Recent Advances in MRI Technology

Software innovations offer new possibilities to expand the use of MRI 

Philips' ScanWise software automatically sets MRI protocols based on MR-conditional implantable devices the patients has. This is supposed to speed workflow and improve image quality.

The most recent big advances in magnetic resonance imaging (MRI) technology have been on the software side, enabling faster contrast scans, greatly simplified cardiac imaging workflows, and allowing MR scans of the lungs. In addition, a few new MRI scanners have entered the market in the past year. 

Watch the video “MRI Technology Report at RSNA 2015.” Contributing Editor Greg Freiherr offers an overview of MRI advances at the Radiological Society of North America (RSNA) 2015 annual meeting.

Multi-Contrast MRI Images From a Single Acquisition

In September, the U.S. Food and Drug Administration (FDA) granted market clearance for GE Healthcare’s MAGiC (MAGnetic resonance image Compilation) software, the industry’s first multi-contrast MRI technique that delivers eight contrasts in a single acquisition in a fraction of the time of conventional imaging. MAGiC is the result of a collaboration with SyntheticMR AB and gives clinicians more data than conventional scanning. This technique gives users the flexibility to manipulate MR images retrospectively, leading to significant timesavings, fewer rescans and therefore cost savings, which combined can assist the clinician in making a more decisive diagnosis. It uses an acquisition technique that allows the ability to modify image contrast after scanning has been completed, which is not possible with conventional MR. GE said MAGiC delivers more potential for the clinician to utilize changes in the image contrast to enhance their diagnosis and to reduce orders for rescans. Clinicians have the ability to generate multiple image contrasts in a single MR scan – including T1, T2, STIR, T1 FLAIR, T2 FLAIR, dual IR, phase sensitive IR and proton density weighted images of the brain in a single acquisition. To change the contrast, users simply move the cursor on the interface to change the parameters such as TR, TE and TI. MAGiC enables one scan that can do the work of many. MAGiC is available on GE’s Optima MR450, Optima MR450w, Discovery MR750, Discovery MR750w and Signa Pioneer MRI systems.

Lung MRI Now Possible

Lung MRI has been problematic since the lungs are filled with air and there is a low density of the hydrogen atoms required to create MR images. For this reason, computed tomography (CT) has traditionally been used for lung imaging. At RSNA 2015, Toshiba introduced its Ultrashort Echo Time (UTE) sequence for dedicated pulmonary MRI. Available on the Vantage Titan 3.0T MR system, UTE allows clinicians to view tissue with very short relaxation times and high susceptibility regions where signals generally disappear too quickly for accurate MR imaging. 

Software Greatly Reduces MRI Scan Times

In April, the FDA approved two new Siemens MRI applications. The Simultaneous Multi-Slice application acquires MR images simultaneously as opposed to sequentially, reducing 2-D acquisition times by as much as a factor of 8. GOBrain is designed to dramatically reduce the time required for MRI examinations of the brain. Shorter scans are increasingly important at a time when brain scans account for approximately 1 out of every 4 MRI examinations, and when the number of brain MRI exams is expected to swell to 45 million worldwide this year, Siemens said. Using SMS, physicians can reduce the length of MRI brain examinations, which can vary significantly, to times compatible with the clinical routine (e.g., up to 68 percent for diffusion tensor imaging, or DTI) and bring clinical relevance to advanced neurological applications. SMS can be used in the treatment of patients who possess limited tolerance for longer scan times, including pediatric or geriatric patients. In brain surgery cases, SMS may facilitate surgical mapping and improve efficiency in the OR. Enabling clinically validated brain examinations in just five minutes, the new GOBrain application allows acquisition of clinically essential image orientations and contrasts with a single button-push. The technology is backed by Siemens’ high-channel density coils and the company’s MRI scanning software DotGO. GOBrain helps improve patient throughput and potentially reduce costs per scan. Shorter scan times, which are better tolerated by patients, can help curb lengthy and potentially expensive rescans as well as potentially reduce sedation.

The SMS application is available on Siemens’ Magnetom Aera 1.5T, Magnetom Skyra 3T, and Magnetom Prisma and Prisma Fit 3T MRI systems. The GOBrain application is featured on the Magnetom Aera and Magnetom Skyra systems.

Simplifying Cardiac MRI

Cardiac MRI has been very limited, only making up about 1 percent of all MRIs in the United States due to its complexity, long exam times and high cost. However, GE Healthcare introduced a new MRI technology at RSNA 2015 to greatly simplify cardiac MR in hopes of expanding its adoption in place of CT scans. Developed for its new Signa MRI scanners, the new ViosWorks cardiac MRI software helps automate the image sequences to perform a full 3-D chest volume scan that includes the full motion of the myocardium during the cardiac cycle, blood flow, time and fully automated quantification to create what GE calls a 7-D cardiac MRI exam. ViosWorks also speeds the imaging time from 70 minutes down to about 10 minutes using a single, free breathing exam. 

Gathering a full volume dataset of a chest in motion creates a large amount of data that would normally clog the average picture archiving and communication system (PACS) and post-processing 3-D image workstation. An average cardiac MRI exam today is about 200 MB, while a ViosWorks exam is about 20 GB. So, GE has launched a new cloud computing service to help process that large amount of data quickly with remote super-computing power. 

