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Modern lifestyle and advanced technology have given life easier, but this has led to many diseases. In advanced lifestyle irregular eating habits, eating unhealthy foods and eating spicy fast food has become a fashion and alcohol consumption is increasing day by day. All of these factors lead to different disorders. Kamala is one among the diseases which are caused due to excessive intake of sour food, alcohol, unhealthy food and when a person with Panduroga continues intake of Pittakara Aahara then he may develop Kamala. According to modern science, Kamala can be correlated with Jaundice. Clinically the Jaundice is a sign of an ongoing disease process with common signs and symptoms like yellowish discolourations of the skin, mucous membranes, the eyes, urine etc. It is characterized by increase deposition of bile pigments in body fluids and tissues. It is perceptible only when the bilirubin level and its conjugates exceeds 1.5 mg/ 100ml plasma. Here is the case study of a patient who appeared to Parul Ayurved Hospital with the history of oedema over the bilateral lower limbs, heaviness in abdomen and chest region in the last 1 year, fever since 4-5 months and yellowish discolourations of eyes, nails and urine are present. In the present study, the patient was treated with Ayurvedic treatments i.e. Virechana Karma and Shamana Chikitsa.

Aim of the study To evaluate the agreement between planned and delivered doses and its potential correlation with the plans' complexity subjected to dosimetric verification. Material and methods Four isocentre volumetric modulated arc therapy for total marrow irradiation plans optimized simultaneously with (P1) and without (P2) MU reduction were evaluated dosimetrically by γ method performed in a global mode for 4 combinations of γ-index criteria (2%/2 mm, 2%/3 mm, 3%/2 mm, and 3%/3 mm). The evaluation was conducted for 4 regions (head and neck, chest, abdomen and upper pelvis, and lower pelvis and thighs) that were determined geometrically by the isocentres. The Wilcoxon test was used to detect significant differences between γ passing rate (GPR) analysis results for the P1 and P2 plans. The Pearson correlation was used to check the relationship between GPR and the plans' complexity. Results Except for the head and neck region, the P2 plans had better GPRs than the P1 plans. Only for hard combinations of γ-index criteria (i.e. 2%/3 mm, 2%/2 mm) were the GPRs differences between P1 and P2 clinically meaningful, and they were detected in the chest, abdomen and upper pelvis, and lower pelvis and thighs regions. The highest correlations between GPR and the indices describing the plans' complexity were found for the chest region. No correlation was found for the head and neck region. Conclusions The P2 plans showed better agreement between planned and delivered doses compared to the P1 plans. The GPR and the plans' complexity depend on the anatomy region and are most important for the chest region.

Summary Deep brain stimulators (DBSs) are sometimes used to treat refractory movement disorders such as Parkinson's disease. When DBSs are implanted in a subcutaneous pocket in the chest region, breast reconstruction becomes a challenge because monopolar electrocautery can lead to DBS dysfunction or brain tissue damage caused by heat. We report a patient with a DBS who underwent one-stage implant-based breast reconstruction. We switched off the DBS before surgery and used monopolar electromagnetic cautery with minimum power settings to undermine the subcutaneous pocket for the breast implant. The DBS was switched back on immediately after completion of the surgery. The patient's postoperative recovery was uneventful with the DBS fully functional.

COVID-19 first emerged in December 2019 in Wuhan, China, and has since spread throughout the world. More than one year has passed, and the virus continues to mutate and infect individuals at an increasingly alarming rate. Providing proper treatment to patients during the initial stages of the infection is highly vital for their survival. There is also a need for quicker testing. Such a situation demands an automated, easy-to-use COVID detection toolkit. Recent research using computer vision techniques suggests that chest X-rays contain essential features about the effects of the virus in the chest region. Advanced deep learning techniques and clinical imaging can be utilized to create a tool to detect COVID-19 and its severity. The proposed tool considers chest X-rays as well as a patient's symptoms to predict whether the patient has COVID or not and predict the severity for positive cases.

Computed tomography (CT) is commonly associated with relatively high patient doses. In order to keep the patient doses from the CT examinations on the acceptable level it is necessary to apply the principle of optimization. An essential part of optimization is the achievement of the compromise between the patient dose reduction and the maintenance of the image quality that provides accurate diagnostic information. The aim of the study was to determine the relations between the patient doses, CT image quality and the parameters of the tube current modulation program (Auto mA, CareDose and DoseRight) for the examination of the chest. The study was performed on the three most common modern tomographs in Russia: Ingenuity Core 128, Philips; Optima 64, General Electric; Definition AS, Siemens. The anthropomorphic phantom Lungman (Kyoto Kagaku CO., LTD) was used in the study. In order to assess the tube current modulation for the range of tube voltage (80–120 kV), the reference mA∙s (ref. mAs), Noise Index (NI) and Dose Right Index (DRI) were changed for the CareDose (Siemens), Auto mA (GE) and RightDose (Philips), respectively. Estimation of the effective dose was performed using the method from Methodical guidance 2.6.1.2944-11 (MU 2.6.1.2944-11). In order to evaluate the image quality, the noise of a CT image in the mediastinum was selected as the most homogenous for chest region. It was estimated, that for the GE units with Auto mA, the noise of CT image had a liner relationship with NI; the patient dose decreased with the increase of NI. For the Siemens units with CareDose, the noise of CT image decreased with the ref.mAs for the range of tube voltage (80–120 kV); the patient dose was directly proportional to the ref.mAs and increased with the tube voltage. For the Philips units with DoseRight, the noise of CT image decreased with the DRI for the range of tube voltage (80–120 kV); the patient dose was directly proportional to the DRI and had no dependence on the tube voltage. The tube current modulations are proprietary for each manufacturer; it is necessary to consider them for the protocol development. The obtained dependences could be useful for optimization of CT protocols.

Purpose The aim of this study is to propose an algorithm for the automated calculation of water‐equivalent diameter (Dw) and size‐specific dose estimation (SSDE) from clinical computed tomography (CT) images containing one or more substantial body part. Methods All CT datasets were retrospectively acquired by the Toshiba Aquilion 128 CT scanner. The proposed algorithm consisted of a contouring stage for the Dw calculation, carried out by taking the six largest objects in the cross‐sectional image of the patient's body, followed by the removal of the CT table depending on the center position (y‐axis) of each object. Validation of the proposed algorithm used images of patients who had undergone chest examination with both arms raised up, one arm placed down and both arms placed down, images of the pelvic region consisting of one substantial object, and images of the lower extremities consisting of two separated areas. Results The proposed algorithm gave the same results for Dw and SSDE as the previous algorithm when images consisted of one substantial body part. However, when images consisted of more than one substantial body part, the new algorithm was able to detect all parts of the patient within the image. The Dw values from the proposed algorithm were 9.5%, 15.4%, and 39.6% greater than the previous algorithm for the chest region with one arm placed down, both arms placed down, and images with two legs, respectively. The SSDE values from the proposed algorithm were 8.2%, 11.2%, and 20.6% lower than the previous algorithm for the same images, respectively. Conclusions We have presented an improved algorithm for automated calculation of Dw and SSDE. The proposed algorithm is more general and gives accurate results for both Dw and SSDE whether the CT images contain one or more than one substantial body part.

