As with most projects for which a considerable amount of new technology is developed and which have duration spanning several years, at project completion it was determined that several upgrades would improve the overall system performance. Some possible upgrades are discussed. Overall, the system has been very robust, accurate, reproducible, and reliable. The authors found the pencil beam scanning system to be particularly satisfactory; prostate treatments can be delivered on the scanning nozzle in less time than is required on the passive scattering nozzle.

The computerized scheme has the potential to improve the diagnostic accuracy of radiologists in the distinction of benign and malignant solitary pulmonary nodules.

In this study, the super-resolution convolutional neural network (SRCNN) scheme, which is the emerging deep-learning-based super-resolution method for enhancing image resolution in chest CT images, was applied and evaluated using the post-processing approach. For evaluation, 89 chest CT cases were sampled from The Cancer Imaging Archive. The 89 CT cases were divided randomly into 45 training cases and 44 external test cases. The SRCNN was trained using the training dataset. With the trained SRCNN, a high-resolution image was reconstructed from a low-resolution image, which was down-sampled from an original test image. For quantitative evaluation, two image quality metrics were measured and compared to those of the conventional linear interpolation methods. The image restoration quality of the SRCNN scheme was significantly higher than that of the linear interpolation methods (p < 0.001 or p < 0.05). The high-resolution image reconstructed by the SRCNN scheme was highly restored and comparable to the original reference image, in particular, for a ×2 magnification. These results indicate that the SRCNN scheme significantly outperforms the linear interpolation methods for enhancing image resolution in chest CT images. The results also suggest that SRCNN may become a potential solution for generating high-resolution CT images from standard CT images.

CAD has the potential to improve diagnostic accuracy in the detection of lung nodules on digital radiographs.

A temporal subtraction technique has been developed to assist radiologists in the detection of interval changes on chest radiographs. Although the overall performance of the current temporal subtraction technique is relatively good, severe misregistration errors, mainly due to AP inclination and/or rotation, are observed in some cases. In order to reduce these errors, we attempted to improve the subtraction scheme by applying an iterative image warping technique. In cases obtained with the new temporal subtraction technique 177 (97.8%) of 181 showed adequate, good, or excellent quality. We also found that 156 (86.2%) of cases obtained with the new scheme showed improvements in the quality of the subtraction images compared with the previous scheme. The results indicate that the performance of the temporal subtraction technique was greatly improved by use of the iterative image warping technique.

The cellular basis of the length-dependent increases in contractile force in the beating heart has remained unclear. Our aim was to investigate whether length-dependent mediated increases in contractile force are correlated with myosin head proximity to actin filaments, and presumably the number of cross-bridges activated during a contraction. We therefore employed x-ray diffraction analyses of beat-to-beat contractions in spontaneously beating rat hearts under open-chest conditions simultaneous with recordings of left ventricle (LV) pressure-volume. Regional x-ray diffraction patterns were recorded from the anterior LV free wall under steady-state contractions and during acute volume loading (intravenous lactate Ringers infusion at 60 ml/h, <5 min duration) to determine the change in intensity ratio (I(1,0)/I(1,1)) and myosin interfilament spacing (d(1,0)). We found no significant change in end-diastolic (ED) intensity ratio, indicating that the proportion of myosin heads in proximity to actin was unchanged by fiber stretching. Intensity ratio decreased significantly more during the isovolumetric contraction phase during volume loading than under baseline contractions. A significant systolic increase in myosin head proximity to actin filaments correlated with the maximum rate of pressure increase. Hence, a reduction in interfilament spacing at end-diastole ( approximately 0.5 nm) during stretch increased the proportion of cross-bridges activated. Furthermore, our recordings suggest that d(1,0) expansion was inversely related to LV volume but was restricted during contraction and sarcomere shortening to values smaller than the maximum during isovolumetric relaxation. Since ventricular volume, and presumably sarcomere length, was found to be directly related to interfilament spacing, these findings support a role for interfilament spacing in modulating cross-bridge formation and force developed before shortening.

A novel contralateral subtraction technique has been developed to assist radiologists in the detection of asymmetric abnormalities on a single chest radiograph. With this method, the lateral inclination is first corrected by rotating and shifting the original chest image so that the midline of the thorax is aligned with the vertical centerline of the original chest image. The rotated image is then flipped laterally to produce a reversed "mirror" image. Finally, the mirror image is warped and subtracted from the original image for derivation of the contralateral subtraction image. The three key techniques which are employed in this study are applied successively to the initial contralateral subtraction technique for acquisition of improved subtraction images. One hundred PA chest radiographs, including 50 normals and 50 abnormals, were used as the database for this study. The percentage of chest images, which were rated as being adequate, good, or excellent quality of subtraction images by employing a subjective evaluation method, was improved from 73% to 91% by use of the three key techniques. The contralateral subtraction technique can be used for detection of any asymmetric abnormalities, such as lung nodules, pneumothorax, pneumonia, and emphysema, on a single chest radiograph, and therefore has potential utility in a high proportion of abnormal cases.

OBJECTIVE. Our objectivewas to evaluatethe impact of a computer-aideddiagnostic scheme on radiologists' interpretations of chest radiographs with interstitial opacities by per forming an observer test using receiver operating characteristic (ROC) analysis.MATERIALS AND METHODS. Twentychestradiographs with normalfindingsand20 chest radiographs with abnormal findings were used. Each radiograph was divided into four quadrants. One hundred twenty-nine quadrants (80 normal and 49 abnormal quadrants) were used for testing because we excluded 3 1 equivocal quadrants. Sixteen independent observers (10 residents and six attending radiologists) participated in this study. The radiologists' per formance without and with computer assistance, which indicated cases with normal and ab normal findings by various markers, was evaluated by ROC analysis. RESULTS. Thediagnostic accuracy ofthe observers improved bya statistically significant mag nitude whencomputer-aideddiagnosiswasused.Thus, the valuesfor the areaunderthe ROC curve obtained with and without the computer-aided diagnostic output were .970 and .948 (p = .0002), re spectively,for all observers;.969and .943(p = .0006),respectively, for the residents'subgroup;and .972 and .960 (p = .162), respectively, for the attending radiologists' subgroup. The value for the areaunderthe ROC curve for thecomputerizedschemeby itself was.943. CONCLUSION.Our computer-aided diagnosticschemecanassistradiologistsin thedi agnosis or exclusion of interstitial disease on chest radiographs.