Read the article "Cardiac MRI Advances."

Simplifying MRI-Conditional Implant Scans

Advancements in medical implant technologies have greatly increased the number of patients with these devices in recent years, which complicated MRI scanning of these patients. MR-conditional implants include knee and hip replacements, spine implants, pacemakers and implantable cardioverter defibrillators (ICDs). More of these devices are becoming MR-conditional, which permits MRI scanning within certain parameters. These implants require adjustments in the scanner setup in order to create optimal images in the presence of these metal implants and to ensure patient safety. However, these adjustments can be time consuming and complex, causing patients with MR-conditional implants to often be denied MRI exams. At RSNA 2015, Philips unveiled the first MRI automated user interface technology designed to greatly simplify exams with patients that have MR-conditional medical implants. The new ScanWise Implant software offers a guided user interface and automatic scan parameter selection designed to support “first-time-right” imaging. The software guides operators to meet the specific criteria for each implant. 

FDA Clears First 7T MRI System

In October 2017, the FDA cleared the first 7T MRI system, more than doubling the static magnetic field strength available for use in the United States. The Magnetom Terra from Siemens Healthineers is the first 7T MRI system cleared for clinical use in the United States. The first approved indications for the system are The system’s neurological and musculoskeletal (MSK). Read the article.

Hitachi Expands Apps for MRI

Last fall, Hitachi Medical Systems America released its new MRI software platform Evolution 5 for current Hitachi customers and new system orders. Evolution 5 offers nearly 40 new features and improvements implemented that continue to raise the level of imaging performance and to expand the breadth of diagnostic applications. With the integration of a new image processing algorithm (VIVID), new reconstruction task (NCC) that reduces redundant noise pickup and new optimized fast-spin echo sequence (opFSE), customers that migrate to Evolution 5 will see dramatically improved sharpness and clarity. The software also includes applications for motion compensation, a neuro suite, selective saturation for controlled MR angiography (MRA) evaluation in the abdomen, diffusion with enhanced functional analysis including kurtosis imaging (DKI), liver imaging with iron quantification, and breast imaging with breast spectroscopy for therapy monitoring.

Silent MRI Scanning

GE Healthcare has expanded its SilenScan MRI noise reduction technology to its Signa Pioneer 3T system, which features an enhanced SilentScan package to greatly reduce noise during MRI scans. SilentScan has been added for musculoskeletal (MSK) imaging and spine imaging, in addition to a complete neuro exam that also includes diffusion weighted imaging (DWI). SilentScan includes two distinct approaches to reduce acoustic noise by addressing the source, the gradient-magnet interaction and the mechanical vibration. SilentScan is available on GE’s Discovery MR750w, Optima MR450w, Signa PET/MR, Signa Pioneer and Signa Explorer.

Toshiba Expands MRI Advanced Visualization Capability

In the fall of 2015, Toshiba acquired Olea Medical SA, which will help Toshiba to accelerate the growth of its MRI business by leveraging Olea’s cutting-edge software technology for advanced post-processing and image analysis. Toshiba will also be able to provide multimodality solutions by integrating Olea’s post-processing software with Vitrea by Vital Images Inc., another subsidiary of Toshiba.

Shortening Prostate MRI Exams

The FDA in January cleared the noninvasive SEEit prostate MR imaging solution from Siemens. Powered by syngo MR E11 software architecture, SEEit enables users of Siemens’ Magnetom Aera 1.5T and Magnetom Skyra 3T MRI systems to perform a routine prostate exam in just 10 minutes without using an endorectal coil, which can cause patient discomfort. Siemens’ Direct RF and high-density coil technology Tim 4G – coupled with its Resolve diffusion technology – deliver the signal-to-noise ratio (SNR) and resolution that enable users to perform these examinations using only the company’s new Body 30/60 surface coil.

Weight-bearing MRI Exams

Esaote demonstrated its G-Scan Brio at RSNA 2015.  It can tilt to put patients into a weight-bearing position up to a full 90 degrees, an application seeing increasing interest. Some clinical pathologies, particularly in the musculoskeletal environment, are not really apparent in the supine position. The body coil is placed on the patient in the supine position, and then positioning adjustments are made directly on the scanner. A full exam can be completed in six to eight minutes. 

Siemens Introduces Magnetom Amira MRI Scanner

In January 2016, Siemens announced FDA clearance for the Magnetom Amira 1.5T system. It offers technology that enables significant power savings in standby mode. The system offers technology to help shorten many exams and enable many patients to undergo scans in routine applications. Siemens offers a package of protocols optimized for rapid examinations while maintaining high image quality. Additionally, the system features DotGO, Siemens’ latest generation of MRI examination software that simplifies protocol management and offers the right operating sequence for each individual scan to suit requirements. This software can help users increase exam consistency, reproducibility and efficiency. The Magnetom Amira is equipped with Siemens’ latest applications and syngo MR E11 software architecture. Hospitals that operate a Magnetom Amira alongside other Siemens systems can switch seamlessly between scanners. They also can exchange many coils between all current 1.5T MRI systems. The system’s software platform includes Quiet Suite technology, which minimizes system noise during an MRI examination. 

