three-dimensional data were acquired initially for prospective image registration of subsequent BOLD measurements. An algorithm for kidney alignment for BOLD renal imaging (KALIBRI) was implemented to detect the positions of the left and right kidney so that the kidneys were acquired in the subsequent BOLD measurement at consistent anatomical locations. Residual in-plane distortions were corrected retrospectively so that semiautomatic dynamic R2* measurements of the renal cortex and medulla become feasible. KALIBRI was tested in six healthy volunteers during a series of BOLD experiments, which included a 600- to 1000-mL water challenge. RESULTS Prospective image registration and BOLD imaging of each kidney was achieved within a total measurement time of about 17 s, enabling its execution within a single breath-hold. KALIBRI improved the registration by up to 35% as found with mutual information measures. In four volunteers, a medullary R2* decrease of up to 40% was observed after water ingestion. CONCLUSION KALIBRI improves the quality of two-dimensional time-resolved renal BOLD MRI by aligning local renal anatomy, which allows for consistent R2* measurements over many breath-holds. Magn Reson Med 77:1573-1582, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

We address the problem of cardiovascular shape representation from misaligned Cardiovascular Magnetic Resonance (CMR) images. An accurate 3D representation of the heart geometry allows for robust metrics to be calculated for multiple applications, from shape analysis in populations to precise description and quantification of individual anatomies including pathology. Clinical CMR relies on the acquisition of heart images at different breath holds potentially resulting in a misaligned stack of slices. Traditional methods for 3D reconstruction of the heart geometry typically rely on alignment, segmentation and reconstruction independently. We propose a novel method that integrates simultaneous alignment and segmentation refinements to realign slices producing a spatially consistent arrangement of the slices together with their segmentations fitted to the image data.

We measured respiratory flow ( V ), breathing frequency ( f R ), tidal volume ( V T ), breath duration and end-expired O 2 content in bottlenose dolphins ( Tursiops truncatus ) before and after static surface breath-holds ranging from 34 to 292 s. There was considerable variation in the end-expired O 2 , V T and f R following a breath-hold. The analysis suggests that the dolphins attempt to minimize recovery following a dive by altering V T and f R to rapidly replenish the O 2 stores. For the first breath following a surface breath-hold, the end-expired O 2 decreased with dive duration, while V T and f R increased. Throughout the recovery period, end-expired O 2 increased while the respiratory effort ( V T , f R ) decreased. We propose that the dolphins alter respiratory effort following a breath-hold according to the reduction in end-expired O 2 levels, allowing almost complete recovery after 1.2 min.

The case presented here highlights the feasibility of using an extraglottic airway device as a conduit for delivering high levels of lifesaving positive end expiratory pressure (PEEP), as well as other means of combating recalcitrant hypoxia. The case also highlights the merit of an approach to the hypoxic patient with an in-situ extraglottic airway device based not only on deciding if the device is functioning to maintain a patent airway, but also, simultaneously considering the patient's physiology. A 71 year old male suffered an out-of-hospital cardiac arrest. Part of his resuscitation included placement of a dual-balloon extraglottic airway device by EMS. He was hypoxic, but the device seemed to be providing for a patent airway without an air leak. There was also a favorable end-tidal carbon dioxide waveform. The flight team chose to the leave the device in place. PEEP was up-titrated to 17 cmH20 without issue. Sigh breaths, as well as breath holds, were also able to be delivered. The patient's hypoxia improved over the course of the patient's transport, and he ultimately did well.

Quantitative cardiovascular magnetic resonance (CMR) imaging can be used to characterize fibrosis, oedema, ischaemia, inflammation and other disease conditions. However, the need to reduce artefacts arising from body motion through a combination of electrocardiography (ECG) control, respiration control, and contrast-weighting selection makes CMR exams lengthy. Here, we show that physiological motions and other dynamic processes can be conceptualized as multiple time dimensions that can be resolved via low-rank tensor imaging, allowing for motion-resolved quantitative imaging with up to four time dimensions. This continuous-acquisition approach, which we name cardiovascular MR multitasking, captures - rather than avoids - motion, relaxation and other dynamics to efficiently perform quantitative CMR without the use of ECG triggering or breath holds. We demonstrate that CMR multitasking allows for T1 mapping, T1-T2 mapping and time-resolved T1 mapping of myocardial perfusion without ECG information and/or in free-breathing conditions. CMR multitasking may provide a foundation for the development of setup-free CMR imaging for the quantitative evaluation of cardiovascular health.