This Following on from work by Babalola et al. It is shown that the sex of mice can be determined from x-ray images of the chest region alone using convolutional neural networks. The anatomical differences that may be responsible for this is further sinvestigated, as it may be useful in determining phenotype changes caused by knocking out genes - hence in understanding genotype-phenotype effects. Our results indicate that the cervical vertebrae may play an important role in the ability of our convolutional neural network to classify the sex of mice correctly using only x-rays of the chest region.

The application of segmentation methods to medical imaging has the potential to create novel diagnostic support models. With respect to fetal ultrasound, the thoracic wall is a key structure on the assessment of the chest region for examiners to recognize the relative orientation and size of structures inside the thorax, which are critical components in neonatal prognosis. In this study, to improve the segmentation performance of the thoracic wall in fetal ultrasound videos, we proposed a novel model-agnostic method using deep learning techniques: the Multi-Frame + Cylinder method (MFCY). The Multi-frame method (MF) uses time-series information of ultrasound videos, and the Cylinder method (CY) utilizes the shape of the thoracic wall. To evaluate the achieved improvement, we performed segmentation using five-fold cross-validation on 538 ultrasound frames in the four-chamber view (4CV) of 256 normal cases using U-net and DeepLabv3+. MFCY increased the mean values of the intersection over union (IoU) of thoracic wall segmentation from 0.448 to 0.493 for U-net and from 0.417 to 0.470 for DeepLabv3+. These results demonstrated that MFCY improved the segmentation performance of the thoracic wall in fetal ultrasound videos without altering the network structure. MFCY is expected to facilitate the development of diagnostic support models in fetal ultrasound by providing further accurate segmentation of the thoracic wall.

The realistic numerical breast model is an important tool for verifying algorithms, improving design concepts, and exploring new technologies related to microwave breast cancer detection. Recently, several numerical breast models have been developed. However, these models do not include the real breast boundary and the chest region, which causes the electromagnetic wave propagation in the breast models to deviate from the actual situation. The proposed breast models in this paper overcome the significant deficiencies of the recent breast models in terms of structure completeness and authenticity. The model construction based on magnetic resonance imaging (MRI) scans is a multistep approach. Firstly, intensity inhomogeneity in MRI images is corrected by an improved nonparametric nonuniform intensity normalization (N4) algorithm. Then, a dual threshold and morphological transformation (DTMT) method is developed to segment the real breast region. Subsequently, a modified maximum inter-class variance (MICV) method is employed to automatically divide the breast region into the fat and the fibroglandular clusters with desired complexity. Finally, the dielectric properties of breast tissues are calculated by a piecewise weighted mapping method. The applicability and effectiveness of the proposed method are verified by constructing four breast models with varying tissue density, shape, and size. The constructed models in this study are significant to achieve reliable and precise effects for microwave breast cancer detection due to the accurate expression of the breast anatomical information and electromagnetic characteristics.

Image in medicine Five (5) years old male patient came to outpatient department with complain of multiple swelling over chest region with upper extremities. The clinical examination revealed that there is chest multiple mass growth of about 3-4 cm bilaterally each over chest, upper extremities and forehead. The development of multiple benign osteocartilaginous masses (exostoses) begins with the relation with the ends of long bones of the lower limbs such as the femurs and tibias and of the upper limbs such as the humerus and forearm bones with chest region. The patient also had complains of difficulty in eating, finger grips, as well as loss of functional independence. On clinical examination the patient was diagnosed with a rare case of hereditary multiple osteochondromas (HMO). Figure 1 A) anterior view of the patient; B) multiple osteochondromas showing in the chest region

Objectives: This study aims to first measure patient doses during computed tomography (CT) chest, abdomen, and extremities procedures for evaluation lymphedema, and second to estimate the radiation dose-related risks during the procedures. Material and Methods: Radiation effective doses from CT lymphography procedures quantified using CT machines from different vendors. After the calibration of CT systems, the data collected for a total of 28 CT lymphography procedures. Effective and organ doses extrapolated using national radiological protection software based on Monte Carlo simulation. Results: The mean patient doses for chest and abdomen procedures in term of CTDIvol (mGy) and DLP (mGy.cm) are 10.0 ± 3 and 425 ± 222 and 24 ± 12 and 1118 ± 812 for CT 128 and CT 16 slice, respectively. The mean DLP (mGy.cm) for extremities was 320 ± 140 and 424 ± 212 for CT 128 and CT 16 slice, in that order. Conclusion: Patients’ dose showed significant differences due to variation in the scan length and clinical indication. Organs lay in the primary beam received high radiation doses especially in the chest region which increases the probability of radiation-induced cancer. The current patient’s doses are higher compared to the previous studies.

Previous studies have indicated that there is no consensus on the effects of extremely low-frequency electromagnetic (ELF-EMF) exposure on the cardiovascular system. This study aimed to explore the short-term effect of ELF-EMF exposure on heart rate (HR) and HR variability (HRV). The sample consisted of 34 healthy males aged 18-27 years. The participants were randomly assigned to the EMF (n = 17) or the Sham group (n = 17). We employed a double-blind repeated-measures design consisting of three 5 min experimental periods. The chest region of each individual in the EMF group was exposed to 50 Hz, 28 mu T, linear polarized, continuous EMF during the EMF exposure period. HR and HRV data were recorded continuously by using a photoplethysmography sensor. Within-subject statistical analysis indicated a significant HR deceleration in both the EMF and Sham groups. However, the standard deviation of the NN intervals (SDNN), root mean square of successive differences (RMSSD), low-frequency (LF), and high-frequency (HF) powers increased only in the EMF group and remained stable in the Sham group. We also compared the same HRV indices measured during the EMF and Sham periods between the two experimental groups. The between-subject analysis results demonstrated significantly higher SDNN, RMSSD, LF, and HF values in the EMF group than in the Sham group. The LF/HF ratio did not change significantly within and between groups. on the basis of these results, we concluded that short-term exposure of the chest region to ELF-EMF could potentially enhance parasympathetic predominance during the resting condition. (c) 2020 Bioelectromagnetics Society., Ege University Scientific Research Project Coordination UnitEge University; Ege University Planning and Monitoring Coordination of Organizational Development; Directorate of Library and Documentation, We thank the Ege University Scientific Research Project Coordination Unit for their support. We are also grateful to Ege University Planning and Monitoring Coordination of Organizational Development, and Directorate of Library and Documentation for their support in editing and proofreading service of this study.