Philips Installs First Ingenia 1.5T System

The Philips Ingenia 1.5T system with in-bore Ambient Experience technology offers a soothing patient experience with imagery, sound and light, helping patients relax. The first U.S. Installation took place in August at the Alexandria VA Medical Center in Pineville, La. About 35 percent of patients have claustrophobia or some considerable level of anxiety about the machine itself, with about 20 percent requiring repeat scans due to motion during the scan. The Ambient Experience MRI can help calm patients for better, motion-free exams. The system can be personalization for each patient with a selection of video themes viewable from inside the MRI, which are combined with sound through headphones. Noise is one of the most uncomfortable parts of an MRI exam for many patients, so the system offers technology to automatically provide up to 80 percent noise reduction. 

The Ingenia 1.5T also offers upgrades such as ScanWise Implant, the industry's first MRI-guided user interface to simplify the scanning of patients with MR conditional implants like knee and hip replacements, spine implants and pacemakers. The software helps users streamline exams in this expanding healthcare area and complements Philips' suite of diagnostic imaging solutions, helping to improve hospital workflow and enhance the patient experience.

Toshiba Announces Upgrades to Vantage Titan 3T MRI System

Toshiba introduced the Vantage Titan 3T/intelligent Solution (iS) Edition MR system at RSNA 2015. The new system includes patient-friendly upgrades that improve image quality and throughput while providing more coverage and a better exam experience. The enhancements include an entirely new gradient design to provide increased performance and image stability for maximum image quality. There is a dedicated 16-channel Tx/Rx knee speeder coil designed for easy setup. The new Atlas Speeder Head/Neck Coil is designed for optimal imaging of the head and neck, with improved patient comfort. There also is a new automatic alignment tool in EasyTech for cardiac, neuro and spinal exams to help reduce exam times and provide more consistent results by automating the alignment and location of anatomy.

GE Relaunches Signa MRI 

Nearly two years ago GE rebranded its MRI line under the Signa name. At RSNA 2015 it showcased advancements in applications as well as the hardware with its Signa Pioneer 3.0T, Signa Explorer and Signa Creator 1.5T MRI scanners. 

The Signa Pioneer also features technology called Total Digital Imaging (TDI) enabling improved image quality and increasing SNR by up to 25 percent. TDI is composed of Direct Digital Interface (DDI), Digital Surround Technology (DST) and Digital Micro Switching (DMS). DDI employs an independent analog-to-digital converter to digitize inputs from each of the 97 RF channels. Every input is captured and every signal is digitized; DST combines the digital signal from every surface coil element with the signal from the integrated RF body coil resulting in richer, higher SNR spine and body images with superior homogeneity and uniformity; and DMS is a significant advancement in RF coil design with intelligent Micro Electro-Mechanical Switches (MEMS) that support ultra-fast coil switching, which enables future expansion of Zero TE imaging capabilities. Zero TE enables imaging of tissues that are conventionally difficult to see with MRI, such as cortical bone, ligaments and tendons.

Both Signa Creator and Signa Explorer 1.5T MR scanners are designed to lower total cost of ownership and use 34 percent less power than previous-generation MRI systems and require a smaller footprint for installation.

Comparison of MRI Systems

This article served as an introduction for the MRI comparison chart in the October 2016 print issue of ITN. The chart can be accessed at www.itnonline.com/content/mri-wide-bore-systems. It requires a login, but it is free and only takes a moment to enter minimal information. 

Related MRI Content:

VIDEO: MRI Technology Report at RSNA 2015

RSNA Technology Report 2015: Magnetic Resonance Imaging

Software Advances in MRI Technology

Advances in Cardiac Imaging at RSNA 2016

Recent Trends and Developments in Contrast Media

Comparison Chart: MRI Wide Bore Systems 
(chart access will require a login, but is free and only takes a minute to register)

Comparison Chart: MRI Contrast Agents
(chart access will require a login, but is free and only takes a minute to register)

Comparison Chart: Cardiovascular MRI Analysis Software
(chart access will require a login, but is free and only takes a minute to register)

the validity of the data that feed machine learning in medicine

A giant with feet of clay: on the validity of the data that feed machine learning in medicine

Federico Cabitza, Davide Ciucci, Raffaele Rasoini

(Submitted on 21 Jun 2017 (v1), last revised 26 Jun 2017 (this version, v2))

This paper considers the use of Machine Learning (ML) in medicine by focusing on the main problem that this computational approach has been aimed at solving or at least minimizing: uncertainty. To this aim, we point out how uncertainty is so ingrained in medicine that it biases also the representation of clinical phenomena, that is the very input of ML models, thus undermining the clinical significance of their output. Recognizing this can motivate both medical doctors, in taking more responsibility in the development and use of these decision aids, and the researchers, in pursuing different ways to assess the value of these systems. In so doing, both designers and users could take this intrinsic characteristic of medicine more seriously and consider alternative approaches that do not "sweep uncertainty under the rug" within an objectivist fiction, which everyone can come up by believing as true.

peer re·view

peer re·view

noun

1. 1.

   evaluation of scientific, academic, or professional work by others working in the same field.

verb

1. 1.

   subject (someone or something) to a peer review.
2. " peer review process"is supposed" to uphold the quality and validity of individual articles and the journals that publish them.
   Peer review has been a formal part of scientific communication since the first scientific journals appeared more than 300 years ago. The Philosophical Transactions of the Royal Society is thought to be the first journal to formalize the peer review process"
3. 
   
