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The present report describes a case of successful chemoembolization via the right inferior phrenic artery (RIPA) in a patient with hepatocellular carcinoma and celiac stenosis due to the median arcuate ligament sling. The RIPA, which was not visualized on celiac angiography obtained at full expiration, was evidently visualized on angiography performed at full inspiration, followed by successful catheterization. Angiography at full inspiration can visualize and facilitate the catheterization of the RIPA in patients with celiac stenosis due to the median arcuate ligament sling.

Lan Song,1,* Jonas A Leppig,2,* Ralf H Hubner,3 Bianca C Lassen-Schmidt,4 Konrad Neumann,5 Dorothea C Theilig,2 Felix W Feldhaus,2 Ute L Fahlenkamp,2 Bernd Hamm,2 Wei Song,1 Zhengyu Jin,1 Felix Doellinger2 1Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China; 2Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany; 3Department of Internal Medicine/Infectious Diseases and Respiratory Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany; 4Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany; 5Institute of Biometrics and Clinical Epidemiology, Charité Universitätsmedizin Berlin, Berlin, Germany*These authors contributed equally to this workCorrespondence: Zhengyu JinDepartment of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Dongcheng District, Beijing, People’s Republic of ChinaTel +86 10 69 155 439Fax +86 10 69 155 058Email jinzy@pumch.cnPurpose: The aim of this retrospective study was to evaluate correlations between parameters of quantitative computed tomography (QCT) analysis, especially the 15th percentile of lung attenuation (P15), and parameters of clinical tests in a large group of patients with pulmonary emphysema.Patients and Methods: One hundred and seventy-two patients with pulmonary emphysema and chronic obstructive pulmonary disease (COPD) global initiative for chronic obstructive lung disease (GOLD) stage 3 or 4 were assessed by nonenhanced thin-section CT scans in full inspiratory and expiratory breath-hold, pulmonary function test (PFT), a 6-minute walk test (6MWT), and quality of life questionnaires (SGRQ and CAT). QCT parameters included total lung volume (TLV), total emphysema score (TES), and P15, all measured at inspiration (IN) and expiration (EX). Differences between inspiration and expiration were calculated for TLV (TLVDiff), TES (TESDiff), and P15 (P15Diff). Spearman correlation analysis was performed.Results: CT-measured lung volume in inspiration (TLVIN) correlated strongly with spirometry-measured total lung capacity (TLC) (r=0.81, p< 0.001) and moderately to strongly with residual volume (RV), forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV1)/FVC (r=0.60, 0.56, and − 0.49, each p< 0.001). Lung volume in expiration (TLVEX) correlated moderately to strongly with TLC, RV and FEV1/FVC ratio (r=0.75, 0.66, and − 0.43, each p< 0.001). TES and P15 showed stronger correlations with the carbon monoxide transfer coefficient (KCO%) (r= − 0.42, 0.44, both p< 0.001), when measured during expiration. P15Diff correlated moderately with KCO% and carbon monoxide diffusing capacity (DLCO%) (r= 0.41, 0.40, both p< 0.001). The 6MWT and most QCT parameters showed significant differences between COPD GOLD 3 and 4 groups.Conclusion: Our results suggest that QCT can help predict the severity of lung function decrease in patients with pulmonary emphysema and COPD GOLD 3 or 4. Some QCT parameters, including P15EX and P15Diff, correlated moderately to strongly with parameters of pulmonary function tests.Keywords: chronic obstructive pulmonary disease, pulmonary emphysema, quantitative CT, pulmonary function test