Objective: to develop a methodology for quantitative assessment of changes in density parameters of pulmonary tissue on the basis of dynamic CT data, which makes it possible to assess the presence of the dependence of changes in lung tissue on the time elapsed after radiation therapy (RT), the dose and volume of irradiated pulmonary tissue.Materials and methods. Using the data collected by 11 patients with malignant lymphomas, we developed a new diagnostic technique for quantitative analysis, which is based on the analysis of the density of pulmonary tissue before and after RT in areas with a selected range of doses throughout the lung volume. All selected patients received LT in the chest region, using 3D-planning, fractions of 2Gy and total focal doses of 13–56 Gy. Also, each patient had at least two CT examinations (a total of 25 studies in the Dicom- format). The first CT scan was performed before LT, repeated – within 2–7 months after the end of RT.Results. In 6 patients, control CT examinations were performed 2.1–2.8 months after RT. As a result, a quantitative increase in the density indices in the range from +12 to +62 HU in regions of the lungs irradiated at a dose of more than 19 Gy was noted, different from the control areas. The volume of these areas of the lungs was from 16% to 30% of the total lung volume, and the volume of regions with the maximum values of density growth – from 7% to 14%. These changes in density are below the “visual” threshold. In control areas, the density change varied from −15 HU (increased airiness) to + 8 HU. According to the data of other CT studies performed later than 3 months after RT, the reverse development of changes characterizing the early radiation reaction was observed.Conclusions. A series of CT studies performed before and at various intervals after RT allows quantitative assessment of the dynamics of the indices of the density of irradiated pulmonary tissue, which is necessary for an objective assessment of the severity of early radiation-induced injuries of pulmonary tissue sites, depending on the dose. A study of the dynamics of these changes in pulmonary tissue density over time with RT and the connection of this indicator with the baseline data may allow one to predict radiation-induced damage to the lungs on the one hand, and on the other, to evaluate individual radiosensitivity.

Sexual desire can be triggered by external (visual, tactile, auditory, olfactory) or internal (memories, fantasies) stimuli. However, few studies have investigated these different components of sexual desire. In our investigation, we focused on visual stimuli with the aim of establishing whether or not there exists a specific pattern of visual exploration linked to sexual desire among male and female subjects. In another words, we wanted to investigated what parts of the body visually explored are the more relevant to feel sexual desire. To assess this question, we conducted an eye-tracking study in which participants made a judgment of sexual desire, during the visualization of explicit visual stimuli. The main results for male viewers revealed that they explored the body longer than the face (P = .05). Within the body area, the chest region was scanned more extensively than the abdomen (P = .014) and the genital area (P = .003). There were no difference between the abdomen and the genital area. For female viewers, the pattern of exploration showed they explored the body longer than the face (P = .05). Inside the body area, the abdomen was scanned more extensively than the chest/pectoral region (P

Purpose: This study examined tackle characteristics and their relationships with match-play tackle outcomes, tackling ability, and physical qualities in rugby league players. Methods: Fifteen rugby league matches were analysed, with the tackle characteristics and outcomes of 2355 tackle events coded. Muscle strength and power tests, and a standardized assessment of tackling ability were performed in 16 players. Results: Medium body position, utilizing a shoulder or smother tackles, and producing leg drive upon contact decreased the odds of a missed tackle. Performing a front-on tackle, with a contact zone at the chest region reduced the odds of an offload. Tackling ability was significantly related to defenders moving forward prior to contact (rs = 0.60, 95% CI 0.15–0.85, P = 0.02), front-on tackles (rs = 0.53, 95% CI 0.05–0.81, P = 0.04), and displaying medium body height (rs = 0.57, 95% CI 0.10–0.83, P = 0.02) in match-play tackles. Lower-body strength was significantly related to defenders exhibiting a medium body position (rs = 0.60, 95% CI 0.15–0.85, P = 0.01) and the ball-carrier being placed on their back (rs = 0.72, 95% CI 0.35–0.90, P = 0.002). Conclusion: The findings suggest that match-play tackle performance is related to both tackle characteristics and physical qualities.

Developmental changes in the body proportions of western North Pacific Bryde’s whales (Balaenoptera edeni) were investigated by examining the proportion of each body part to the total body length. The head and chest region increased to a certain body length; subsequently, the length of head region stabilized, and that of the chest region decreased. The length of the abdominal region remained constant to a certain body length and subsequently showed a marked increase, and that of the tail region decreased consistently. The length of dorsal fin and flukes decreased consistently, whereas that of the flippers remained constant to a certain body length and subsequently decreased. The relative growth pattern determined by an allometric analysis was positive for the head region but negative for the lower body part, flippers, flukes, and dorsal fin. Both sexes demonstrated the same growth pattern, but the coefficients differed. This is the first study to investigate developmental changes in the body proportions of Bryde’s whales using more than 700 specimens covering a wide body length range. We believe that the results of this study will contribute to various research fields, including taxonomy, phylogeny, and feeding ecology of this species.

An important step for computerized analysis of breast magnetic resonance imaging (MRI) is segmentation of the breast region. Due to the similar signal intensity of fibroglandular tissue and the chest wall, the segmentation process is difficult for breasts with fibroglandular tissue connected to the chest wall. In order to overcome this challenge, a new framework is presented that relies on a chest region atlas. The proposed method first detects the approximated breast-chest wall boundary using an intensity-based operation. A support vector machine (SVM) then determines the connectivity of fibroglandular tissue to the chest wall by the extracted features from the obtained breast-chest wall boundary. Finally, the obtained breast-chest wall boundary is accurately refined using the geometric shape of the chest region, which is obtained by an atlas-based segmentation method. The proposed method is validated using a dataset of 5964 breast MRI images from 126 women. The Dice similarity coefficient (DSC), total overlap (TO), false negative (FN), and false positive (FP) values are calculated to measure the similarity between automatic and manual segmentation results. Our method achieves DSC, TO, FN, and FP values of 96.46%, 96.41%, 3.59%, and 3.51%, respectively. The results prove the effectiveness of the presented algorithm for breasts with different sizes, shapes, and density patterns.

Automatic lung segmentation is an essential step towards the Computer-Aided Diagnosis of the lung CT scan. However, in presence of dense abnormalities, existing methods fail in accurate lung segmentation. In this paper, a generative adversarial networks-based approach is proposed for improving the accuracy of lung segmentation. The proposed network effectively segments the lung region from the surrounding chest region hence, named as LungSeg-Net. In the proposed LungSeg-Net, the input lung CT slices are processed through the trail of encoders which encode these slices into a set of feature maps. Further, a multi-scale dense-feature extraction (MSDFE) module is designed for extraction of multi-scale features from the set of encoded feature maps. Finally, the decoders are employed to obtain the lung segmentation map from the multi-scale features. The MSDFE makes the network to learn the relevant features of dense abnormalities whereas the iterative down-sampling followed by the up-sampling makes it invariant to the size of the dense abnormality. The publicly available benchmark ILD dataset is used for the experimental analysis. The qualitative and quantitative analysis has been carried out to compare the performance of the proposed network with the existing state-of-the-art methods for lung segmentation. The experimental analysis show that the performance of the proposed LungSeg-Net is invariant to the presence of dense abnormalities in lung CT scan.

