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Phonocardiogram (PCG) signals generated by the heart contain information about heart conditions. This review examines how PCG analysis identifies and diagnoses heart issues. We studied traditional signal processing and artificial intelligence techniques and provided a complete picture of the current state of this field. Adhering to the systematic review guidelines, our comprehensive review covers 103 studies from reputed journals. It includes Machine Learning (ML) and Deep Learning (DL) techniques used to develop the computer-aided diagnostic tools using PCG signals. This review evaluates the strengths and weaknesses of various ML and DL methods, emphasizing their effectiveness in diagnosing several abnormalities. Additionally, we examine the obstacles and challenges limiting the widespread adoption of PCG-based diagnostic systems in clinical settings. We outline a plan for future research to develop improved versions of PCG analysis models. These models will be more robust, precise, and user-friendly. They will improve cardiovascular care by enabling machines to screen for problems automatically and intelligently.

Background: Chest computed tomography (CT) has a high sensitivity for detecting COVID-19 lung involvement and is widely used for diagnosis and disease monitoring. We proposed a new image classification model, swin-textural, that combined swin-based patch division with textual feature extraction for automated diagnosis of COVID-19 on chest CT images. The main objective of this work is to evaluate the performance of the swin architecture in feature engineering. Material and method: We used a public dataset comprising 2167, 1247, and 757 (total 4171) transverse chest CT images belonging to 80, 80, and 50 (total 210) subjects with COVID-19, other non-COVID lung conditions, and normal lung findings. In our model, resized 420 × 420 input images were divided using uniform square patches of incremental dimensions, which yielded ten feature extraction layers. At each layer, local binary pattern and local phase quantization operations extracted textural features from individual patches as well as the undivided input image. Iterative neighborhood component analysis was used to select the most informative set of features to form ten selected feature vectors and also used to select the 11th vector from among the top selected feature vectors with accuracy >97.5%. The downstream kNN classifier calculated 11 prediction vectors. From these, iterative hard majority voting generated another nine voted prediction vectors. Finally, the best result among the twenty was determined using a greedy algorithm. Results: Swin-textural attained 98.71% three-class classification accuracy, outperforming published deep learning models trained on the same dataset. The model has linear time complexity. Conclusions: Our handcrafted computationally lightweight swin-textural model can detect COVID-19 accurately on chest CT images with low misclassification rates. The model can be implemented in hospitals for efficient automated screening of COVID-19 on chest CT images. Moreover, findings demonstrate that our presented swin-textural is a self-organized, highly accurate, and lightweight image classification model and is better than the compared deep learning models for this dataset.

The prevalence of vaping worldwide is showing an upward trend. This study aimed to determine the factors associated with motivation to quit vaping among vapers in the Federal Territory of Kuala Lumpur, Malaysia, through a cross-sectional, purposive sampling study. Respondents were required to complete a questionnaire consisting of vapers’ sociodemographic questions, habitual behavioral pattern questions, the e-Fagerström Test of Nicotine Dependence, the Glover–Nilsson Smoking Behavioral Dependence Questionnaire, perception questions, motivation to quit questions, and withdrawal symptom questions. A total of 311 vapers participated in this study. The majority of the vapers were male (84.6%), younger (18–25 years) (55.3%), and with monthly income less than RM 4000 (USD 868; 83.9%). The level of motivation to quit vaping was found to have a significant association with the perception of vaping being as satisfying as cigarette smoking (p = 0.006) and mild to very strong nicotine dependence (p = 0.001). Participants who recorded moderate and strong habitual vaping behaviors had lower odds of having high motivation to quit vaping compared to those recording slight habitual behaviors (OR = 0.279, 95%CI(0.110–0.708), p = 0.007 and OR = 0.185, 95%CI(0.052–0.654), p = 0.009, respectively). Factors associated with higher motivation to quit vaping could be explored to gain better understanding of how to increase their motivation level for future quit attempts.

