Deluge in the size and heterogeneity of medical image databases necessitates the need for content based retrieval systems for their efficient organization. In this paper, we propose such a system to retrieve prostate MR images which share similarities in appearance and content with a query image. We introduce deeply learnt hashing forests (DL-HF) for this image retrieval task. DL-HF effectively leverages the semantic descriptiveness of deep learnt Convolutional Neural Networks. This is used in conjunction with hashing forests which are unsupervised random forests. DL-HF hierarchically parses the deep-learnt feature space to encode subspaces with compact binary code words. We propose a similarity preserving feature descriptor called Parts Histogram which is derived from DL-HF. Correlation defined on this descriptor is used as a similarity metric for retrieval from the database. Validations on publicly available multi-center prostate MR image database established the validity of the proposed approach. The proposed method is fully-automated without any user-interaction and is not dependent on any external image standardization like image normalization and registration. This image retrieval method is generalizable and is well-suited for retrieval in heterogeneous databases other imaging modalities and anatomies.

1948 Objectives The use of positron emitting radiotracers for whole-body PET has proven to be a valuable tool for cancer diagnosis and staging. There is however no established method to transfer this information to an interventional setting to provide live radioguidance, such as to identify cancerous tissue during surgery. Indeed, while diagnostic systems are limited by their most common gantry-based design as well as their long acquisition time, the surgeon mostly relies on cognitive fusion of preinterventional image information with the surgical reality. We suggest the development of a dedicated system, where a light-weight handheld PET detector is combined with an external plate for the live acquisition of PET images. The design of the handheld detector, which should be brought as close as possible to the region of interest, also allows an endoscopic application and consequent increase in sensitivity. The work presented in this submission demonstrates the feasibility of freehand PET (fhPET) with a detector prototype and a first phantom study. Methods This pilot system is based on matrices of 4x4 LYSO:Ce crystals with an individual size of 3.5x3.5x15 cubic mm coupled to arrays of 4x4 SiPMs. The plate consists in 256 matrices grouped by 4 and read out by 64-channel STiC-ASICs, of which 16 are hosted by each of the 4 front-end boards. The plate is held by a mechanical arm that allows its placement and fixation. The endoscope is made out of 2 matrices read out by a TOFPET ASIC on a front-end board. Each frontend board contains the FPGAs that concentrate event data and transmit it via an HDMI cable to a PCIe data acquisition card, where further event handling and coincidence creation are handled. The position of the plate and endoscope are tracked by an optical tracking system. An iterative MLEM algorithm reconstructs the image. We conduct 3 experiments with a phantom made out of four Eppendorf tubes filled with 5 MBq of 18F-FDG each. We acquire data by rotating the detectors by 360, 180 and 90 degrees around the phantom to study the influence of full versus partial angular information. The acquisition time was fixed to 100s. The energy spectra are recorded. The number of iterations in the reconstruction is varied. Results Energy peaks are clearly identifiable for both detectors. While image quality decreases with reduced angular coverage, all images clearly showed four hotspots. 5 iterations are sufficient to provide an image. Conclusions This submission presents first results acquired on phantoms with a freehand PET system, giving a first hint at image quality that can be achieved. Few iterations are sufficient to identify all sources, allowing for a reduction of the total reconstruction time in view of live interventional fhPET. Further developments and experiments are ongoing towards including excellent time-of-flight performance such as to provide a system that can distinguish smallest radioactive hotspots in a noisy environment.