4. 
   Professional peer review focuses on the performance of professionals, with a view to improving quality, upholding standards, or providing certification. In academia, peer review is common in decisions related to faculty advancement and tenure.[citation needed] Henry Oldenburg (1619–1677) was a British philosopher who is seen as the 'father' of modern scientific peer review.
   
   WA prototype[clarification needed] professional peer-review process was recommended in the Ethics of the Physician written by Ishāq ibn ʻAlī al-Ruhāwī (854–931). He stated that a visiting physician had to make duplicate notes of a patient's condition on every visit. When the patient was cured or had died, the notes of the physician were examined by a local medical council of other physicians, who would decide whether the treatment had met the required standards of medical care.
   
   Professional peer review is common in the field of health care, where it is usually called clinical peer review. Further, since peer review activity is commonly segmented by clinical discipline, there is also physician peer review, nursing peer review, dentistry peer review, etc. Many other professional fields have some level of peer review process: accounting, law,engineering (e.g., software peer review, technical peer review), aviation, and even forest fire management.
   
   Peer review is used in education to achieve certain learning objectives, particularly as a tool to reach higher order processes in the affective and cognitive domains as defined by Bloom's taxonomy. This may take a variety of forms, including closely mimicking the scholarly peer review processes used in science and medicine
   Scholarly peer review
   Scholarly peer review (also known as refereeing) is the process of subjecting an author's scholarly work, research, or ideas to the scrutiny of others who are experts in the same field, before a paper describing this work is published in a journal, conference proceedings or as a book. The peer review helps the publisher (that is, the editor-in-chief, the editorial board or the program committee) decide whether the work should be accepted, considered acceptable with revisions, or rejected.
   
   Peer review requires a community of experts in a given (and often narrowly defined) field, who are qualified and able to perform reasonably impartial review. Impartial review, especially of work in less narrowly defined or inter-disciplinary fields, may be difficult to accomplish, and the significance (good or bad) of an idea may never be widely appreciated among its contemporaries. Peer review is generally considered necessary to academic quality and is used in most major scientific journals, but it does by no means prevent publication of invalid research. Traditionally, peer reviewers have been anonymous, but there is currently a significant amount of open peer review, where the comments are visible to readers, generally with the identities of the peer reviewers disclosed as well.
   
   Medical peer review may be distinguished in 4 classifications: 
   
   See also
5. 1) clinical peer review;
6.  2) peer evaluation of clinical teaching skills for both physicians and nurses
7.  3) scientific peer review of journal articles
8.  4) a secondary round of peer review for the clinical value of articles concurrently published in medical journals.
9. ] Additionally, "medical peer review" has been used by the American Medical Association to refer not only to the process of improving quality and safety in health care organizations, but also to the process of rating clinical behavior or compliance with professional society membership standards
10.  Thus, the terminology has poor standardization and specificity, particularly as a database search term.

ALGORITHMS IN DECISION-MAKING

When I go to buy something in the shop and my credit card gets rejected!

I am totally dejected, embarrassed and confused!

 what is going on?

Some guy altered/Authored the fraud detection algorithm which is being used by the credit card company and somehow it does not want to authorize that particular purchase because the algorithm says this could be a fraudulent transaction.

ALGORITHMS IN DECISION-MAKING

The House of Commons science and technology committee launched an inquiry into ‘Algorithms in decision-making’ following a fantastic pitch from our policy manager Dr Stephanie Mathisen. As Steph argues, algorithms — quite rapidly and without debate — have come to replace humans in making decisions that affect many aspects of our lives, from criminal justice to education. Algorithms in themselves are neither ‘good’ nor ‘bad’, but where the public has little access to information about the workings of algorithms in decision-making, there is a serious lack of transparency and therefore accountability and choice. We look forward to the committee’s report in 2018.

world at Night

Earth at Night Wall Map

Item #20306C
https://shop.nationalgeographic.com/product/maps/wall-maps/world-maps/earth-at-night-wall-map


This intriguing map reveals in stunning detail the pulsating lights of the Earth at night. See where populations are most and least concentrated. The rare view is a composite image made by three satellites on cloud-free nights over a one-year period. In addition to showing lighted areas of the Earth, this map also features where fires rage and natural gas burn-off and night fishing locations

I am glad to see that India is almost on par with/or even better than China

Of course! The most prolific energy users and wasters we Americans

Dark continent ! What an apt name!

Russia seems to have more gas to burn them the Saudi Arabia!
And Nigeria is just behind these two

The seven EPIC MAPS

http://www.ninepointfive.org/

https://earth.nullschool.net/#current/wind/surface/level/orthographic=78.91,10.53,1582

http://www.arcgis.com/apps/CEWebViewer/viewer.html?3dWebScene=04b66d38061849149d3c59c9d07604c0

http://osmlab.github.io/show-me-the-way/

https://developers.arcgis.com/javascript/latest/sample-code/widgets-directlinemeasurement-3d/index.html

https://developers.arcgis.com/javascript/latest/sample-code/layers-scenelayer-filter-query/live/index.html


http://richiecarmichael.github.io/sat/index.html
http://richiecarmichael.github.io/cable/index.html

http://whales.smartmine.com/

https://www.flightradar24.com/

This is very interesting India's skies are jam packed with planes!
where as
 marine traffic is very sparse!