To determine the limits of agreement of hepatic fat fraction and R2* relaxation rate quantified with accelerated magnetic resonance (MR) imaging reconstructed with combined compressed sensing and parallel imaging compared with conventional fully sampled acquisitions.Eleven subjects with type 2 diabetes and a healthy control subject were recruited with the approval of the Newcastle and North Tyneside 2 ethics committee and written consent. Undersampled data at ratios of 2.6×, 2.9×, 3.8×, and 4.8× were prospectively acquired in addition to fully sampled data by using five gradient echoes per repetition time at 3.0 T. Fat fraction maps were calculated by using combined compressed sensing and parallel imaging (CS-PI) reconstruction and Bland-Altman analysis performed to assess bias and 95% limits of agreement. Inter- and intrarater analysis was performed for quantitative fat fraction and R2* relaxation rate, and image quality was assessed with a four-point scale by two independent observers.The fat fractions from the accelerated acquisitions had 95% limits of agreement of 1.2%, 1.2%, 1.1%, and 1.5%, respectively, with no bias. When compared with the intra- and interrater 95% limits of agreement (0.7% and 0.8%), acceleration of up to 3.8× did not greatly degrade the fat fraction measurements. No or minimal artifact was detected at 2.6× and 2.9× accelerations, moderate artifact was detected at 3.8× acceleration, and substantial artifact was detected at 4.8× acceleration.Prospective undersampling and CS-PI reconstruction of liver fat fractions can be used to accelerate liver fat fraction measurements. The fat fractions and image quality produced were acceptable up to a factor of 3.8×, thereby shortening the required breath-hold duration from 17.7 seconds to 4.7 seconds.

Understanding the structure of the heart at the microscopic scale of cardiomyocytes and their aggregates provides new insights into the mechanisms of heart disease and enables the investigation of effective therapeutics. Diffusion Tensor Cardiac Magnetic Resonance (DT-CMR) is a unique non-invasive technique that can resolve the microscopic structure, organisation, and integrity of the myocardium without the need for exogenous contrast agents. However, this technique suffers from relatively low signal-to-noise ratio (SNR) and frequent signal loss due to respiratory and cardiac motion. Current DT-CMR techniques rely on acquiring and averaging multiple signal acquisitions to improve the SNR. Moreover, in order to mitigate the influence of respiratory movement, patients are required to perform many breath holds which results in prolonged acquisition durations (e.g., \(\sim \)30 min using the existing technology). In this study, we propose a novel cascaded Convolutional Neural Networks (CNN) based compressive sensing (CS) technique and explore its applicability to improve DT-CMR acquisitions. Our simulation based studies have achieved high reconstruction fidelity and good agreement between DT-CMR parameters obtained with the proposed reconstruction and fully sampled ground truth. When compared to other state-of-the-art methods, our proposed deep cascaded CNN method and its stochastic variation demonstrated significant improvements. To the best of our knowledge, this is the first study using deep CNN based CS for the DT-CMR reconstruction. In addition, with relatively straightforward modifications to the acquisition scheme, our method can easily be translated into a method for online, at-the-scanner reconstruction enabling the deployment of accelerated DT-CMR in various clinical applications.

Background and purpose To report preliminary results of passive breath gating (PBG) equipment for cone-beam CT image-guided gated RapidArc gastric cancer treatments. Material and methods Home-developed PBG equipment integrated with the real-time position management system (RPM) for passive patient breath hold was used in CT simulation, online partial breath hold (PBH) CBCT acquisition, and breath-hold gating (BHG) RapidArc delivery. The treatment was discontinuously delivered with beam on during BH and beam off for free breathing (FB). Pretreatment verification PBH CBCT was obtained with the PBG-RPM system. Additionally, the reproducibility of the gating accuracy was evaluated. Results A total of 375 fractions of breath-hold gating RapidArc treatments were successfully delivered and 233 PBH CBCTs were available for analysis. The PBH CBCT images were acquired with 2–3 breath holds and 1–2 FB breaks. The imaging time was the same for PBH CBCT and conventional FB CBCT (60 s). Compared to FB CBCT, the motion artifacts seen in PBH CBCT images were remarkably reduced. The average BHG RapidArc delivery time was 103 s for one 270-degree arc and 269 s for two full arcs. Conclusions The PBG-RPM based PBH CBCT verification and BHG RapidArc delivery was successfully implemented clinically. The BHG RapidArc treatment was accomplished using a conventional RapidArc machine with high delivery efficiency.