510 Objectives The gold standard for prostate biopsy, transrectal ultrasound (TRUS) guided random biopsy (RB), suffers from low sensitivity. Recent advancements in prostate PET imaging with 68Ga-HBED-PSMA (Prostate Specific Membrane Antigen), combined with multiparametric MR, provide improved identification of suspicious areas. The development of a dedicated framework for PET/MR to TRUS image fusion guided biopsy (IFGB) might improve prostate cancer (PCa) detection rates. Methods We propose a platform with minimal overhead in the clinical workflow that provides both rigid PET/MR to TRUS registration based on the manual selection of landmarks and elastic registration supported by automatically segmented images. The distance between the surfaces of manual and automatic segmentations and registration errors (RE) on manually selected landmarks evaluate the technical performance. The initial clinical study includes 16 patients who had at least one prior negative RB. A targeted biopsy was carried out following a systematic 10-core RB. All samples were histologically analyzed. Results The mean surface distance between manual and automatic segmentation is below 2 mm. The average RE for the rigid and elastic registration are 4.6 mm and 2.5 mm. On PSMA-PET/MR, 7 prostates revealed at least one PCa-suspicious lesion, 5 were described as equivocal and 4 as inconspicuous. The histological analysis indicated PCa in 8 of the patients, out of which 6 had suspicious and 2 equivocal findings on PSMA-PET/MR. Conclusions PSMA-PET/MR to TRUS IFGB could be a valuable tool for PCa detection in patients with prior negative RB. Further developments and studies are necessary to improve and evaluate its full potential.

3D ultrasound segmentation is a challenging task due to image artefacts, low signal-to-noise ratio and lack of contrast at anatomical boundaries. Current solutions usually rely on complex, anatomy-specific regularization methods to improve segmentation accuracy. In this work, we propose a highly adaptive learning-based method for fully automatic segmentation of ultrasound volumes. During training, anatomy-specific features are obtained through a sparse auto-encoder. The extracted features are employed in a Hough Forest based framework to retrieve the position of the target anatomy and its segmentation contour. The resulting method is fully automatic, i.e. it does not require any human interaction, and can robustly and automatically adapt to different anatomies yet enforcing appearance and shape constraints. We demonstrate the performance of the method for three different applications: segmentation of midbrain, left ventricle of the heart and prostate.

Transrectal ultrasound (TRUS)-guided random prostate biopsy is, in spite of its low sensitivity, the gold standard for the diagnosis of prostate cancer. The recent advent of PET imaging using a novel dedicated radiotracer, \(^{68}\hbox {Ga}\)-labeled prostate-specific membrane antigen (PSMA), combined with MRI provides improved pre-interventional identification of suspicious areas. This work proposes a multimodal fusion image-guided biopsy framework that combines PET-MRI images with TRUS, using automatic segmentation and registration, and offering real-time guidance.

Although various modalities are used in prostate cancer imaging, transrectal ultrasound (TRUS) guided biopsy remains the gold standard for diagnosis. However, TRUS suffers from low sensitivity, leading to an elevated rate of false negative results. Magnetic Resonance Imaging (MRI) on the other hand provides currently the most accurate image-based evaluation of the prostate. Thus, TRUS/MRI fusion image-guided biopsy has evolved to be the method of choice to circumvent the limitations of TRUS-only biopsy. Most commercial frameworks that offer such a solution rely on rigid TRUS/MRI fusion and rarely use additional information from other modalities such as Positron Emission Tomography (PET). Other frameworks require long interaction times and are complex to integrate with the clinical workflow. Available solutions are not fully able to meet the clinical requirements of speed and high precision at low cost simultaneously. We introduce an open source fusion biopsy framework that is low cost, simple to use and has minimal overhead in clinical workflow. Hence, it is ideal as a research platform for the implementation and rapid bench to bedside translation of new image registration and visualization approaches. We present the current status of the framework that uses pre-interventional PET and MRI rigidly registered with 3D TRUS for prostate biopsy guidance and discuss results from first clinical cases.