Medical physics is the application of physics principles and techniques in medicine. Medical physicists are actively applying their knowledge and skills in the prevention, diagnosis and treatment of diseases to improve health via research and clinical practice. In this paper, we present the roles of medical physicists in the three primary fields, namely, diagnostic imaging, radiotherapy and nuclear medicine. Medical physicists have been playing a crucial role in the advancement of new technologies that have revolutionised medicine today. This includes the continuous development of medical imaging and radiotherapy techniques since the discovery of X-ray and radioactivity. The last decade has seen tremendous development in the field that allows for better diagnosis and targeted treatment of various diseases. In the era of big data and artificial intelligence, while medical physicists continue to ensure that the application of the technologies in medicine is optimal and safe, it is paramount for the profession to evolve and be equipped with new skills to continue to contribute to the advancement of medicine.

Radioembolization shows great potential as a treatment for intermediate- and advanced-stage liver cancer. However, the choices of radioembolic agents are currently limited, and hence the treatment is relatively costly compared to other approaches. In this study, a facile preparation method was developed to produce samarium carbonate-polymethacrylate [152Sm2(CO3)3-PMA] microspheres as neutron activatable radioembolic microspheres for hepatic radioembolization. The developed microspheres emits both therapeutic beta and diagnostic gamma radiations for post-procedural imaging. The 152Sm2(CO3)3-PMA microspheres were produced from commercially available PMA microspheres through the in situ formation of 152Sm2(CO3)3 within the pores of the PMA microspheres. Physicochemical characterization, gamma spectrometry and radionuclide retention assay were performed to evaluate the performance and stability of the developed microspheres. The mean diameter of the developed microspheres was determined as 29.30 ± 0.18 µm. The scanning electron microscopic images show that the spherical and smooth morphology of the microspheres remained after neutron activation. The 153Sm was successful incorporated into the microspheres with no elemental and radionuclide impurities produced after neutron activation, as indicated by the energy dispersive X-ray analysis and gamma spectrometry. Fourier transform infrared spectroscopy confirmed that there was no alteration to the chemical groups of the microspheres after neutron activation. After 18 h of neutron activation, the microspheres produced an activity of 4.40 ± 0.08 GBq.g−1. The retention of 153Sm on the microspheres was greatly improved to greater than 98% over 120 h when compared to conventionally radiolabeling method at ~85%. The 153Sm2(CO3)3-PMA microspheres achieved suitable physicochemical properties as theragnostic agent for hepatic radioembolization and demonstrated high radionuclide purity and 153Sm retention efficiency in human blood plasma.

3D printing has been increasingly used for medical applications with studies reporting its value, ranging from medical education to pre-surgical planning and simulation, assisting doctor–patient communication or communication with clinicians, and the development of optimal computed tomography (CT) imaging protocols. This article presents our experience of utilising a 3D-printing facility to print a range of patient-specific low-cost models for medical applications. These models include personalized models in cardiovascular disease (from congenital heart disease to aortic aneurysm, aortic dissection and coronary artery disease) and tumours (lung cancer, pancreatic cancer and biliary disease) based on CT data. Furthermore, we designed and developed novel 3D-printed models, including a 3D-printed breast model for the simulation of breast cancer magnetic resonance imaging (MRI), and calcified coronary plaques for the simulation of extensive calcifications in the coronary arteries. Most of these 3D-printed models were scanned with CT (except for the breast model which was scanned using MRI) for investigation of their educational and clinical value, with promising results achieved. The models were confirmed to be highly accurate in replicating both anatomy and pathology in different body regions with affordable costs. Our experience of producing low-cost and affordable 3D-printed models highlights the feasibility of utilizing 3D-printing technology in medical education and clinical practice.