Author(s): Lamb, James M; Ginn, John S; O'Connell, Dylan P; Agazaryan, Nzhde; Cao, Minsong; Thomas, David H; Yang, Yingli; Lazea, Mircea; Lee, Percy; Low, Daniel A | Abstract: PurposeMagnetic resonance image (MRI) guided radiotherapy enables gating directly on the target position. We present an evaluation of an MRI-guided radiotherapy system's gating performance using an MRI-compatible respiratory motion phantom and radiochromic film. Our evaluation is geared toward validation of our institution's clinical gating protocol which involves planning to a target volume formed by expanding 5 mm about the gross tumor volume (GTV) and gating based on a 3 mm window about the GTV.MethodsThe motion phantom consisted of a target rod containing high-contrast target inserts which moved in the superior-inferior direction inside a body structure containing background contrast material. The target rod was equipped with a radiochromic film insert. Treatment plans were generated for a 3 cm diameter spherical planning target volume, and delivered to the phantom at rest and in motion with and without gating. Both sinusoidal trajectories and tumor trajectories measured during MRI-guided treatments were used. Similarity of the gated dose distribution to the planned, motion-frozen, distribution was quantified using the gamma technique.ResultsWithout gating, gamma pass rates using 4%/3 mm criteria were 22-59% depending on motion trajectory. Using our clinical standard of repeated breath holds and a gating window of 3 mm with 10% target allowed outside the gating boundary, the gamma pass rate was 97.8% with 3%/3 mm gamma criteria. Using a 3 mm window and 10% allowed excursion, all of the patient tumor motion trajectories at actual speed resulting in at least 95% gamma pass rate at 4%/3 mm.ConclusionsOur results suggest that the device can be used to compensate respiratory motion using a 3 mm gating margin and 10% allowed excursion results in conjunction with repeated breath holds. Full clinical validation requires a comprehensive evaluation of tracking performance in actual patient images, outside the scope of this study.

The potential for transforming nutritional and health research through the discovery and application of non-invasive markers of dietary intake and metabolic status is profound. The science of metabolomics for the fingerprinting of volatile organic compounds (VOCs) from expired human breath holds great promise in this regard. Coupled with tools utilising sensor technology, breath volatile signatures allow a new horizon of research in which indicators of metabolic risk and indicators of dietary intake could be collected at a population level with unprecedented simplicity and low cost. Metabolomics (measuring metabolites from physiological process) provides a “window into the body”, which could transform how we measure health, how we identify and monitor people most at risk of disease and the way we monitor food intake. [...]

Purpose: Motion must be accounted for with focal treatments such as liver directed stereotactic body radiotherapy otherwise there is a risk of marginal miss and/or increased toxicity to surrounding structure. There have been many proposed methods for motion management including respiratory gating, inhibition and tracking. The purpose of this study is to evaluate a pressure-based respiratory motion management system with biofeedback to the patient for MR-guided radiotherapy treatments. Methods: A respiratory motion management belt was modified in house to provide visual biofeedback of subject respiratory trace using pressure readings from an air bladder. Three groups participated in the study: Group I included two investigators who were imaged twice, with imaging sessions separated by one week, while wearing the motion management belt. Group II included four healthy volunteers, imaged using the belt for CINE and anatomical imaging. Group III included two cancer patients with liver lesions imaged while wearing the device, imaged pre-radiotherapy treatment, and post-treatment. During image acquisition, a display showed participants their respiratory traces and guidelines to indicate the desired respiratory amplitude. Results: The average peak-to-peak motion of the liver dome was decreased from 30.55 ± 7.83 mm to 5.58 ± 0.85 mm for free-breathing and utilizing a small window guiding box with visual guidance CINE image sets respectively in the investigator study. Volunteers and cancer patients were able to consistently manage their breath traces, including sequential breath holds, over the course of 30–60 min imaging sessions. Conclusions: The proposed motion management belt with visual biofeedback design is able to provide greatly reduced respiratory motion of the liver, and repeatable breath hold in MR simulation. The components used in the device also allow it to be in place during all steps of the radiotherapy planning process, including MR anatomical imaging, CT simulation, and treatment delivery due to the absence of high z or metallic material.

