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Technology and Health Care is intended to serve as a forum for the presentation of original articles and technical notes, observing rigorous scientific standards. Furthermore, upon invitation, reviews, tutorials, discussion papers and minisymposia are featured.
The following types of contributions and areas are considered:
1. Original articles:
Technology development in medicine: New concepts, procedures and devices associated with the use of technology in medical research and clinical practice are presented to a readership with a widespread background in engineering and/or medicine.
Significance of medical technology and informatics for healthcare: The appropriateness, efficacy and usefulness deriving from the application of engineering methods, devices and informatics in medicine and with respect to public health are discussed.
2. Technical notes:
Short communications on novel technical developments with relevance for clinical medicine.
3. Reviews and tutorials (upon invitation only):
Tutorial and educational articles for persons with a primarily medical background on principles of engineering with particular significance for biomedical applications and vice versa are presented.
4. Minisymposia (upon invitation only):
Under the leadership of a Special Editor, controversial issues relating to healthcare are highlighted and discussed by various authors.
Abstract: BACKGROUND: CT images are often affected by blooming artifacts during the diagnosis that facilitate an overestimation of the expression of calcification stenosis, thereby impeding the accurate diagnosis of this condition. OBJECTIVE: Arterial calcification can act as a blooming artifact in computed tomography (CT) images, leading to overestimations of the blood vessel and the size of calcified plaque. This study proposes an improved CT post-processing method that accurately measures calcium and lumen size in blood vessels. METHODS: Six hundred and thirty calcium datasets were obtained from 63 patients diagnosed with a vascular disease. Patients…were grouped into three sets corresponding to each image acquisition method used: G1, for the invasive coronary angiography (ICA); G2, for multiplanar reconstruction (MPR) imaging and post-processing; and G3, for the novel method of mixed Gaussian filter and K-mean clustering (GK). Results of GK were generated by adding Gaussian and k-mean clustering algorithms to the MPR post-processing procedure. The analysis of variance (ANOVA), linear regression, and intraclass correlation coefficient (ICC) were used to compare the accuracy and sensitivity of the different methods. All measurements were performed multiple times to mitigate human error. RESULTS: The ANOVA test revealed no significant differences between the G1 and G3 groups. Hence, linear regression was used to analyze the correlation between the G1 and G3 groups (p < 0.05, R2 = 0.885), and a higher correlation than G1 and G2 was reported (p > 0.05, R2 = 0.432). ICC was performed for reproducibility, wherein high correlation was identified among all groups. CONCLUSIONS: Results of the study indicate that the GK method yields images that are very similar to ICA image measurements. This suggests that the GK can be used as a more effective post-processing method over the inaccurate MPR while remaining non-intrusive when determining the arterial stenosis degree, unlike the ICA.
Abstract: BACKGROUND: The coherent plane wave compounding (CPWC) is a promising technique to enhance the imaging quality while maintaining the high frame rate in the plane wave ultrasound imaging. Recently, the spatial-coherence-based method has been specially designed to process echo matrix required by the minimum variance (MV) method. OBJECTIVE: In this paper, a novel beamforming method that integrates the submatrix-spatial-coherence-based MV with the sign coherence factor (SCF) is proposed to further improve the imaging quality. METHOD: The submatrix smoothing technique is modified to smooth and de-correlate signals of the receiving array dimension. Then, the…SCF is used to modify the input vector of the beamformer, which can reduce side lobe noises with almost no increase in the amount of calculation. Simulation, phantom, in vivo , and sound velocity error experiments have been performed to verify the superiority of the proposed beamformer. RESULTS: The imaging results show that the proposed approach performs better in the imaging resolution and contrast compared to the traditional CPWC method. CONCLUSION: The robustness of the proposed method is enhanced, and the over-suppression phenomenon can be alleviated, which is a phenomenon that occurs in the original spatial-coherence and SCF methods.
Abstract: BACKGROUND: Knowledge regarding the hypothalamic nuclei is essential for understanding neuroanatomy and has substantial clinical relevance. OBJECTIVE: The aim was to contribute to elucidate the complex hypothalamic architecture for research and provide an anatomical basis for clinical brain operation. METHODS: In this research, high-resolution and true-color sectioned images from Visible Korean were employed for hypothalamic nuclei and neighboring structures surface modeling, and a high-resolution three-dimensional atlas of the hypothalamus was created. RESULTS: Surface models of 26 structures including the hypothalamic nuclei and its neighboring structures were produced, which contained 5…anterior hypothalamic areas’ nuclei, 4 intermediate hypothalamic areas’ nuclei, 3 lateral hypothalamic areas’ nuclei, and 2 posterior hypothalamic areas’ nuclei, as well as 12 hypothalamic neighboring structures. CONCLUSIONS: The study evaluated the topographical anatomy of the hypothalamic nuclei and its neighboring structures based on true-color and highresolution sectioned images of Visible Korean.