A 70-year-old female patient presenting with swelling and subcutaneous nodule formation localized to the knee scars over a two-month period is presently reported. Dermatological examinations found erythematous swelling and small papules on the patient's knee scars, along with subcutaneous nodules beneath and around the scars. Computer tomography of the chest region identified multiple obscure tubercles in the lungs and swollen lymph nodes in the hilum pulmonis and mediastinum. Skin biopsy revealed multiple non-caseating granulomas, which had infiltrated the dermis. The patient was diagnosed with scar sarcoidosis as a result of these observations. The onset of scar sarcoidosis is rare and, therefore, not well understood; however, inflammatory alterations in preexisting scars may be important indicators for disease onset.

1706 Objectives: 90Y-radioembolization treatment planning includes determination of the lung shunt fraction (LSF) to maintain mean lung dose to below 25-30 Gy. The estimated mean lung dose constrains the total amount of administered activity and hence the ability to treat tumor to higher dose levels. The device package inserts recommend use of 1000 g lung mass in the calculation of lung dose. Errors in lung mass and lung shunt fraction contributes to the overall errors in lung doses. Here we investigated the accuracy and 95% prediction interval (95%PI) of 5 common methods for calculating the lung mass. The bias can be corrected, if errors are normally distributed, rendering the 95%PI as the more relevant metric. As secondary objective, we investigated the mean errors in lung mass and lung dose that stems from using a fixed 1000 g lung mass for all patients. Relative errors in lung mass estimation are directly proportional to the errors in lung dose. Methods: An IRB-approved retrospective study was conducted on 52 consecutive HCC patients assessed for 90Y-radioembolization with TheraSphere from 2015-2016. As part of routine workup, all patients underwent a diagnostic contrast CT (cCT) of the chest and abdomen prior to the 99mTc-MAA SPECT and non-contrast CT (ncCT) of the liver and chest region. Of these 52 patients, 12 had complete lungs in the SPECT/ncCT field of view (FOV) while 40 had a varying range of lung in the SPECT/ncCT FOV. The gold-standard estimate of true lung mass was defined as the mean of the masses estimated from the cCT and the ncCT using an HU-based volume&density calculation. Linear regression was derived from the complete lung scan data to estimate true lung mass from a lung mass estimated using the cCT HU-based volume&density Methods: This regression was then used on all 52 patients to calculate the true lung mass from the cCT HU-based volume&density mass estimation. The 5 common methods of lung mass calculation investigated were: 1) ncCT HU-based volume&density, 2) ncCT volume & fixed 0.3 g/ml density, 3) fixed mass of 1000 g, 4) gender-based fixed mass of 1000 g for men and 800 g for women, and 5) weight-scaled gender-based fixed mass. A Bland-Altman analysis was performed to estimate the mean relative error and 95%PI of these 5 methods compared to the true lung mass. Results: The mean relative error [95%PI] for lung mass was -9% [±21%] and -11% [±23%] with the ncCT HU-based volumed the errors changed to -23% [±24%] and -14% [±33%], respectively, when partial lung was scanned. In all 52 cases, the fixed mass based methods (1000 g, gender-based, weight-scaled-gender) had large mean errors (26%, 20%, 37%) and very wide 95%PI (±44%, ±41%, ±54%). The errors were not normally distributed in the 1000 g and gender-based fixed mass methods. The 95%PI after bias corrections for all patients were 26%, 31%, and 54% for ncCT HU-based volume&density, ncCT volume&fixed-density, and weight-scaled-gender fixed mass methods. On average, the fixed lung mass of 1000 g overestimated the true lung mass by 23% [±44%] resulting in a corresponding underestimation of the lung dose. Conclusion: Use of the default fixed lung mass of 1000 g severely overestimates the true lung mass. Errors in both ncCT-based methods were lowest compared to fixed mass methods but HU-based volume&density had the narrowest 95%PI. Over all patients, lung mass errors in 95%PI after bias correction with the ncCT HU-based volume&density and volume&fixed-density methods were 26% and 31%. We recommend scanning the maximum lung volume allowed in 99mTc-MAA SPECT/CT and using the bias-corrected ncCT HU-based volume&density method to estimate lung mass when calculating mean lung dose for 90Y-radioembolization treatment planning. Investigations on incorporation of additional errors from LSF estimation on the final mean lung dose is currently underway.

Objective: The aim of this study was to evaluate the complementary and alternative medicine (CAM) methods, the prevalence of their use, and to assess the factors that influence using these methods in children with asthma and/or allergic rhinitis in Van. Material and Methods: The study was conducted between June 2015 and January 2016. A survey form consisting of 15 questions was prepared. These questions were posed to the parents of the children with asthma and/or allergic rhinitis who were being followed-up at the pediatric allergy and immunology outpatient clinic. Results: The study included 127 parents of children aged 2-17 years. The mean age of the patients was 7.9 ± 3.6 years. 62 (48.8%) of the 127 parents stated that they had used CAM methods at any time of their life. 9 (14.5%) of the CAM users thought that they had benefited from these methods. The most common modality was molasses used in 45 (72.5%) of the patients. 44 (70%) of the patients used herbs and spices (linden, rosehip, mountain thyme, black pepper, cinnamon, etc.), 23 (37%) used honey, 13 (20%) used quail eggs, 10 (16.1%) used olive oil, 6 (9.6%) used cow’s milk, 1 (1.6%) used bee milk, 1 (1.6%) used bee pollen and 1 (1.6%) used Vicks application to the chest region. Most of the parents had accessed information about CAM methods through a herbalist and the media. Conclusion: In conclusion, the prevalence of reported CAM use among patients with diagnosed asthma and/or allergic rhinitis in Van was found to be high (48.8%) and at a similar rate with other regions of our country, with molasses (72.5%) being the most popular modality. The pediatric allergy specialist should have knowledge about these methods and inform parents about their possible side effects.

Monitoring of the heart rhythm is the cornerstone of the diagnosis of cardiac arrhythmias. It is done by means of electrocardiography which relies on electrodes attached to the skin of the patient. We present a new system approach based on the so-called vibrocardiogram that allows an automatic non-contact registration of the heart rhythm. Because of the contactless principle, the technique offers potential application advantages in medical fields like emergency medicine (burn patient) or premature baby care where adhesive electrodes are not easily applicable. A laser-based, mobile, contactless vibrometer for on-site diagnostics that works with the principle of laser Doppler vibrometry allows the acquisition of vital functions in form of a vibrocardiogram. Preliminary clinical studies at the Klinikum Karlsruhe have shown that the region around the carotid artery and the chest region are appropriate therefore. However, the challenge is to find a suitable measurement point in these parts of the body that differs from person to person due to e. g. physiological properties of the skin. Therefore, we propose a new Microsoft Kinect-based approach. When a suitable measurement area on the appropriate parts of the body are detected by processing the Kinect data, the vibrometer is automatically aligned on an initial location within this area. Then, vibrocardiograms on different locations within this area are successively acquired until a sufficient measuring quality is achieved. This optimal location is found by exploiting the autocorrelation function.