Investigations on breath analysis have provided preliminary data on its potential in the noninvasive diagnosis of lung diseases. Although the conventional comparisons of exhaled breath in study populations (ie, diseased vs healthy) may help to identify patients with various lung diseases, we believe that the analysis of exhaled breath holds promise beyond this scenario. On the basis of preliminary findings, we hypothesize that breath analysis (1) could be applied not only to identify patients with lung disease but also to better phenotype healthy subjects at risk and patients with a particular disease, which is in-line with current efforts toward individualized medicine; (2) could be useful in estimating internal body time to determine the optimal time of drug administration, thereby maximizing drug activity and reducing toxicity (chronopharmacology); and (3) could be applied to monitor drugs or drug metabolites, thus, enhancing adherence to prescribed medications and enabling studies on pharmacokinetics.

A modified Look–Locker acquisition using saturation recovery (MLLSR) for breath-held myocardial T1 mapping is presented. Despite its reduced dynamic range, saturation recovery enables substantially higher imaging efficiency than conventional inversion recovery T1 mapping because it does not require time for magnetization to relax to equilibrium. Therefore, MLLSR enables segmented readouts, shorter data acquisition windows, and shorter breath holds compared with inversion recovery. T1 measurements in phantoms using MLLSR showed a high correlation with conventional single-point inversion recovery spin echo. In vivo T1 measurements from normal and infarcted myocardium in 41 volunteers and patients were consistent with previously reported values. Twenty subjects were also scanned with MLLSR using an accelerated sampling scheme that required half the scan time (eight vs. 16 heartbeats) but yielded equivalent results. The flexibility afforded by the improved imaging efficiency of MLLSR allows the acquisition to be tailored to particular clinical needs and to individual patient's breath-holding abilities. Magn Reson Med, 2012. © 2011 Wiley Periodicals, Inc.

The development of hybrid medical imaging scanners has allowed imaging with different detection modalities at the same time, providing different anatomical and functional information within the same physiological time course with the patient in the same position. Until now, the acquisition of proton MRI of lung anatomy and hyperpolarised gas MRI of lung function required separate breath-hold examinations, meaning that the images were not spatially registered or temporally synchronised. We demonstrate the spatially registered concurrent acquisition of lung images from two different nuclei in vivo. The temporal and spatial registration of these images is demonstrated by a high degree of mutual consistency that is impossible to achieve in separate scans and breath holds. Copyright © 2010 John Wiley & Sons, Ltd.

Laryngeal closure following hypoxic gasps has been documented, but its efficacy in improving autoresuscitation capacity is unknown. We studied SWR/J mice who normally cannot autoresuscitate and the C57/BLJ strain who can. We evaluated the effects of elevated end-inspiratory lung volume immediately following a gasp. We compared upper airway-intact mice with tracheostomized mice in which the vocal cords are bypassed. We used the techniques of repeated autoresuscitate trials to test autoresuscitation capability. Both SWR/J and C57/BLJ mice could maintain elevated lung volume immediately after a gasp (breath holding). Such breath holding increased autoresuscitation ability in C57/BLJ mice but did not in SWR/J mice. In SWR/J mice, the duration of the breath holds was less than that in the C57/BLJ mice. These findings indicate that gasp-associated breath holding improves autoresuscitation capability during repeated autoresuscitation trials. Also, they show that SWR/J mice have a deficiency in central nervous system mechanisms regulating glottic closure during hypoxic gasping.

This paper describes an algorithm for extracting pulmonary vascular trees (arteries plus veins) from three-dimensional (3D) thoracic computed tomographic (CT) images. The algorithm integrates tube enhancement filter and traversal approaches which are based on eigenvalues and eigenvectors of a Hessian matrix to extract thin peripheral segments as well as thick vessels close to the lung hilum. The resultant algorithm was applied to a simulation data set and 44 scans from 22 human subjects imaged via multidetector-row CT (MDCT) during breath holds at 85% and 20% of their vital capacity. A quantitative validation was performed with more than 1000 manually identified points selected from inside the vessel segments to assess true positives (TPs) and 1000 points randomly placed outside of the vessels to evaluate false positives (FPs) in each case. On average, for both the high and low volume lung images, 99% of the points was properly marked as vessel and 1% of the points were assessed as FPs. Our hybrid segmentation algorithm provides a highly reliable method of segmenting the combined pulmonary venous and arterial trees which in turn will serve as a critical starting point for further quantitative analysis tasks and aid in our overall goal of establishing a normative atlas of the human lung.