Purpose: The aim of this retrospective study was to evaluate correlations between parameters of quantitative computed tomography (QCT) analysis, especially the 15th percentile of lung attenuation (P15), and parameters of clinical tests in a large group of patients with pulmonary emphysema. Patients and Methods: One hundred and seventy-two patients with pulmonary emphysema and chronic obstructive pulmonary disease (COPD) global initiative for chronic obstructive lung disease (GOLD) stage 3 or 4 were assessed by nonenhanced thin-section CT scans in full inspiratory and expiratory breath-hold, pulmonary function test (PFT), a 6-minute walk test (6MWT), and quality of life questionnaires (SGRQ and CAT). QCT parameters included total lung volume (TLV), total emphysema score (TES), and P15, all measured at inspiration (IN) and expiration (EX). Differences between inspiration and expiration were calculated for TLV (TLVDiff), TES (TESDiff), and P15 (P15Diff). Spearman correlation analysis was performed. Results: CT-measured lung volume in inspiration (TLVIN) correlated strongly with spirometry-measured total lung capacity (TLC) (r=0.81, p< 0.001) and moderately to strongly with residual volume (RV), forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV1)/FVC (r=0.60, 0.56, and − 0.49, each p< 0.001). Lung volume in expiration (TLVEX) correlated moderately to strongly with TLC, RV and FEV1/FVC ratio (r=0.75, 0.66, and − 0.43, each p< 0.001). TES and P15 showed stronger correlations with the carbon monoxide transfer coefficient (KCO%) (r= − 0.42, 0.44, both p< 0.001), when measured during expiration. P15Diff correlated moderately with KCO% and carbon monoxide diffusing capacity (DLCO%) (r= 0.41, 0.40, both p< 0.001). The 6MWT and most QCT parameters showed significant differences between COPD GOLD 3 and 4 groups. Conclusion: Our results suggest that QCT can help predict the severity of lung function decrease in patients with pulmonary emphysema and COPD GOLD 3 or 4. Some QCT parameters, including P15EX and P15Diff, correlated moderately to strongly with parameters of pulmonary function tests.

The aim of this study was to evaluate the ability of experienced thoracic radiologists to assess full inspiration based on two CT slices, one above and one below the carina, in normal subjects. Ten healthy volunteers were studied. Total lung capacity (TLC) was measured with a body plethysmograph. High-resolution computed tomography (HRCT) was performed in two slices at TLC and at various expired volumes. Mean Hounsfield values (HU) were calculated. Unidentifiable images, stored on a web server, were analysed visually by experienced thoracic radiologists. The results show that the mean lung density at TLC varied by approximately 40 HU between individuals. Within an individual this may correspond to a decrease in lung volume of approximately 25% of TLC. On visual determination of images taken at 65-74% of TLC, more than one-third of the images were assessed as taken at full inspiration; of the images taken at 75-84% of TLC, approximately 50% were assessed as taken at full inspiration. We conclude that visual determination of full inspiration on CT images in normal subjects is highly inaccurate. If quantitative density measurements are to be used in the diagnosis or follow-up of lung disease, thorough control of full inspiration is recommended.

The aim of the study was to measure the single-breath diffusing capacity of the lung for carbon monoxide (D(LCO)sb) in healthy subjects in the following two conditions originally proposed by the American Thoracic Society (ATS) guidelines: relaxation against the shutter; and full inspiration without straining.D(LCO)sb was measured in 76 young adults in duplicate, in the two conditions. Mouth pressure was recorded during all of the trials.The mean (+/- SD) value of the duplicate D(LCO)sb measurements was higher when measured with the patient in the nonrelaxed condition than in the relaxed condition (32.65 +/- 7.65 vs 31.54 +/- 7.11 mL/min/mm Hg, respectively; p0.001). The mean effective alveolar volume measured during the single-breath maneuver (VAeff) was also higher in the nonrelaxed condition (VAeff: nonrelaxed condition, 5,779 +/- 1,093 mL; relaxed condition, 5,596 +/- 1,097 mL; p0.001), at least as a consequence of a higher inspiratory volume (Vin) in the nonrelaxed condition (nonrelaxed condition, 4,378 +/- 900 mL; relaxed condition, 4,232 +/- 902 mL; p0.001). Asking the subject performing a D(LCO)sb maneuver to relax on the shutter during apnea lowers the D(LCO)sb value by approximately 3.4% in comparison to full inspiration without straining, at least in part because it results in a reduced Vin.These data lend further support to the new European Respiratory Society/ATS Task Force recommendations (full inspiration maintained with near atmospheric intrapulmonary pressure).