The injury outcomes in side impact are correlated to the door trim design, vehicle motion, as well as the side restraint system. A well controlled side intrusion can vastly reduce the injury index of the thorax, abdomen during the side impact. For the safety issue, it is essential to know the sensitivity of side structure's intrusion velocity upon occupant injury in side impact. Objective: This paper is focusing on the influences of different side intrusion velocities upon occupant injuries, based on a validated MADYMO side impact simulation model. Method and Material: With the Prescribed Structure Motion method, the side impact model was built up and correlated with the physical impact test to ensure the accuracy of the model. Through the method of Prescribed Structure Motion Scaling, the different door's intrusion velocities corresponding to the chest region were realized. Upon the MADYMO simulations, the side structure intrusion velocity effects on occupant injuries were evaluated. Results: The study indicates that the door's intrusion velocity corresponding to the chest region has significant effects on the rib deformation and T12-Mx index. By increasing the intrusion velocity from 5.87m/s to 7.5m/s, the maximum of low rib deformation could be increased by 58.6% and T12-Mx index could be increased by 78.4%.

Localized scleroderma in the chest region of adolescent girls leads to incomplete breast development and breast asymmetry, for which patients may require treatment. The site of localized scleroderma, its activity, the surgeon, and the patient's desires influence the selection of treatment method. There have been few reports on surgical treatment of this disease. In the current report, we present a case in which improved breast asymmetry was achieved through multiphased surgery, and we review treatment methods and indications of this disease. Level of Evidence: 5 ![Graphic][1] [1]: /embed/inline-graphic-1.gif

This study presents comparison results between axial and spiral scanning in the head and chest region with 64 MDCT to evaluate organ doses in infants and toddlers, who ar e more radiosensitive to radiation than adults and rise in the number of CT examinations, during CT scanning. Organ doses were significantly lower in spiral scanning than axial scanning regardless of scanned regions. The average organ dose for the chest scan using pitch of 1.355 was found to be significantly higher(average -12 .03%) than for the other two pitch settings(0.525 and 0.988) in the spiral scanning mode compared with the axial one. Organ doses in the spiral scanning mode were lower by average 20.54% than the axial scann ing mode. The results of the study that evaluated organ doses with an anthropomorphic phantom will help to demonstrate the result values of Monte Carlo simulations and make a contribution to more accurate eval uations of organ doses in toddlers undergoing a CT examination. Key Words : Infants and Toddlers, Axial Scan, Spiral Scan, Organ dose, demonstrate

Quality of X-ray image plays an important role in diagnostic results. The traditional method for taking x-ray image depends on the operator's judgments and requires high professional quality of the radiologist. The quality of X-ray image for chest region obtains the best results when the ribcage is full air. That corresponds the peak time of inhaling cycle. In this paper, we use a depth camera of Microsoft Kinect to record the patient's breath and find the time of the deepest inhaling to improve the quality of X-ray image. Our design utilizes image processing methods to record human breath fluctuation, to calculate the breath rate and to predict the peak time of inhaling for the next breath cycle to capture automatically X-ray image.

Objectives 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). Materials and Methods 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. Results 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. Conclusion 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.

In Japan, the number of patients suffering from bedsores has been increasing with the progression of population aging. In this study, we investigated techniques for analyzing posture or motion for the prevention of bedsores. In particular, we propose a method for analyzing the posture of a person lying in bed using depth maps and color images obtained from a Kinect sensor. First, the color images are used to perform color identification of the hair, from which the position of the head is estimated. Hair color by acquiring the color information from each pixel found a part that many belongs. Based on these analyses, it was possible to determine to be the position of the head. Second, the depth maps are divided into four regions: the head region, chest region, abdominal region, and foot region. Based on these analyses, it was possible to determine which of three positions, prone, supine, or sideways, the person was lying down in.

Considerable number of women are enjoying swimming, however, the chest-region of swimsuits including cup inserts are not stable during swimming. The purpose of this study was to explore alternate designs and methods of stabilizing the breast cup to the swimmer's body by using 3D technology to design and position the pad and cup pattern of the swimming suit. To position the pad optimally, a 3D pattern of a nude woman was divided into blocks and different reduction rates were applied to blocks around the outlines of the breast. Two types of 3D patterns were developed. The first, referred to as the 'basic 3D pattern' provided for the curved surface of the breast point to be maintained with the remaining slack distributed evenly along the neckline, armhole and side seam. The second, referred to as the '1/3 shoulder moved 3D pattern' ignored the curved nature of the breast point by overlapping, with the resulting position of the shoulder strip moved toward the center. Three women of corresponding size and body shape evaluated the two 3D pattern designs as well as the conventional 2D pattern style of swimsuit. Respondents rated the'the basic 3D pattern' design highest in terms of stability and easy of movement in the chest region.

Male and female Texel (Tex, n = 130) and Scottish Blackface (SBF, n = 103) lambs were grazed together on low-ground pastures from birth to slaughter. Lambs were scanned using computer tomography (CT) on a maximum of four occasions during the growth period: at approximately 8, 11 and 16 weeks of age and pre-slaughter, which occurred in five batches over a 12-week period. The aim was to investigate the use of in vivo CT scanning over the growth period (from ca. 15 to 45 kg live weight, corresponding to an age of ca. 40 to 200d) to study changes in carcass traits and their relationships during growth, in two contrasting breeds. Relationships among CT traits and between CT traits and live weight were investigated within breed, to assess changes with growth. Increased live weight was associated with increases in total fat proportion, fat:muscle ratio, muscle:bone ratio, loin muscle area and proportion of fat in the chest region, in both breeds. Two-dimensional muscle shape (depth:width ratio) in the hind leg (HL S ) and the loin (LM S ), and proportion of muscle in the loin also increased with live weight in Tex lambs. Live weight was negatively associated with proportion of fat in the leg in both breeds, and with HL S , LM S and CT fat density in SBF lambs. Similar trends between CT traits and total fat proportion suggest that associations hold for increasing maturity, as well as size. The results suggest that slaughtering SBF lambs at lighter weights will avoid them becoming over-fat, maintain overall muscle proportion at a higher level and lead to rounder muscle shapes in the hind leg and loin. However, Tex lambs can be slaughtered at heavier weights without becoming over-fat, and this will result in a higher proportion of muscle being deposited in the economically important loin area, and the muscles in the loin and hind leg being rounder in cross-section. CT scanning lambs during growth allows accurate composition and muscle shape measurements on large numbers of lambs at different stages of development and can help understand the developmental patterns of different economically important sheep breeds. This knowledge can aid in management decisions to improve carcass quality at slaughter. Further work is now needed to examine the genetic background to the relationships between traits presented in this study, and their changes with growth, to allow the incorporation of such CT traits into selection programmes for different sheep breeds.