Introduction: Neutron-activated samarium-153-oxide-loaded polystyrene ([153Sm]Sm2O3-PS) microspheres has been developed in previous study as a potential theranostic agent for hepatic radioembolization. In this study, the therapeutic efficacy and diagnostic imaging capabilities of the formulation was assessed using liver cancer Sprague-Dawley (SD) rat model. Methods: Twelve male SD rats (150–200 g) that implanted with N1-S1 hepatoma cell line orthotopically were divided into two groups (study versus control) to monitor the tumour growth along 60 days of treatment. The study group received an intra-tumoural injection of approximately 37 MBq of [153Sm]Sm2O3-PS microspheres, while control group received an intra-tumoural injection of 0.1 mL of saline solution. A clinical single photon emission computed tomography/computed tomography (SPECT/CT) system was used to scan the rats at Day 5 post-injection to investigate the diagnostic imaging capabilities of the microspheres. All rats were monitored for change in tumour volume using a portable ultrasound system throughout the study period. Histopathological examination (HPE) was performed after the rats were euthanized at Day 60. Results: At Day 60, no tumour was observed on the ultrasound images of all rats in the study group. In contrast, the tumour volumes in the control group were 24-fold larger compared to baseline. Statistically significant difference was observed in tumour volumes between the study and control groups (p < 0.05). The SPECT/CT images clearly displayed the location of [153Sm]Sm2O3-PS in the liver tumour of all rats at Day 5 post-injection. Additionally, the [153Sm]Sm2O3-PS microspheres was visible on the CT images and this has added to the benefits of 153Sm as a CT contrast agent. The HPE results showed that the [153Sm]Sm2O3-PS microspheres remained concentrated at the injection site with no tumour cells observed in the study group. Conclusions: Neutron-activated [153Sm]Sm2O3-PS microspheres demonstrated excellent therapeutic and diagnostic imaging capabilities for theranostic treatment of liver cancer in a SD rat model. Further studies with different animal and tumour models are planned to validate this finding.

Abstract Microwave ablation (MWA) is gaining popularity for the treatment of small primary hepatocellular carcinoma and metastatic lesions especially if patients are not candidates for surgical resection. Deep neuromuscular blockade (DMB) is perceived to improve surgical working conditions compared to moderate neuromuscular blockade (MMB) but no studies have examined the same benefits in MWA of liver tumours. This study aimed to compare the clinical outcomes of DMB and MMB in MWA of liver tumours in terms of liver excursion, performance scores by the interventional radiologists and patients, requirements of additional muscle relaxants and complications. 50 patients were recruited and 45 patients (22 in MMB group, 23 in DMB group) completed the study. The mean liver excursion for the MMB group (1.42 ± 1.83 mm) was significantly higher than the DMB group (0.26 ± 0.38 mm) (p = 0.001). The mean Leiden-Surgical Rating Scale (L-SRS) rated by the two interventional radiologists were 4.5 ± 0.59 and 3.6 ± 0.85 for the DMB and MMB groups, respectively (p = 0.01). There was also statistically significant difference on patient satisfaction scores (0–10: Extremely Dissatisfied–Extremely Satisfied) between DMB (8.74 ± 1.1) and MMB (7.86 ± 1.25) groups (p = 0.01). 5 patients from MMB group and none from DMB group required bolus relaxant during the MWA procedure. Adverse events were also noted to be more severe in the MMB group. In conclusion, DMB significantly reduced liver excursion and movement leading to improved accuracy, safety and success in ablating liver tumour.

Background Renal size is an important indicator in the diagnosis of renal diseases and urinary tract infections in children. Purpose The purpose of this study is twofold. First, it aimed to measure the renal length and calculate the renal volume of normal Thai children using 2-dimensional ultrasonography (2D-US) and study their correlations with somatic parameters. Second, it aimed to compare the age-specific renal size of normal Thai children with the published data of their Western and Chinese counterparts. Methods A total of 321 children (150 boys, 171 girls; age, 6–15 years) with a normal renal profile were prospectively recruited. All subjects underwent 2D-US by an experienced pediatric radiologist and the renal length, width, and depth were measured. Renal volume was calculated using the ellipsoid formula as recommended. The data were compared between the left and right kidneys, the sexes, and various somatic parameters. The age-specific renal lengths were compared using a nomogram derived from a Western cohort that is currently referred by many Thailand hospitals, while the renal volumes were compared with the published data of a Chinese cohort. Results No statistically significant difference (P