Peer review and its ill effects :Trial by peers comes up short

Oh Boy!

This is Music to My ears, but what is the Point?

Peer review and its ill effects are so firmly embedded in the scientific and societal culture so much so that people who have been hurt by this so-called fair peer review do not have any recourse to seek justice.

This article only talks about scientific publication which may not be the life-and-death for the scientist but the same peer review process for doctors regarding their hospital privileges and their medical licenses which is once again dependent on peer review committees can really be a life-and-death situation. Somebody who is inducted by a peer review committee by the so-called peers who have never worked with the doctor and how absolutely no personal connection to him sit in the room and make decisions which can the physician's life and career.

I am the living example of that.

"If peer review were a new medicine, it would never get a licence." 

"peer review is actually 'competitor review' and they may be trying to find reasons to shoot down their rivals."

"Our review focused on biomedical research, but there's no reason to assume that the inefficiency of this system would not pertain across other scientific disciplines."

"We had great difficulty in finding any real hard evidence of the system's effectiveness, which is disappointing, as peer-review is the cornerstone of editorial policies worldwide."

The following is an article published in the Guardian online newspaper in the year 2003 so even after 14 years of this publication nothing has really changed as far as peer reviews concerned.

Sophie Petit-Zeman

Thu 16 Jan 2003 06.51 EST

"

Trial by peers comes up short

Sophie Petit-Zeman examines the 200-year practice of peer review

Sophie Petit-Zeman

Thu 16 Jan 2003 06.51 ESTFirst published on Thu 16 Jan 2003 06.51 EST

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When US President Benjamin Franklin wrote "nothing can be said to be certain, except death and taxes", he should have checked with a scientist. A recurrent ordeal for all is the tribulation that follows the triumph. For the "eureka" moment, when the years spent poring over test tubes come good, is not the end of the road to fame or even professional respect.

For first, researchers must bare their methods and results to the scrutiny of their peers. In this way, the prestigious scientific journals decide what gets published and, hence, what breakthroughs we hear about. But a report out this month from a well-respected international collaboration of scientists will reveal that this time-honoured system of peer review, which has existed in some form for at least 200 years, is possibly bunk.

According to Dr Tom Jefferson, from the Cochrane Collaboration Methods Group: "If peer review were a new medicine, it would never get a licence." As he explains: "Peer-review is generally assumed to be an important part of the scientific process and is used to assess and improve the quality of submissions to journals as well as being an important part of the process of deciding what research is funded.

"But we have found little empirical evidence to support the use of peer-review as a mechanism to ensure the quality of research reporting, and there's even more depressing evidence about its value in deciding what should be funded."

Jefferson adds: "Our review focused on biomedical research, but there's no reason to assume that the inefficiency of this system would not pertain across other scientific disciplines." Jefferson's team scrutinised 135 studies, designed to assess the evidence that peer review is an effective method of deciding what should be published.

He said: "We had great difficulty in finding any real hard evidence of the system's effectiveness, which is disappointing, as peer-review is the cornerstone of editorial policies worldwide."

He added: "Scientists compete with each other for space to publish in the most prestigious and most widely read journals, space is allocated by editors, and peer-review plays a big part in the process. Publishing is the key to advancement and research riches. Nobel prizes have hinged on peer review, yet it may be seriously flawed. The problem is compounded because scientists can't agree about how the quality of peer review should be measured."

These findings come in the wake of four international congresses on peer review that have promoted research into all aspects of it. Jefferson and colleagues are now calling for a large, well-funded programme of research on the effects of peer-review. But does their work cut the mustard? Asked whether it was peer reviewed, Jefferson says: "Yes, and it was done through collaboration rather than in the adversarial way that can happen. Editors can usually only publish about 10% of what they receive, so they're looking for reasons to reject papers. Furthermore, peer review is actually 'competitor review' and they may be trying to find reasons to shoot down their rivals."

Sir Iain Chalmers, founder of the Cochrane Collaboration, the international organisation that assesses effective healthcare and within which this research was conducted, told the Guardian it was important not to be too negative about the results. But, he added: "The acquiescence of the scientific world in the threadbare empirical evidence base for the process needs challenging." He encouraged readers to access the Cochrane reviews and submit their criticisms, through www.nelh.nhs.uk.