Death due to ice pick injury rarely reported in forensic literature. We report death of a 16-year old male, who was allegedly assaulted on chest, back and thigh by his school-mate, with an ice pick. The accused had got the ice pick from his father's ice shop to attack the victim. The multiple stabs to the chest region had perforated the lung and penetrated the heart chambers. The victim succumbed to death on the way to hospital and medico-legal autopsy was conducted. The injuries inflicted by the ice pick are highlighted and its pattern is discussed in this article, owing to the peculiar nature of the wounds produced by the ice-pick.

Errors in dose calculation by treatment planning computers are known to arise when calculation algorithms do not account for electron disequilibrium near interfaces between tissues of different density. The accuracy of a treatment planning system (Plato, Nucletron International BV) was investigated for two treatments in the chest region: tangential 6MV photons to the chest wall and opposed AP-PA 18MV photon fields to the mediastinum. Thermo-luminescent dosimeters were used to measure dose at 40 sites in the chest of a humanoid phantom (Rando, Alderson Associates). Measurements were compared with point doses calculated using two different versions of the Plato external beam calculation software: RTS 1.8 and the newer RTS 2.2. Measured and calculated doses differed by 3% or more at more than one quarter of all sites. The greatest discrepancies occurred for points located in lung, which were generally over-estimated. The maximum discrepancies for the 6MV tangential breast irradiation were 8.5% for RTS 1.8 and 3.5% for RTS 2.2. For the 18MV opposed field irradiation, the maximum discrepancies were 11.4% and 8.1% respectively. RTS 2.2 was more accurate than RTS 1.8, with smaller mean and maximum discrepancies.

Background and purpose : In-vivo dosimetry is vital to assure an accurate delivery of total body irradiation (TBI). In-vivo lung dosimetry is strongly recommended because of the risk of radiation-induced interstitial pneumonia (IP). Here we report on our 5-year experience with in-vivo dosimetry using diodes in combination with portal films and assessing the effectiveness of in-vivo dosimetry in improving the accuracy of the treatment. Moreover, we wished to investigate in detail the possibility of in-vivo portal dosimetry to yield individual information on the lung dose and to evaluate the impact of CT planning on the correspondence between stated and in-vivo measured doses. Materials and methods : From March 1994 to March 1999, 229 supine-positioned patients were treated at our Institute with TBI, using a 6 MV X-rays opposed lateral beam technique. 146 patients received 10 Gy given in three fractions, once a day (FTBI), shielding the lungs by the arms; 70 received 12–13.2 Gy, given in 6–11 fractions, 2–3 fractions per day (HFTBI): in this case about 2/3 of the lungs were shielded by moulded blocks (mean shielded lung dose equal to 9 or 9.5 Gy). Thirteen patients received 8 Gy given in a single fraction (SFTBI, lung dose: 7 Gy). For all HFTBI and FTBI patients, midline in-vivo dosimetry was performed at the first fraction by positioning two diodes pairs (one at entrance and one at the exit side) at the waist (umbilicus) and at the pelvis (ankles). If at least one of the two diodes doses (waist-pelvis) was outside ±5% from the prescribed dose, actions could be initiated, together with possible checks on the following fractions. Transit dosimetry by portal films was performed for most patients; for 165 of them (117 and 48, respectively for FTBI and HFTBI) the midline in-vivo dose distribution of the chest region was derived and mean lung dose assessed. As a CT plan was performed for all HFTBI patients, for these patients, the lung dose measured by portal in-vivo dosimetry was compared with the expected value. Results : Concerning all diodes data, 528 measurements were available: when excluding the data of the first fraction(s) of the patients undergoing corrections ( n =392), mean and SD were respectively 0.0% and 4.5% (FTBI: −0.3±4.8%; HFTBI: 0.4±3.9%). In total 105/229 patients had a change after the first fraction and 66/229 were controlled by in-vivo dosimetry for more than one fraction. Since January 1998 a CT plan is performed for FTBI patients too: when comparing the diodes data before and after this date, a significant improvement was found (i.e. rate of deviations larger than 5% respectively equal to 30.7% and 13.1%, P =0.007). When considering only the patients with a CT plan, the global SD reduced to 3.5%. Concerning transit dosimetry data, for FTBI, the mean (midline) lung dose was found to vary significantly from patient to patient (Average 9.13±0.81 Gy; range 7.4–11.4 Gy); for the HFTBI patients the mean deviation between measured and expected lung dose was 0.0% (1 SD=3.8%). Conclusions : In vivo dosimetry is an effective tool to improve the accuracy of TBI. The impact of CT planning for FTBI significantly improved the accuracy of the treatment delivery. Transit dosimetry data revealed a significant inter-patient variation of the mean lung dose among patients undergoing the same irradiation technique. For patients with partial lung shielding (HFTBI), an excellent agreement between measured and expected lung dose was verified.

We propose a method to observe cardiac beat from 3D shape information of body surface by using grid-based active stereo, and report preliminary experiments to evaluate validities of the proposed method. By comparing results of our proposed with those of electrocardiogram ECG, we confirmed sufficient correspondences between peak intervals of inter-frame depth changes measured by the active stereo and R-R intervals measured by ECG. We tried the visualization of the spatial distribution of inter-frame depth change plotted on the 3D shape of chest region. And, the shape change by cardiac beat is mainly found on the left side of the chest region.

Gunshot trauma is an important, but often overlooked, avenue for interpreting the historic past. Ten skeletons of Seventh Cavalry troopers, killed during the Battle of the Little Bighorn in 1876, are analysed osteologically. Six of the ten specimens have gunshot wounds, including three to the cranial vault. The other wounds are to postcranial remains, including one in an innominate. This wound location aids the identification of the individual, confirming and complementing historic accounts. Of the remaining two, one is to the humerus and the other to the chest region. These wounds provide insights into the nature of perimortem injuries, weapons used in the battle, and interpretations of the battle.

Purpose: Inconsistency in the scan range for a given protocol can be a source of variability in patient dose. The purpose of this study was to determine the variability in the over-scan length in clinical CT operation for chest and abdominopelvic (A&P) protocols. Methods: A total of 51 abdomen-pelvis and 121 chest CT exams were randomly selected from our clinical database. A commercial dose monitoring solution was used to extract and database the total exposure area and the geometrical information related to automatically-segmented anatomical landmarks for each target region. The data were exported off-line for the statistical analysis. The over-scan length (delta) was calculated as the difference between the real scanned length and ideal scanning length based on the anatomical landmarks for each target region. Results: The mean delta for abdomen-pelvis exams was 12 mm (median 8 mm; min −191 mm; max 158 mm; standard deviation 71 mm). The average delta values at the interfaces with the chest and lower extremity regions were 69 mm and −57 mm, respectively. For chest exams, the average delta was 91 mm (median 93 mm; min 36 mm; max 190 mm; standard deviation 29 mm), and the average delta values at interfaces with the neck and abdomen regions were 26 mm and 65 mm, respectively. The percentage delta mean related to the abdomen-pelvis and chest lengths were 3% and 45%, respectively. Conclusion: Although there is greater over-scan in the chest region, there is considerably more variability in the over-scan area for abdomen-pelvis exams. Estimation of the over-scan length must be included in the effective dose estimates, which uses different coefficients for different target region (ICRP 102). Furthermore, knowledge of over-scan lengths and variability can guide steps to improve clinical consistency and operation.