Purpose: Although magnetite nanoparticles (MNPs) are promising agents for hyperthermia therapy, insufficient drug encapsulation efficacies inhibit their application as nanocarriers in the targeted drug delivery systems. In this study, porous magnetite nanoparticles (PMNPs) were synthesized and coated with a thermosensitive polymeric shell to obtain a synergistic effect of hyperthermia and chemotherapy. Materials and methods: PMNPs were produced using cetyltrimethyl ammonium bromide template and then coated by a polyethylene glycol layer with molecular weight of 1500 Da (PEG1500) and phase transition temperature of 48 ± 2 °C to endow a thermosensitive behavior. The profile of drug release from the nanostructure was studied at various hyperthermia conditions generated by waterbath, magnetic resonance-guided focused ultrasound (MRgFUS), and alternating magnetic field (AMF). The in vitro cytotoxicity and hyperthermia efficacy of the doxorubicin-loaded nanoparticles (DOX-PEG1500-PMNPs) were assessed using human lung adenocarcinoma (A549) cells. Results: Heat treatment of DOX-PEG1500-PMNPs containing 235 ± 26 mg·g−1 DOX at 48 °C by waterbath, MRgFUS, and AMF, respectively led to 71 ± 4%, 48 ± 3%, and 74 ± 5% drug release. Hyperthermia treatment of the A549 cells using DOX-PEG1500-PMNPs led to 77% decrease in the cell viability due to the synergistic effects of magnetic hyperthermia and chemotherapy. Conclusion: The large pores generated in the PMNPs structure could provide a sufficient space for encapsulation of the chemotherapeutics as well as fast drug encapsulation and release kinetics, which together with thermosensitive characteristics of the PEG1500 shell, make DOX-PEG1500-PMNPs promising adjuvants to the magnetic hyperthermia modality.

Purpose: This study aimed to evaluate the effects of various computed tomography (CT) acquisition parameters and metal artifacts on CT number measurement for CT thermometry during CT-guided thermal ablation. Methods: The effects of tube voltage (100–140 kVp), tube current (20–250 mAs), pitch (0.6–1.5) and gantry rotation time (0.5, 1.0 s) as well as metal artifacts from a radiofrequency ablation (RFA) needle on CT number were evaluated using liver tissue equivalent polyacrylamide (PAA) phantom. The correlation between CT number and temperature from 37 to 80 °C was studied on PAA phantom using optimum CT acquisition parameters. Results: No statistical significant difference (p > 0.05) was found on CT numbers under the variation of different acquisition parameters for the same temperature setting. On the other hand, the RFA needle has induced metal artifacts on the CT images of up to 8 mm. The CT numbers decreased linearly when the phantom temperature increased from 37 to 80 °C. A linear regression analysis on the CT numbers and temperature suggested that the CT thermal sensitivity was –0.521 ± 0.061 HU/°C (R2 = 0.998). Conclusion: CT thermometry is feasible for temperature assessment during RFA with the current CT technology, which produced a high CT number reproducibility and stable measurement at different CT acquisition parameters. Despite being affected by metal artifacts, the CT-based thermometry could be further developed as a tissue temperature monitoring tool during CT-guided thermal ablation.

The diagnostic value of coronary computed tomography angiography (CCTA) is significantly affected by high calcification in the coronary arteries owing to blooming artifacts limiting its accuracy in assessing the calcified plaques. This study aimed to simulate highly calcified plaques in 3D-printed coronary models. A combination of silicone + 32.8% calcium carbonate was found to produce 800 HU, representing extensive calcification. Six patient-specific coronary artery models were printed using the photosensitive polyurethane resin and a total of 22 calcified plaques with diameters ranging from 1 to 4 mm were inserted into different segments of these 3D-printed coronary models. The coronary models were scanned on a 192-slice CT scanner with 70 kV, pitch of 1.4, and slice thickness of 1 mm. Plaque attenuation was measured between 1100 and 1400 HU. Both maximum-intensity projection (MIP) and volume rendering (VR) images (wide and narrow window widths) were generated for measuring the diameters of these calcified plaques. An overestimation of plaque diameters was noticed on both MIP and VR images, with measurements on the MIP images close to those of the actual plaque sizes (

Despite the development and implementation of several MRI techniques for breast density assessments, there is no consensus on the optimal protocol in this regard. This study aimed to determine the most appropriate MRI protocols for the quantitative assessment of breast density using a personalized 3D-printed breast model. The breast model was developed using silicone and peanut oils to simulate the MRI related-characteristics of fibroglandular and adipose breast tissues, and then scanned on a 3T MRI system using non-fat-suppressed and fat-suppressed sequences. Breast volume, fibroglandular tissue volume, and percentage of breast density from these imaging sequences were objectively assessed using Analyze 14.0 software. Finally, the repeated-measures analysis of variance (ANOVA) was performed to examine the differences between the quantitative measurements of breast volume, fibroglandular tissue volume, and percentage of breast density with respect to the corresponding sequences. The volume of fibroglandular tissue and the percentage of breast density were significantly higher in the fat-suppressed sequences than in the non-fat-suppressed sequences (p < 0.05); however, the difference in breast volume was not statistically significant (p = 0.529). Further, a fat-suppressed T2-weighted with turbo inversion recovery magnitude (TIRM) imaging sequence was superior to the non-fat- and fat-suppressed T1- and T2-weighted sequences for the quantitative measurement of breast density due to its ability to represent the exact breast tissue compositions. This study shows that the fat-suppressed sequences tended to be more useful than the non-fat-suppressed sequences for the quantitative measurements of the volume of fibroglandular tissue and the percentage of breast density.