Automatic and robust registration of pre-operative magnetic resonance imaging (MRI) and intra-operative ultrasound (US) is essential to neurosurgery. We reformulate and extend an approach which uses a Linear Correlation of Linear Combination (LC2)-based similarity metric, yielding a novel algorithm which allows for fully automatic US-MRI registration in the matter of seconds. It is invariant with respect to the unknown and locally varying relationship between US image intensities and both MRI intensity and its gradient. The overall method based on this both recovers global rigid alignment, as well as the parameters of a free-form-deformation (FFD) model. The algorithm is evaluated on 14 clinical neurosurgical cases with tumors, with an average landmark-based error of 2.52 mm for the rigid transformation. In addition, we systematically study the accuracy, precision, and capture range of the algorithm, as well as its sensitivity to different choices of parameters.

INTRODUCTION:Round expander-implants (Beckers 25 and 50) and anatomical expander-prostheses filled with firm cohesive gel (McGhan Style 150) are established choices for single-stage expander breast reconstruction. Because of their drawbacks we selectively adopted the anatomical Becker-35 expander-implant filled with soft cohesive gel from January 2005. PATIENTS AND METHODS:All patients undergoing reconstructive breast surgery using the Contour Profile Becker-35 expandable implant over a two-year period were retrospectively reviewed with respect to indication, implant sizes, inflation details, complications and outcomes. RESULTS:36 patients, mean age 48.9 years (r=14-69), received 39 anatomical Becker-35 expanders (three bilaterally). Three quarters of these implants (29) were used for immediate breast reconstruction while the remainder were equally divided between delayed postmastectomy reconstruction (5) and correction of congenital breast asymmetry (5). Half of the patients had simultaneous latissimus dorsi myocutaneous flap coverage of the implants. The median numbers of inflations and deflations needed to achieve the target expansion size and shape were 3 (r=0-7) and 0 (r=0-4), respectively. The mean time from expander insertion to completion of reconstruction was 4.6 months (r=0-13 months). Four patients required surgical intervention for haematoma, implant infection, severe capsular contracture, and palpable rippling. Additionally there were three injection port adjustments, giving a 20% overall revisional surgery rate (8/39 breasts) after a median follow-up of 20 months (r=6-38 months). Four implants (10%) developed significant but asymptomatic rippling. The significant capsular contracture rate was 21% (8/39 breasts), which was related to chest wall radiotherapy. CONCLUSION:In this short-term study, the Becker-35 expander was successfully used for single-stage prosthetic breast reconstruction with an incidence of early complications comparable to alternative prostheses. Although it has expanded the range of implants available to the breast surgeon, its exact role in reconstructive breast surgery has yet to be established.

OBJECTIVE:1) To determine if detorsion of the twisted adnexa is better than traditional adnexectomy to conserve the adnexa and preserve its function. 2) To determine the feasibility of detorsion in conservation of adnexa.DESIGN:Prospective Study from September 2004 to September 2008.SETTING:Private IVF and Endoscopy Centre.PATIENTS:22 patients with twisted adnexa (15 non-pregnant and 7 pregnant).INTERVENTION:Surgical intervention and either detorsion of adnexa or adnexectomy.MAIN OUTCOME MEASURES:Ovarian preservation and conservation of ovarian function in 77.2% cases determined by: a) Follicular development on sonography (performed for one year after adnexectomy). b) Subsequent surgery for unrelated cause showing healthy ovaries. c) controlled ovarian hyperstimulation and successful oocyte retrieval subsequently.RESULTS:We could conserve the adenexa in 77.2% cases. Laparoscopic detorsion was performed in 11/15(73.33 %) of non-pregnant women and adnexectomy done in four women 26.66%. Among the seven pregnant women, adnexa could be preserved in 6/7(85.7%) and only one woman required adnexectomy. Laparotomy was required in 2/22(9%) women both of which were in late second trimester of pregnancy. In one case (4.54%) we had recurrence of torsion. 88.23% of the women with conserved adnexa showed preservation of ovarian function.CONCLUSION:Our study showed that timely diagnosis and intervention could make the difference between ovarian loss and salvage- an outcome of great importance in population of reproductive age females. Laparoscopy with its many benefits proves to be superior to laparotomy.

initial results from and quantitative analysis of two leading open source hypervisors, Xen and KVM. This study focuses on the overall performance, performance isolation, and scalability of virtual machines running on these hypervisors. Our comparison was carried out using a benchmark suite that we developed to make the results easily repeatable. Our goals are to understand how the different architectural decisions taken by different hypervisor developers affect the resulting hypervisors, to help hypervisor developers realize areas of improvement for their hypervisors, and to help users make informed decisions about their choice of hypervisor.