To compare simple and sophisticated evaluation strategies for CT dosimetry surveys with focus on DRLs.Based on data from a nationwide Austrian CT dose survey, different evaluation strategies are compared. These were pooled data analysis, weight banding excluding data from patients with weights outside ±20 kg of the standard weights (70 and 75.6 kg representing the actual average weight), and a regression method estimating DLP probability distributions for the standard patient for each scanner before calculating quartiles.In the abdomen and chest region, weight restriction (-9% and -4% around 70 and 75.6 kg, respectively, compared to pooled data analysis) and statistically weighting each scanner equally (-9%) have the largest effect on DRLs derived. However, the difference in 3rd quartiles calculated using weight restriction alone compared to regression analysis is relatively small (1% for 70 ± 20 and -6% for 75.6 ± 20 kg, respectively, trunk region). In the head/neck region the effect of weight restriction is less than in for scans of the trunk (-1.3% and -0.2%, respectively); the most prominent changes resulted from excluding scanners with less than 10 patient cases (-5%), and equally weighting scanners rather than cases (-3%).For adult CT examinations (different to a paediatric survey), quite simple evaluation strategies yield results very comparable to those from sophisticated strategies.

1. 1. Eight male Japanese Brazilians and 11 male Japanese volunteered for this study. Each one sat on a chair for 45 min at 40°C (r.h. 50%). 2. 2. Then, they exercised using a bicycle ergometer in a semi-reclining position for 45 min at 40% of maximal oxygen uptake. 3. 3. Thermal and comfort sensation confirmed that Japanese Brazilians felt cooler and more comfortable in 40°C environment than the Japanese. 4. 4. Oxygen uptake, sweat rate and body weight loss for both groups were not significantly different. 5. 5. Forearm blood flow and heart rate for Brazilians were significantly lower than those for Japanese. 6. 6. Skin temperature at chest region for Brazilians was found to be significantly higher than that for Japanese. 7. 7. Thus the thermoregulatory responses observed in Japanese Brazilians may be largely attributed to the climate in their native places located on the Tropic of Capricorn. 8. 8. These results may indicate that environment condition is the important factor in determining the thermoregulatory responses.

With development of endoscopic surgery and medical robotics, surgery using endoscope robots has become a representative of robotic surgery. This chapter describes classification, design methods and evaluation methods of endoscope robots. Expectations for a minimally invasive surgery have increased year by year with the dramatic advancement of image diagnosis technology, including CT and MRI. A camera (endoscope) and surgical instruments are inserted into tiny holes made in the patients’ abdomen or chest region for surgical procedures. Compared to abdominal or open chest surgery, endoscopic surgery has less pain and has a greater advantage in cosmetic appearance as well as the economic advantages, resulting in its growing popularity. The most distinctive feature of endoscopic surgery is that the surgical field is observed through images taken by an endoscope, rather than the naked eye. The most important element to surgical safety and efficient operating is how well an endoscope reveals the field of view during surgery. Generally, a camera assistant operates the endoscope. The operation of the endoscope needs fine adjustment for the angle of the field of view and the distance of the surgical area as well as correct aiming of the endoscope at the surgical field. Camera assistants sometimes operate the endoscope according to instructions of a surgeon; however, camera assistants need to operate the endoscope using their judgment in understanding the surgeon’s intentions so that they can move the endoscope according to how the surgery is progressing moment to moment. The operation of an endoscope by camera assistants requires as much proficiency as that of surgeons. There are not many surgeons who have sufficient proficiency in endoscopic surgery, which requires special techniques. In fact, it is not unusual for surgery to be interrupted due to a camera assistant not being sufficiently proficient in using the endoscope and is unable to obtain the exact field of surgery required. To solve this problem, "endoscope robots that can hold and position an endoscope instead of a human camera assistant" (Fig. 1) have been developed. Fig. 1(a) shows a usual endoscopic

Eight male Japanese Brazilians (20-32 yrs) and 11 male Japanese (22-24 yrs) volunteered for this study. The Brazilians had been staying for about 2-21 weeks in Japan. Their physical characteristics are not significantly different from those of the Japanese. Each one of them sat on a chair for 45 min at 40 degrees C (R.H. 50%) in a climatic chamber. Then, they exercised using a bicycle ergometer in a semi-reclining position for 45 min at 40% of maximal oxygen uptake. Forearm blood flow (FBF), oxygen uptake (VO2), heart rate (HR), skin temperature (Tsk), sweat rate (SR) at chest region and body weight loss (delta Wt) were measured. Thermal sensation and thermal comfort were also measured. Thermal and comfort sensation confirmed that Japanese Brazilians felt cooler and more comfortable in 40 degrees C environment than the Japanese. VO2, SR and delta Wt for both groups were not significantly different. FBF and HR for Brazilians were significantly lower than those for Japanese. Tsk at chest region for Brazilians was found to be significantly higher than that for Japanese. Thus the thermoregulatory responses observed in Japanese Brazilians may be largely attributed to the climate in their native places located on the Tropic of Capricorn.

Computerized tomography scans of a ferruginous concretion within the chest region of an ornithischian dinosaur reveal structures that are suggestive of a four-chambered heart and a single systemic aorta. The apparently derived condition of the cardiovascular system in turn suggests the existence of intermediate-to-high metabolic rates among dinosaurs.

A mausoleum of a Japanese feudal Lord, Lord Tadamune Date (1599–1658) was excavated in 1981. His body had been buried in an underground stone chamber in a sitting posture and his coffin was packed with lime. It appeared that his body was almost completely skeletonized. A considerable amount of mercury used for the burial was also found. During the course of the osteological investigation, part of the soft tissue from his chest region was found. Gross anatomically, the tissue was identified as pieces of the human thoracic viscera. Immuno-electrophoresis detected human albumin in this tissue. Electron microscopy showed it contained dense connective tissue composed of fibrous structures suggestive of collagen fibrils. Since the soil in Japan is quite unfavourable for the preservation of organic matter even skeletons are rarely discovered after being buried for a long time. The present case is remarkable because part of the soft tissue was preserved for more than 320 years without special treatment. The coexistence of mercury is concluded as the cause of this exceptionally long preservation of the soft tissue.

In many clinical application, the monitoring of heart and lung activity is of vital importance. State of the art monitoring implies the use of electrodes or other contact based sensors (electrocardiogram (ECG), impedance cardiography (ICG), pulse oximetry or equivalent).Hereby, side effects like skin irritation, difficult application or additional cabling may occur. As known from bioimpedance application, heart and lung activity can be monitored by impedance fluctuations within the chest region. This paper ppresents an extensible multichannel simultaneos magnetic induction Tomography Measurement (Mussimitos), which is especially suited for contact-less monitoring of repeated fast impedance changes and allows a simultaneous measurement of more than 12 channels. In addition to an overall system description, special focus is given to the dynamic behavior and bandwidth requirements of heart and lung activity monitoring. Additionally, performance specifications and first in vivo results are presented.