The study was conducted to develop a simple model for more robust lung registration of volumetric CT data, which is essential for various clinical lung analysis applications, including the lung nodule matching in follow up CT studies, semi-quantitative assessment of lung perfusion, and etc. The purpose of this study is to find the most effective reference point and geometric model based on the lung motion analysis from the CT data sets obtained in full inspiration (In.) and expiration (Ex.). Ten pairs of CT data sets in normal subjects obtained in full In. and Ex. were used in this study. Two radiologists were requested to draw 20 points representing the subpleural point of the central axis in each segment. The apex, hilar point, and center of inertia (COI) of each unilateral lung were proposed as the reference point. To evaluate optimal expansion point, non-linear optimization without constraints was employed. The objective function is sum of distances from the line, consist of the corresponding points between In. and Ex. to the optimal point x. By using the nonlinear optimization, the optimal points was evaluated and compared between reference points. The average distance between the optimal point and each line segment revealed that the balloon model was more suitable to explain the lung expansion model. This lung motion analysis based on vector analysis and non-linear optimization shows that balloon model centered on the center of inertia of lung is most effective geometric model to explain lung expansion by breathing.

The alteration ratio of lung field CT numbers in different respiratory phases was studied in 52 patients with chronic pulmonary obstructive disease (COPD) and 20 subjects with normal lung. The 52 patients with COPD consisted of 30 with clinically diagnosed chronic pulmonary emphysema (CPE), 15 with suspected CPE (sCPE) and seven with bronchial asthma (BA). The 20 subjects with normal lung were divided into two groups according to age. CT images were obtained in each case under different respiratory conditions, i.e., full inspiration and end expiration. The following parameters were employed for numerical evaluation: %(I-E)Apex = (MLDApexI-MLDApexE/MLDApexE x 100 %(I-E)Mid = (MLDMidI-MLDMidE)/MLDMidE x 100 %(I-E)Base = (MLDBaseI-MLDBaseE)/MLDBaseE x 100 %(I-E)Whole = (MLDWholeI-MLDWholeE)/MLDWholeE x 100 where MLD is mean lung density and the letters I and E stand for full inspiration and end expiration, respectively. The small letters Apex, Mid, Base and Whole stand for apex cut, mid-thorax cut, base cut and whole lung, respectively. The values of %(I-E)Whole were significantly different between disease groups except for those between the sCPE and BA groups. The values of %(I-E)Whole showed a good positive correlation with FEV1.0% (r = 0.79) and V25/H (r = 0.80) and a good negative correlation RV/TLC (r = -0.75). Diagnostic differentiation of COPDs by %(I-E)Whole values identified 80% of CPE cases and 91% of normal lung cases. In the sCPE group, the values of %DLco in patients with %(I-E)Whole above 9% were smaller than those in patients with %(I-E)Whole under 9%.(ABSTRACT TRUNCATED AT 250 WORDS)

Posteroanterior and lateral radiographs of the lungs of 30 normal adults were obtained at total lung capacity (TLC) and 1 sec after initiation of forced expiration from ttlc. simultaneous spirographic recording of the volume expired (FEV-1) and independent plethysmographic recording of TLC were obtained. Two types of measurements were made from the radiographs: 1) surface areas of the lung fields, measured planimetrically; and 2) combinations of linear distances between selected points. These radiographic measurements and the measured lung volumes were subjected to computer analysis to develop reliable formulas for determining lung volumes solely from radiographs. Formulas derived using planimetry produced multiple correlation coefficients of 0.95 for TLC and 0.89 for volume during forced expiration. Use of linear measurements produced multiple correlation coefficients of 0.92 for TLC and 0.84 for dynamic volume. Thus, in normal subjects, static lung volumes and lung volumes during dynamic forced expiration can be determined from radiographs.