The following correction was printed in the Guardian's Corrections and Clarifications column, Friday January 17 2003

The reference to President Benjamin in this article was misplaced. George Washington was the first president of the US. At the end of his presidency, in 1797, Franklin had been dead for seven years."

butterfly effect

The so-called butterfly effect refers to the future’s extreme sensitivity to initial conditions. Tiny variations, which seem dismissible as trivial rounding errors in measurements, can accumulate into massively different future events
Identical twins with the same observable demographic characteristics, lifestyle, medical care, and genetics necessarily generate the same predictions — but can still end up with completely different real outcomes.
Though no method can precisely predict the date you will die, for example, that level of precision is generally not necessary for predictions to be useful. By reframing complex phenomena in terms of limited multiple-choice questions 
(e.g., Will you have a heart attack within 10 years? 
Are you more or less likely than average to end up back in the hospital within 30 days?),
 predictive algorithms can operate as diagnostic screening tests to stratify patient populations by risk and inform discrete decision making.

even a perfectly calibrated prediction model may not translate into better clinical care. An accurate prediction of a patient outcome does not tell us what to do if we want to change that outcome — in fact, we cannot even assume that it’s possible to change the predicted outcomes

It is true, for instance, that palliative care consults and norepinephrine infusions are highly predictive of patient death, but it would be irrational to conclude that stopping either will reduce mortality. 

many such predictions are “highly accurate” mainly for cases whose likely outcome is already obvious to practicing clinicians. 


With machine learning situated at the peak of inflated expectations, we can soften a subsequent crash into a “trough of disillusionment”2 by fostering a stronger appreciation of the technology’s capabilities and limitations. Before we hold computerized systems (or humans) up against an idealized and unrealizable standard of perfection, let our benchmark be the real-world standards of care whereby doctors grossly misestimate the positive predictive value of screening tests for rare diagnoses, routinely overestimate patient life expectancy by a factor of 3, and deliver care of widely varied intensity in the last 6 months of life

Whether such artificial-intelligence systems are “smarter” than human practitioners makes for a stimulating debate — but is largely irrelevant. Combining machine-learning software with the best human clinician “hardware” will permit delivery of care that outperforms what either can do alone. Let’s move past the hype cycle and on to the “slope of enlightenment,”2 where we use every information and data resource to consistently improve our collective health

mostly from  http://www.nejm.org.ezp-prod1.hul.harvard.edu/doi/10.1056/NEJMp1702071