Keywords: Hypothalamus, Visible Korean, true-color, sectioned image, three-dimensional model
Abstract: BACKGROUND: According to statistics of the Ministry of Health and Welfare in 2017, the second leading cause of death in Taiwan was lung cancer. OBJECTIVE: Routine treatment planning does not consider photoneutron dose equivalent (PNDE) of patient induced secondary radiation resulting from primary exposure of lung cancer. However, such treatment is potentially important for improving estimates of health risks. METHODS: This study used 10, 30, 50, 70, and 90 kg of polymethylmethacrylate (PMMA) phantoms as patient to measure PNDE varying anatomical area during lung cancer of intensity modulated radiotherapy (IMRT) treatment. Paired thermoluminescent…dosimeters (TLD-600 and 700) were calibrated using university reactor neutrons. TLDs were inserted into phantom which was closely corresponded of the represented tissues or organs. RESULTS: Neutron doses (ND) of organ or tissue (N D T ) were determined in these phantoms using paired TLDs approach. The risks of incurring fatal secondary malignancies, maximum statistical and total errors were estimated. Evaluated PNDE ranged from 0.80 ± 0.12 to 0.56 ± 0.08 mSv/Gy for these phantoms. CONCLUSION: The estimated N D T decreased with increasing distance that is from the central axis. Evaluated PNDE and N D 𝑠𝑘𝑖𝑛 for these phantoms were discussed. This investigation also identified secondary risks associated with PNDE relating to radiation protection.
Abstract: BACKGROUND: Automated diagnosis of gastrointestinal stromal tumors’ (GISTs) cancerization is an effective way to improve the clinical diagnostic accuracy and reduce possible risks of biopsy. Although deep convolutional neural networks (DCNNs) have proven to be very effective in many image classification problems, there is still a lack of studies on endoscopic ultrasound (EUS) images of GISTs. It remains a substantial challenge mainly due to the data distribution bias of multi-center images, the significant inter-class similarity and intra-class variation, and the insufficiency of training data. OBJECTIVE: The study aims to classify GISTs into higher-risk and lower-risk categories.…METHODS: Firstly, a novel multi-scale image normalization block is designed to perform same-size and same-resolution resizing on the input data in a parallel manner. A dilated mask is used to obtain a more accurate interested region. Then, we construct a multi-way feature extraction and fusion block to extract distinguishable features. A ResNet-50 model built based on transfer learning is utilized as a powerful feature extractor for tumors’ textural features. The tumor size features and the patient demographic features are also extracted respectively. Finally, a robust XGBoost classifier is trained on all features. RESULTS: Experimental results show that our proposed method achieves the AUC score of 0.844, which is superior to the clinical diagnosis performance. CONCLUSIONS: Therefore, the results have provided a solid baseline to encourage further researches in this field.
Keywords: GIST, EUS image, multi-scale image normalization, transfer learning, classification
Abstract: BACKGROUND: Ticks are known as the representatives of hematophagous arachnids. They cause various tick-borne diseases, such as severe fever with thrombocytopenia syndrome (SFTS) and Lyme disease. To understand the mechanism of virus infection caused by ticks, morphology for the anatomical characteristics of crucial organs has been widely studied in acarological fields. The conventional methods used for tick observation have inevitable limitations. Dissection is the standard method to obtain the morphological information, and complex microscopy methods were utilized alternatively. OBJECTIVE: The study goal is to obtain the morphological information of ticks in different growth stages non-invasively.…METHODS: Optical coherence tomography (OCT) is employed to acquire structural images of various internal organs without damage for observing the growth process of larva, nymph, and adult in Haemaphysalis longicornis ticks in real-time. RESULTS: Various internal organs, such as salivary glands, rectal sac, genital aperture, and anus, were well-visualized by the OCT enface and cross-sectional images, and the variation in size of these organs in each growth stage was compared quantitatively. CONCLUSIONS: Based on the obtained results, we confirmed the potential feasibility of OCT as a non-destructive real-time tool for morphological studies in acarology. Further research using OCT for acarological applications can include monitoring the growth process of ticks in terms of structural changes and investigating morphological differences between normal and virus-infected tick specimens.