The application of CNNs in medical image analysis has assumed a pivotal role, despite constraints related to the large amount of labeled data required. The aim of this study is to present a CNN for recognition and quantification of ILD patterns and to evaluate their correlations to functional data. 27 patients with chronic hypersensitivity pneumonitis (FEV1%p=61.6±15.9, FVC%p=57.0±16.8) were acquired via HRCT at full inspiration. The CNN (6 layers: 2 convolutional, 1 average pooling, 3 fully connected) was trained and tested on 395 regions of interest (ROIs) identified by one experienced pneumologist on the CT images resulting in a test accuracy=0.816, F1-score=0.810. The CNN was then applied to the patients’ full scans. 5 ILD patterns were analyzed: air trapping (AT), consolidation (C), ground glass opacity (GGO), healthy (H) and reticulation (R). The percentage of ILD tissue (ILD%) on the whole volume was correlated (Spearman Test) to spirometry. Fig. 1 reports CNN results on a representative patient. In the overall population, negative correlation was found between ILD% and FVC%p (r=-0.436, p In conclusion, the proposed CNN allows the recognition of ILD with significant correlations to functional data. The classification of pathological ROIs into different ILD patterns may represent a first step towards the development of a computer aided diagnosis system.

Background: Tuberculosis is one of the biggest public health concerns in India with a prevalence of 195 cases per 100000. Silica is cytotoxic to macrophage which is primary defense mechanism to tubercular bacilli and, hence, exposure to silica dust increases risk for TB. Silica exposed persons are at 2.8 to 39 times greater risk of affected by pulmonary tuberculosis in comparison to healthy subjects. Methodology: A cross-sectional epidemiological study was conducted among 935 workers in sandstone mining. Full-size posteroanterior view (PA) chest X-ray in full inspiration was evaluated and evidence of tuberculosis was noted. Fourier transform infrared spectrophotometer was used for determining the free silica in 23 dust samples. Results: 6.4% X-rays showed evidence of TB and silica dust concentration was 0.11 to 0.16 mg/m3. The TB cases significantly increased from 2% to 6% to 12.7% as the work exposure increased from 20 years respectively. 8.5% of the TB cases were seen among the workers having more than 10 years of work exposure. The odds ratio (95% CI) for work exposure more than 10 years to less than 10 years was 4.53 (1.92–10.65). Conclusion: Reduction of silica particles from work environment can significantly reduce the number of TB cases and hence wet drilling should be practiced and personal protective equipment should be regularly used.

Kirby RL, Heimrath O, Stewart A, Smith C, MacLeod DA. Effect of respiration on the static rear stability of wheelchairs. Objective To test the hypothesis that the static rear stability of an occupied wheelchair is greater during full inspiration than expiration. Design Within-subject comparisons. Setting Rehabilitation center. Participants Able-bodied participants (N=10). Intervention None. Main Outcome Measures We measured the static rear stability (brakes unlocked) of an occupied wheelchair on a test platform according to International Organization for Standardization standards. We also used the Exhalation Threshold Test. The Exhalation Threshold Test was positive if, having been positioned at the maximum degree of platform tilt needed to maintain stability during full inspiration, the wheelchair tipped backward when the participant exhaled. Results The mean static rear stability values at full inspiration and expiration ± SD were 16.5°±2.3° and 16.1°±2.4°, with a mean difference of .46°±.24° (3%; P=.002). The Exhalation Threshold Test was positive in 19 (95%) of 20 trials. Conclusions Respiration has a slight but statistically significant effect on the rear stability of occupied wheelchairs, with greater stability at full inspiration. This has potential clinical implications for stability testing and the training of wheelchair skills, but further study is needed.