A new method for identifying denial-of-service attacks uses the attacker's media access control address for identification and traceback. The technique pinpoints the boundary router the attacker is connected to, allows identification after the attack, and imposes minimal extra load on the network

Traditional HVAC and energy design makes use of empirical methods based on one- and two- dimensional approaches. These methods, while very powerful and established, often neglect wind effects and many other relevant situational factors, such as the surrounding terrain and neighboring structures. By combining FLUENT's accurate prediction of wind flow around a building with RadTherm's compre- hensive environmental analysis, transient diurnal thermal results can be generated with minimal com- putation time. Wind flow patterns and eddy current effects are thus captured in FLUENT, while accurate solar shadowing, solar loading through glass, and infrared band heat transfer are rapidly computed in RadTherm. Interior heat loads, infiltration and venti- lation effects are also accounted for in the thermal calculation. This combined approach allows archi- tects and building designers to more accurately improve the thermal performance of each zone of a planned structure, to test the efficacy of energy- saving devices like low-e windows, or to develop passive thermal heating and cooling designs.

Purposes of study: Although certain aspects of the patient–clinician relationship have been shown to speed the recovery of patients with low back pain (LBP), the effects of receiving a causal explanation have not been studied in patients with LBP. The relative effects of each of the distinct aspects of the patient–clinician encounter on outcome are also not known.

In atherosclerosis and tumor initiation, inducible nitric oxide synthase (iNOS) has been implicated in the damage of vascular walls and DNA, respectively. Moderate consumption of red wine has been ascribed as a preventive for coronary heart disease; however, there has been much debate over whether the beneficial effect is from grape polyphenolic components or ethanol. We studied the interaction of grape compounds on nitric oxide (NO) production by macrophages, mediators of blood vessel damage in atherosclerosis. For the murine macrophage cell line RAW 264.7, stimulation with lipopolysaccharide and interferon-γ led to expression of the iNOS gene and production of NO. The polyphenols quercetin and resveratrol at a micromolar range suppressed iNOS gene expression and NO production, as determined by reverse transcription–polymerase chain reaction and nitrite assay. The polyphenols were also found to be scavengers of NO in an acellular system using sodium nitroprusside under physiological conditions. Ethanol, at a moderate level, did not produce any appreciable level of reduction of iNOS or NO activity. However, its presence at 0.1 to 0.75% enhanced the effect of grape polyphenols concentration-dependently. Thus, the interaction between these components plays a significant role in the health effects of red wine, especially with respect to their effect on the NO pathway.

Welfare has been a safety net for many Americans, when the alternative for them is going without food and shelter. Over the years, the government has provided income for the unemployed, food assistance for the hungry, and health insurance for the poor. The federal government in the nineteenth century started to provide minimal benefits for the poor. During the twentieth century the United States federal government established a more substantial welfare system to help Americans when they most needed it. In 1996, welfare reform occurred under President Bill Clinton and it significantly changed the structure of welfare. Social Security has gone through significant change from FDR's signing of the program into law to President George W. Bush's proposal of privatized accounts. The increase in industrialization in the U.S. during the 1820's caused a rise in homelessness. Women made up the majority of the homeless population. During the beginning of the nineteenth century, private charities helped provide food and shelter for the homeless. Towards the end of the nineteenth century men became the majority of the homeless population. The federal government created "mother's pension laws" which were protective labor laws that assisted poor women and children. Shelters required a work test for men to enter and only allowed them to stay for a limited amount of time. Charities did not help men in the nineteenth century (Homelessness in the United States).