Abstract: BACKGROUND: The etiology of polycystic ovary syndrome (PCOS) remains unclear with highly heterogeneous clinical manifestations, recently growing evidence revealing genetic variants play a crucial part in its pathogenesis. OBJECTIVE: This study aimed to examine the correlation between SNPs in miRNA-135a’s binding site of targeted gene IRS2 and clinical manifestations of PCOS in Chinese females. METHOD: A total of 126 Chinese women with PCOS and 109 healthy women were enrolled, divided into 4 groups based on different clinical features of hyperandrogenemia (HA), insulin resistance (IR), polycystic ovary morphology (PCOM) and obesity. We analyzed 2…single nucleotide polymorphisms (SNPs) of the IRS2 gene (rs2289046 and rs1865434) and clinical features’ laboratory measurements such as sex hormone, fasting plasma glucose (FPG), fasting plasma insulin (FINS). RESULTS: Located in miRNA-135a binding site of IRS2 gene, the rs2289046’s triple genotypes distribution showed a significant difference between PCOS/control group and PCOM/non-PCOM group (P < 0.05) while the rs1865434’s triple genotype distribution showed a significant difference between obesity/non-obesity group (P < 0.05). CONCLUSION: The results revealed the two SNPs as rs2289046 and rs1865434 in the IRS-2 binding region of miRNA-135a have correlations with the clinical features of PCOS in Chinese population.
Keywords: Polycystic ovary syndrome (PCOS), single nucleotide polymorphism (SNP), insulin receptor substrate 2 gene (IRS2 gene), microRNA (miRNA), China
Abstract: BACKGROUND: Classifying T1-weighted Magnetic Resonance brain scans into cerebrospinal fluid, gray matter and white matter is one of the most critical tasks in neurodegenerative disease analysis. Since manual delineation is a labor-intensive and time-consuming process, automated methods have been widely adopted for this purpose. One group of commonly used method by biomedical researchers are based on Gaussian mixture model. The main drawbacks of this model include complex computational cost and parameter selection with the presence of imaging defects such as intensity inhomogeneity and noise. OBJECTIVE: To alleviate these aspects, an improved Gaussian mixture model-based method is…proposed in this work. METHODS: Standard mixture model was used to formulate individual voxel intensity. A set of spatial weightings were created to represent local tissue characteristics. The emphasis of this method is its “lite” and robust implementation mode highlighted by a dedicated entropy term. The Expectation-Maximization algorithm was then iteratively executed to estimate model parameters. The Maximum a Posteriori criterion was employed to determine for each voxel if it belongs to a certain tissue. RESULTS: The proposed method was validated on both simulated and real MR scans. The averaged Dice coefficient of segmented brain tissues on each dataset ranged between [66.41, 87.42] for cerebrospinal fluid, [80.57, 85.35] for gray matter, and [83.17, 85.63] for white matter. CONCLUSIONS: Experiments illustrated the effectiveness and reliability in tissue classification against imaging defects compared with manually constructed reference standard.
Abstract: BACKGROUND: Radiologists widely use the minimum detectable difference (MDD) concept for inspecting the imaging quality and quantify the spatial resolution of scans. OBJECTIVE: This study adopted Taguchi’s dynamic algorithm to optimize the MDD of cardiac CT angiography (CTA) using a V-shaped line gauge and three PMMA phantoms (50, 70, and 90 kg). METHODS: The phantoms were customized in compliance with the ICRU-48 report, whereas the V-shaped line gauge was indigenous to solidify the cardiac CTA scan image quality by two adjacent peaks along the V-shaped slit. Accordingly, the six factors A-F assigned in…this study were A (kVp), B (mAs), C (CT pitch), D (FOV), E (iDose), and F (reconstruction filter). Since each factor could have two or three levels, eighteen groups of factor combinations were organized according to Taguchi’s dynamic algorithm. Three welltrained radiologists ranked the CTA scan images three times for three different phantoms. Thus, 27 (3 × 3 × 3) ranked scores were summed and averaged to imply the integrated performance of one specific group, and eventually, 18 groups of CTA scan images were analyzed. The unique signal-to-noise ratio (S/N, dB) and sensitivity in the dynamic algorithm were calculated to reveal the true contribution of assigned factors and clarify the situation in routine CTA diagnosis. RESULTS: Minimizing the cross-interactions among factors, the optimal factor combination was found to be as follows: A (100 kVp), B (600 mAs), C (pitch 0.200 mm), D (FOV 280 mm), E (iDose 5), and F (filter XCA). The respective MDD values were 2.15, 2.32, and 1.87 mm for 50, 70, and 90 kg phantoms, respectively. The MDD of the 90 kg phantom had the most precise spatial resolution, while that of the 70 kg phantom was the worst. CONCLUSION: The Taguchi static and dynamic optimization algorithms were compared, and the latter’s superiority was substantiated.