Background— The number of implantable cardioverter-defibrillators (ICDs) for the prevention of sudden cardiac death is continuing to increase. Given the technological complexity of ICDs, it is of critical importance to identify and control possible harmful electromagnetic interferences between various sources of electromagnetic fields and ICDs in daily life and occupational environments. Methods and Results— Interference thresholds of 110 ICD patients (1-, 2-, and 3-chamber ICDs) were evaluated in a specifically developed test site. Patients were exposed to single and combined electric and magnetic 50-Hz fields with strengths of up to 30 kV·m −1 and 2.55 mT. Tests were conducted considering worst-case conditions, including maximum sensitivity of the device or full inspiration. With devices being programmed to nominal sensitivity, ICDs remained unaffected in 91 patients (83%). Five of 110 devices (5%) showed transient loss of accurate right ventricular sensing, whereas 14 of 31 (45%) of the 2- and 3-chamber devices displayed impaired right atrial sensing. No interference was detected in 71 patients (65%) within the tested limits with programming to maximum sensitivity, whereas 20 of 110 subjects (18%) exhibited right ventricular disturbances and 19 of 31 (61%) subjects exhibited right atrial disturbances. Conclusions— Extremely low-frequency daily-life electromagnetic fields do not disturb sensing capabilities of ICDs. However, strong 50-Hz electromagnetic fields, present in certain occupational environments, may cause inappropriate sensing, potentially leading to false detection of atrial/ventricular arrhythmic events. When the right atrial/right ventricular interferences are compared, the atrial lead is more susceptible to electromagnetic fields. Clinical Trial Registration— URL: http://clinicaltrials.gov/ct2/show/NCT01626261 . Unique identifier: NCT01626261.

In this paper, we propose a non-rigid registration method of lung parenchyma in temporal chest CT scans using region binarization modeling and locally deformable model. To cope with intensity differences between CT scans, we segment the lung vessel and parenchyma in each scan and perform binarization modeling. Then, we match them without referring any intensity information. We globally align two lung surfaces. Then, locally deformable transformation model is developed for the subsequent non-rigid registration. Subtracted quantification results after non-rigid registration are visualized by pre-defined color map. Experimental results showed that proposed registration method correctly aligned lung parenchyma in the full inspiration and expiration CT images for ten patients. Our non-rigid lung registration method may be useful for the assessment of various lung diseases by providing intuitive color-coded information of quantification results about lung parenchyma.

To present the experience of pediatric percutaneous nephrolithotomy (PCNL) of our center.This study was conducted from 1995 to 2015, on patients15 years of age having renal and upper ureteral stones who underwent PCNL. Stones were classified as per Guy's stone score (GSS). Standard bull's eye technique was used for subcostal puncture. To avoid supracostal puncture, puncture was done in full inspiration or by oblique tract. If these maneuvers failed, then supracostal puncture was done. Tract was dilated to 24F.Six hundred sixty PCNLs were performed on 639 patients. Puncture was subcostal in 87.6% cases with tract dilated as much as 24F. Pelvicaliceal system was most commonly accessed through middle calix (73.94%). Upper caliceal puncture (23.78%) was more frequently used in complete (82.35%) and partial staghorn (51%) stones. Two tracts were made in 16 (2.42%) cases, because of large stone burden. Average operative time was significantly longer in complex (45.43 minutes) compared to simple stones (29.39 minutes). Overall success rate was 94.39%, but it was significantly lower in partial (91.37%) and complete staghorn stones (82.35%). Complications were present in 21.66% cases and were classified according to Clavien grading. Majority of patients (97.9%) had minor complications (Clavien grade 12). On multivariate analysis, GSS ≥2, stone size200 mmPCNL is a minimally invasive surgical technique for removal of renal and upper ureteral stones, which have low morbidity rate, high success rate, and short hospital stay. Although the uses of smaller instruments are on the rise, procedure can still be safely performed in children using adult instruments. Supracostal approach if done cautiously does not increase morbidity rate.