Introduction: Transarterial radioembolization (TARE) has been proven as an effective treatment for unresectable liver tumor. In this study, neutron activated, 153Sm-labeled microspheres were developed as an alternative to 90Y-labeled microspheres for hepatic radioembolization. 153Sm has a theranostic advantage as it emits both therapeutic beta and diagnostic gamma radiations simultaneously, in comparison to the pure beta emitter, 90Y. Methods: Negatively charged acrylic microspheres were labeled with 152Sm ions through electrostatic interactions. In another formulation, the Sm-labeled microsphere was treated with sodium carbonate solution to form the insoluble 152Sm carbonate (152SmC) salt within the porous structures of the microspheres. Both formulations were neutron-activated in a research reactor. Physicochemical characterization, gamma spectrometry, and radiolabel stability tests were carried out to study the performance and stability of the microspheres. Results: The Sm- and SmC-labeled microspheres remained spherical and smooth, with a mean size of 35 µm before and after neutron activation. Fourier transform infrared (FTIR) spectroscopy indicated that the functional groups of the microspheres remained unaffected after neutron activation. The 153Sm- and 153SmC-labeled microspheres achieved activity of 2.53 ± 0.08 and 2.40 ± 0.13 GBq·g−1, respectively, immediate after 6 h neutron activation in the neutron flux of 2.0 × 1012 n·cm−2·s−1. Energy-dispersive X-ray (EDX) and gamma spectrometry showed that no elemental and radioactive impurities were present in the microspheres after neutron activation. The retention efficiency of 153Sm in the 153SmC-labeled microspheres was excellent (~99% in distilled water and saline; ~97% in human blood plasma), which was higher than the 153Sm-labeled microspheres (~95% and ~85%, respectively). Conclusion: 153SmC-labeled microspheres have demonstrated excellent properties for potential application as theranostic agents for hepatic radioembolization.

This study aimed to measure the absorbed doses in selected organs for prospectively ECG-triggered coronary computed tomography angiography (CCTA) using five different generations CT scanners in a female adult anthropomorphic phantom and to estimate the effective dose (HE).Prospectively ECG-triggered CCTA was performed using five commercially available CT scanners: 64-detector-row single source CT (SSCT), 2 × 32-detector-row-dual source CT (DSCT), 2 × 64-detector-row DSCT and 320-detector-row SSCT scanners. Absorbed doses were measured in 34 organs using pre-calibrated optically stimulated luminescence dosimeters (OSLDs) placed inside a standard female adult anthropomorphic phantom. HE was calculated from the measured organ doses and compared to the HE derived from the air kerma-length product (PKL) using the conversion coefficient of 0.014 mSv∙mGy-1∙cm-1 for the chest region.Both breasts and lungs received the highest radiation dose during CCTA examination. The highest HE was received from 2 × 32-detector-row DSCT scanner (6.06 ± 0.72 mSv), followed by 64-detector-row SSCT (5.60 ± 0.68 and 5.02 ± 0.73 mSv), 2 × 64-detector-row DSCT (1.88 ± 0.25 mSv) and 320-detector-row SSCT (1.34 ± 0.48 mSv) scanners. HE calculated from the measured organ doses were about 38 to 53% higher than the HE derived from the PKL-to-HE conversion factor.The radiation doses received from a prospectively ECG-triggered CCTA are relatively small and are depending on the scanner technology and imaging protocols. HE as low as 1.34 and 1.88 mSv can be achieved in prospectively ECG-triggered CCTA using 320-detector-row SSCT and 2 × 64-detector-row DSCT scanners.