We have developed a patient dosimetry tool that will permit the optimization of image quality in CT. Published Monte Carlo CT dosimetry data were used to generate values of the energy imparted to an anthropomorphic phantom undergoing head and body CT examinations. Energy imparted factors E 5,n were computed for irradiation of 5 mm thick slabs of the anthropomorphic phantom, which were normalized to the free-in-air dose to muscle at the CT isocenter obtained in the absence of any phantom or patient. Calculations of E 5,n were obtained for CT scanners from five vendors and for 208 contiguous slabs of the anthropomorphic phantom ranging from the top of the head to the upper leg region. Values of E 5,n were relatively constant in the abdomen and chest region, but there was a large inter-scanner variability, with a mean of 170 ± 50 mJ/Gy for five vendors when E 5,n values were averaged over the whole trunk. The mean E 5,n for the neck region was 100 ± 20 mJ/Gy, which increased to 110 ± 30 mJ/Gy for the head region. Adding 0.25 mm Cu filtration increased the value of the normalized energy imparted value E 5,n by an average of 24%. Relative to 100 kVp, increasing the x-ray tube voltage by 20 and 30 kVp increased the normalized energy imparted value E 5,n by 10% and 14%, respectively. Patient energy imparted is useful for studying optimization strategies with respect to x-ray technique factors.

In mammography it is important that the chest wall edge of the X-ray field is accurately aligned with the edge of the film in the film cassette. Too small an X-ray field (which may result in the loss of clinical informa- tion) is easily seen on the resulting image, but too large a field is less easy to detect and is potentially a source of unnecessary patient dose. This is of particular concern when mammography is being used for the screening of asymptomatic women. If the X-ray field is oversized, the scattered radiation dose to the thymus, lungs and to the fraction of the red bone marrow in the chest region will be higher. It is also possible for these organs to be partially irradiated by the primary beam if the field size is excessively large. These organs are recognized as being particularly radiosensitive and are included in the list of tissues considered when calculating effective dose (ICRP, 1990). In use, the test tool is placed on top of a fluorescent screen (an intensifying screen from an old cassette) which is in turn placed on the support table of the mammography unit so that it overlaps the chest wall edge of the table. The compression plate on the unit is removed to avoid the possibility of attenuation by the supporting structure of the plate which could lead to a false impression of the position of the X-ray field boundary. If the tool is initially positioned with its slotted edge approximately aligned with the edge of the support table along the chest wall edge, and an appropriate exposure made with the room lights dimmed, the strip of light seen from the screen will show the difference between the edge of the X-ray field and the slotted edge of the tool. The tool is moved until the light from the screen is seen only through the slots. With the tool in this posi- tion it can be stated that the zero point of the scale must be aligned to within 0.5 mm with the edge of the X-ray field. Any greater error will result in either no light being seen (test tool too far towards chest wall) or a continuous strip of light being seen (test tool too far towards nipple side). In practice it is often possible to align the field so that half the slot appears illuminated, in which case the alignment accuracy will be somewhat better than the ±0.5 mm claimed. Once the test tool has been positioned, a loaded cassette is placed in its usual position and an appropriate exposure made (taking into account the attenuation of the fluorescent screen). The resulting film will show part of the etched scale. The amount cut off the scale (if any) will correspond to the distance that the X-ray field extends towards the chest wall beyond the edge of the film. The geometrical scaling between the plane of the test tool and that of the film for the unmagnified case is approximately 3% on most mammography units and can be ignored in practice. The method can be applied to magnification mammo- graphy, in which case the direct scale reading will give the field alignment in the magnification plane. A correc- tion for the geometrical scaling of the imaged millimetre scale is required to give the equivalent measurement at the plane of the film. The test tool may also be used to measure the alignment of the other sides of the X-ray field should this be necessary.

Key Clinical Message A 55-year-old man of dark complexion presented with multiple extensive swellings over the chest, right upper arm, and left shoulder for 10 years. Swellings were hyperpigmented, firm, and intensely pruritic especially over the chest region. The swellings progressed in size, extended, and developed satellite lesions over its 10 years history.

In this work the investigations of the electrical field generated by the heart, carried out using a computer simulation method are presented. Two models have been constructed approximating the chest region for the following conditions: (a) normal heart activity, and (b) open chest during the cardiac surgery. For the above models the distribution of potentials on the heart surface are determined. The source field investigated takes the following forms: dipole, multidipole, and multipole. Numerical experiments for these models show a difference between normal heart activity and of the heart in the condition when the chest is open during surgery.

particularly important in causing melanoma and we have reported the results of large-scale studies of the outdoor ultraviolet (UV) exposure in schoolchildren in England and Queensland. In the English study, 90 primary schoolchildren (aged 9–10 years) were monitored with UV-sensitive polysulphone film badges over a 3-month period from midApril to mid-July, 1994, in Durham (55°N), Wallingford (51°N), and Plymouth (50°N). Corresponding monitoring in Queensland took place in 112 schoolchildren (aged 11–12 years) over a 2-week period at each site from late spring to early autumn during 1991/92 in Brisbane (27°S), Toowoomba (27°S), and Mackay (21°S). Badges were attached to clothing in the shoulder/chest region. Participants were instructed not to cover badges by clothing, and to transfer badges whenever clothing was changed. Ambient UV radiation was monitored throughout the study periods at all sites in England and Queensland. The average diurnal ambient values recorded were 14 SED (Durham), 19 SED (Wallingford), and 16 SED (Plymouth); 22 SED (Toowoomba), 38 SED (Mackay), and 54 SED (Brisbane). (The SED [standard erythema dose] is a measure of sunburning radiation: minimum erythema on the unacclimatised skin of subjects who always burn and never tan would require an exposure of about 1·5 SED, whereas in people who tan easily and rarely burn, an exposure of about 6 SED would be needed to cause minimum erythema). Although the studies were planned and executed independently and at different times, in both studies children were monitored whilst at school and at weekends, and remained in the vicinity of the radiometer sites throughout the monitoring periods. Polysulphone film photodegrades on exposure to UV and will saturate if over-exposured. Because of differences in ambient UV between Queensland and England, new badges were worn by the Australian children on each day of the monitoring period, whilst in England each child wore two badges per week, one badge Monday to Friday and another badge on Saturday and Sunday. This methodological difference ensured that badges worn by all children in the study received insufficient UV to saturate their response. In each study about 40% of badges were either not returned or rejected due to damage. Missing badges were distributed fairly evenly across all locations and both sexes minimising the likelihood of bias in the reported results. Frequency histograms of daily exposures received by the children in each study are shown in the figure. Whilst the RESEARCH LETTERS