ఇండెక్స్
సంక్షిప్తమైన గాయం స్కేల్ (AIS), 394
అకాడమీ ఆఫ్ కౌంటర్-టెర్రరిస్ట్ ఎడ్యుకేషన్ ఎట్ లూసియానా స్టేట్ యూనివర్సిటీ, 27
ACAM-2000 చిన్నపాటి టీకా, 463-464
ప్రమాదవశాత్తు పారిశ్రామిక పేలుళ్లు, 394
జవాబుదారీతనం, 64, 329-330
ACEP. అమెరికన్ కాలేజీ ఆఫ్ ఎమర్జెన్సీ వైద్యులు
అసిటైl koలినెస్టేజ్ ఇన్హిబిషన్, 449
కొనుగోలు ఇమ్మ్యునోడైఫిసియెన్సీ సిండ్రోమ్
(ఎయిడ్స్), 77-81, 366-367
ACS. తీవ్రమైన కరోనరీ సిండ్రోమ్స్ చూడండి
తీవ్రమైన కరోనరీ సిండ్రోమ్ (ACS), 590
తీవ్రమైన చర్మపు రేడియేషన్ గాయం, 491-492
తీవ్రమైన జీర్ణశయాంతర (GI) సిండ్రోమ్, 491
తీవ్రమైన హెమాటోపాయిటిక్ సిండ్రోమ్, 488-491
తీవ్రమైన నిర్వహణ, 493-494
తీవ్రమైన వైద్య పరిస్థితులు, స్థిరీకరణ, 199
తీవ్రమైన న్యూరోవస్క్యులర్ సిండ్రోమ్, 491
తీవ్రమైన రేడియేషన్ సిండ్రోమ్ (ARS). ఇది కూడ చూడు
అణు సంఘటనలు
తీవ్రమైన చర్మం రేడియేషన్ గాయం,
491-492
తీవ్రమైన GI సిండ్రోమ్, 491
తీవ్రమైన హెమాటోపాయిటిక్ సిండ్రోమ్, 488-491
తీవ్రమైన నిర్వహణ, 493-494
తీవ్రమైన న్యూరోవస్క్యులర్ సిండ్రోమ్, 491
క్లినికల్ పురోగతి, 488
మరణం, 488
అలంకరణా చికిత్స, 498-499
ఆలస్యం ప్రభావాలు, 492-493
పేలుడు సంఘటనలు, 407
సాధారణ పరిశీలనలు, 487-488
ఇంటర్మీడియట్ మేనేజ్మెంట్, 494
గుప్త దశ, 488, 489
లింఫోసైటీ డిప్లిషన్ గినెటిక్స్, 491
మానిఫెస్ట్ (అనారోగ్యం) దశ, 488, 490
వైద్య నిరోధక చర్యలు, 494-498
వైద్య నిర్వహణ, 493
వైద్య చికిత్సలు, 494-498
మరణాల రేటు, 494
అవలోకనం, 482-483
ప్రొడ్రోమాల్ ఫేజ్, 488, 489
రేడియేషన్ కలిపి గాయం, 492
రేడియేషన్-ప్రేరిత ప్రాణాంతకం, 493
పునరుద్ధరణ, 488
చికిత్స, 493-495
చికిత్స మార్గదర్శకాలు, 494
తీవ్రమైన మూత్రపిండ వైఫల్యం (ARF), 570-571
తీవ్రమైన శ్వాస పీడన సిండ్రోమ్ (ARDS),
397, 444
పరిపాలనా నియంత్రిక హోదా,
235-236
అడ్వాన్స్డ్ హాజ్మాట్ లైఫ్ సపోర్ట్ (AHLS), 522
ప్రతికూల సంఘటనలు, యాంటీబయాటిక్స్, మరియు టీకాలు,
224-225
ఏరోసోల్ వ్యాప్తి, 458
వయసు సంబంధిత స్పందనలు, 104
వయసు / మొత్తం శరీర ఉపరితల ప్రాంతం (TBSA)
సర్వైవల్ గ్రిడ్, 424
AHLS. అధునాతన హజ్మాట్ లైఫ్ సపోర్ట్ చూడండి
ఎయిడ్స్. కొనుగోలు చేయబడిన రోగనిరోధక శక్తిని చూడండి
సిండ్రోమ్
ఎయిర్ కండీషనింగ్, 619
గాలి వైపరీత్యాలు
ఎయిర్బస్ 340, 256
ఎయిర్బస్ A300, 257
అంచనా, 258
బోయింగ్ విమానం, 254-257
బ్రిటిష్ కామెట్, 255
చికాగో, ఇల్లినాయిస్, 255
కమాండ్, 257
కమ్యూనికేషన్, 258
కాంకోర్డ్, 256
క్రాష్ సైట్, 257-258
రన్వే మీద వ్యర్ధాలు, 256
పరికరాలు, 257
పరికర వైఫల్యం, 255-256
పొగమంచు, 254-255
భవిష్యత్తు పరిశోధన, 272
హడన్ మాట్రిక్స్, 254
శత్రు వాతావరణం, 256
మంచు, 254
సంభవించే డేటా, 253
గాయం ఈవెంట్స్, ప్రస్తుత, 254
గాయం ఈవెంట్స్, చారిత్రక, 253-254
ఉద్దేశపూర్వకంగా క్రాష్లు, 257
ఇరాన్, 257
ఐరిష్ సముద్రం, 257
జామ్డ్ వాల్వ్, 255-256
లాకర్బీ, స్కాట్లాండ్, 257
మాంచెస్టర్, ఇంగ్లాండ్, 255
MD-81 విమానం, 256
మిలన్, ఇటలీ, 255
అద్భుతమైన మనుగడ, 257
పారిస్, ఫ్రాన్స్, 256
పైలట్ లోపం, 256
ప్రణాళిక, 257
తయారీ, 257
రష్యా, 256-257
భద్రత, 257-258
సన్నివేశం స్పందన, 257-258
కాల్పులు, 256-257
స్టాక్హోమ్, స్వీడన్, 256
తైపీ, తైవాన్, 255
టెనెరిఫే, స్పెయిన్, 254-255
తీవ్రవాద దాడులు, 256-257
టొరంటో, ఒంటారియో, కెనడా, 256
శిక్షణ, 257
రవాణా, 258
చికిత్స, 258
ట్రీజ్, 258
వాషింగ్టన్, DC, 254
గాలిలో ప్రసారం, 76
ఎయిర్బస్ విమానం, 256, 257
ఎయిర్-శుద్దీకరణ రెస్పిరేటర్స్ (APRs), 189-190
ఎఐఎస్. సంక్షిప్తమైన గాయం స్కేల్ ను చూడండి
అల్ సలామ్ బోకాకాసియో 98, 259
అల్ఫ్రెడ్ పి. ముర్రా ఫెడరల్ భవనం బాంబు,
176
అన్ని-విపత్తు విధానం, 58
అన్ని-ప్రమాదాలు అత్యవసర నిర్వహణ
కార్యక్రమాలు, 139-140
643
https://doi.org/10.1017/CBO9780511902482
Https://www.cambridge.org/core నుండి డౌన్లోడ్ చేయబడింది. హార్వర్డ్ విశ్వవిద్యాలయం, 02 ఫిబ్రవరి 2018 న 17:47:45, కేంబ్రిడ్జ్ కోర్ ఉపయోగ నిబంధనలకు అనుగుణంగా, https://www.cambridge.org/core/terms వద్ద అందుబాటులో ఉంది.
644 ■ INDEX
ఆల్ఫా కణాలు, 483-484
ఆల్ఫాబెట్ బాంబర్, 433-434
ప్రత్యామ్నాయ సంరక్షణ సైట్లు, 560
ప్రత్యామ్నాయ సంరక్షణ వ్యవస్థ అభివృద్ధి, 40-41
AMA. అమెరికన్ మెడికల్ అసోసియేషన్ చూడండి
ఔత్సాహిక రేడియో నెట్వర్క్లు, 357
అమెరికన్ కాలేజ్ ఆఫ్ ఎమర్జెన్సీ ఫిజిషియన్స్
(ACEP), 68, 234
అమెరికన్ మెడికల్ అసోసియేషన్ (AMA) కోడ్
మెడికల్ ఎథిక్స్, 67-68
అమెరికన్ రెడ్ క్రాస్, 121, 124, 144-145
అమెరికన్ రెడ్ క్రాస్ సేఫ్ మరియు వెల్ వెబ్ సైట్,
378
అంగచ్ఛేదం, 394, 570-571, 596
సహాయక సరఫరా, 225
అనస్థీషియా, 410, 571
ఉడక అమోనియా, 440-441
యాంటీమార్కెట్ డేటా, 320-321
ఆంత్రాక్స్
యాంటీబయాటిక్స్ మరియు టీకాలు, 215-216, 224
జీవ సంఘటన, 456-461
EID లు, 76, 78, 86-88
PPE, 184
యాంట్రాక్స్ వాక్సిన్ యాన్సోర్డ్డ్ (AVA), 460-461
యాంటీబయాటిక్స్ మరియు టీకాలు. కూడా పాయింట్లు చూడండి
పంపిణీ; టీకాలు
ప్రతికూల సంఘటనలు, 224-225
సహాయక సరఫరా, 225
ఆంత్రాక్స్, 215-216, 224
కెనడియన్ యాంటివైరల్ స్టాక్పీల్
పాండమిక్ ఇన్ఫ్లుఎంజా, 214-215
పిల్లలు, 223
చల్లని గొలుసు నిర్వహణ, 225
CRI, 216
పంపిణీ చట్టాలు, 223-224
2006 లో DOD కేటాయింపుల చట్టం,
216-217
ఔషధ సూత్రాలు, 223
వృద్ధుల, 223
యుఎస్ఏ, 224
సమాఖ్య సహాయం, ఉదాహరణలు, 215-216
భవిష్యత్ ఆదేశాలు, 225
ఆరోగ్య వృత్తిపరమైన మరియు స్వచ్చంద
పాత్రలు, 221
చారిత్రిక దృక్పథాలు, 213
IND, 224
ఇన్ఫ్లుఎంజా పాండమిక్ 1918, 213
సమాచారం సమ్మతి, 224
అంతర్జాతీయ ప్రయత్నాలు, 214-215
ఇజ్రాయెల్ మశూచి టీకా మందుల నిల్వ, 214
లేబులింగ్ నిబంధనలు, 224
మేనేజ్డ్ ఇన్వెంటరీ, 215
మెడ్వాచ్, 225
అవలోకనం, 213
PODs, 215-223
ప్రాజెక్ట్ బయో షీల్డ్ చట్టం, 224
పబ్లిక్ హెల్త్ సర్వీస్ ఆక్ట్, 217, 224
ప్రజా సంసిద్ధత మరియు అత్యవసర పరిస్థితి
సంసిద్ధత చట్టం, 216-217
RSS స్థానం, 215
మశూచి, 213-214
SNS, 215
ప్రత్యేక పరిగణనలు, 223
స్వైన్ ఫ్లూ టీకా కార్యక్రమం 1976, 213
12-గంటల పుష్ ప్యాకేజీలు, 215
యునైటెడ్ కింగ్

30 day hospital readmission prediction

  Since the 1990s there has been a great interest in hospital readmission rates
 there has been increasing interest in using admission rates as health outcome indicators to make comparisons over time and between health authorities. Rates of hospital admission for certain conditions and groups were considered to be useful performance indicators in five of the six areas outlined in the performance assessment framework document (Department of Health 2000). These five areas are health improvement, fair access, effective delivery of appropriate health care, efficiency, and health outcomes of NHS healthcare.
 The performance indicators in question include:
• hospital admissions for serious accidental injury (health improvement)
• elective surgery rates (fair access)
• surgery rates (fair access)
• inappropriately used surgery (effective delivery)
• acute care management (effective delivery)
• chronic care management (effective delivery)
• day case rate (efficiency)
• emergency admissions of older people (health outcomes).

 The national objective to ensure that everyone with health care needs (fair access) receives appropriate and effective health care (effective delivery) offering good value for money (efficiency) for services as sensitive and convenient as possible so that good clinical outcomes are achieved (health outcomes) to maximise the contribution to improved health (health improvement). 

• What are the general factors affecting admission rates?
 • What factors influence admission rates when they are being used specifically as outcome indicators for chronic medical conditions?
 • How should admission rates be calculated when used as health outcome indicators?

 LACE rule
 LACE (length of stay, acuity of admission, comorbidity, emergency department use within six months of admission)
HOSPITAL (low hemoglobin level, discharge from oncology, low sodium level, procedure during hospitalization, nonelective index admission type, number of hospital admissions during the previous year, length of stay)

The Charlson Comorbidity Index contains 19 categories of comorbidity and predicts the ten-year mortality for a patient who may have a range of co-morbid conditions. Each condition is assigned with a score of 1,2,3 or 6 depending on the risk of dying associated with this condition.

Charlson Index Online Calculator - farmacologiaclinica.info

farmacologiaclinica.info/scales/Charlson_Comorbidity/

Clavien–Dindo classification of surgical complications

Prediction is not new to medicine. From risk scores to guide anticoagulation (CHADS2) and the use of cholesterol medications (ASCVD) to risk stratification of patients in the intensive care unit (APACHE), data-driven clinical predictions are routine in medical practice. In combination with modern machine learning, clinical data sources enable us to rapidly generate prediction models for thousands of similar clinical questions. From early-warning systems for sepsis to superhuman imaging diagnostics, the potential applicability of these approaches is substantial

.