Internists
22 years of experience
Video profile
51 N 39th St
Suite 212
Philadelphia, PA 19104
215-662-8978
Locations and availability (1)

Education ?

Medical School Score Rankings
Temple University Physicians (1988)
  • Currently 3 of 4 apples
Top 50%

Affiliations ?

Dr. Nichols is affiliated with 3 hospitals.

Hospital Affilations

Score

Rankings

  • Pennsylvania Hospital University PA Health System
    800 Spruce St, Philadelphia, PA 19107
    • Currently 4 of 4 crosses
    Top 25%
  • University of PA Medical Center/Presbyterian
    51 N 39th St, Philadelphia, PA 19104
    • Currently 3 of 4 crosses
    Top 50%
  • Clinical Care Associates of the University of Pennsylvania Health System
  • Publications & Research

    Dr. Nichols has contributed to 43 publications.
    Title Nurses' Scope of Practice.
    Date January 2011
    Journal The New England Journal of Medicine
    Title Single Photon-emission Computed Tomography.
    Date January 2011
    Journal Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology
    Title Automated Detection of Left Ventricular Dyskinesis by Gated Blood Pool Spect.
    Date December 2010
    Journal Nuclear Medicine Communications
    Excerpt

    The ability to detect left ventricular (LV) apical dyskinesis, the hallmark of an aneurysm, is an important requirement of diagnostic cardiac imaging modalities that perform wall motion analysis. Our investigation assessed the ability of gated blood pool single-photon emission-computed tomography (GBPS) to automatically detect LV dyskinesis, using cardiac magnetic resonance (CMR) as the reference standard.

    Title Recommendations for Reducing Radiation Exposure in Myocardial Perfusion Imaging.
    Date November 2010
    Journal Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology
    Title Prospects for Advancing Nuclear Cardiology by Means of New Detector Designs.
    Date November 2009
    Journal Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology
    Title In Vitro Human Leukocyte Labeling with (64)cu: an Intraindividual Comparison with (111)in-oxine and (18)f-fdg.
    Date September 2009
    Journal Nuclear Medicine and Biology
    Excerpt

    We investigated labeling human leukocytes [white blood cells (WBCs)] in vitro with copper-64 (Cu) comparing labeling efficiency, viability and stability of Cu-WBCs with (111)In-oxine (In) WBCs and (18)F-FDG (FDG) WBCs.

    Title Automated Versus Manual Detection of Left Ventricular Wall Motion Abnormalities by Gated Blood Pool Spect.
    Date June 2009
    Journal Medical Physics
    Excerpt

    The purpose of this investigation was to describe the rationale and implementation of new totally automated algorithms to compute global and regional left ventricular (LV) function measurements from blood pool (BP) gated SPECT data and to test the hypothesis that automated calculations are as accurate as manual calculations for detecting global and regional LV wall motion abnormalities when compared to independent cardiac magnetic resonance (CMR) measurements. From an Institutional Review Board approved retrospective review of data for 43 patients (age 58 +/- 13 years; 82% males; 59% with CHF; 59% with prior MI) evaluated for cardiac disease, CMR data were analyzed along with automated and manual calculations of BP data. There was no difference among global LV EF values (ANOVA p = 0.90) and strong correlation between automated (r = 0.96, p < 0.0001) and manual (r = 0.95, p < 0.0001) global LV EFs versus CMR, with no significant trends or biases. There was "very good agreement" of automated (kappa = 0.91) and manual (kappa = 0.86) discriminations of cases with LV EF < 50% versus CMR. Detection of LV segments with abnormal regional wall motion was equally accurate (p = 0.68) for automated and manual processings of BP data [ROC areas = 87(+/- 2%) versus 86(+/- 2%)]. The authors conclude that automated and manual computations were equivalent to each other and accurate at identifying both global and regional LV wall motion abnormalities.

    Title Relationships Between Blood Pool and Myocardial Perfusion-gated Spect Global and Regional Left Ventricular Function Measurements.
    Date April 2009
    Journal Nuclear Medicine Communications
    Excerpt

    Algorithms have been developed to quantify global and regional left ventricular (LV) function and asynchrony from myocardial perfusion (MP) and blood pool (BP)-gated single-photon emission computer-assisted tomography, but relationships between measurements from these two imaging modalities have not been documented. The objective of this investigation was to determine the degree to which automated BP and MP measurements agree with each other and are accurate, using cardiac magnetic resonance (CMR) as the reference standard. We also sought to determine the extent to which regions of abnormal phase correspond to segments exhibiting abnormal wall motion.

    Title Validation of Gated Blood-pool Spect Regional Left Ventricular Function Measurements.
    Date March 2009
    Journal Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine
    Excerpt

    Blood-pool (BP)-gated SPECT should be able to detect regional left ventricular (LV) dysfunction, as the modality is fully 3-dimensional and capable of resolving all cardiac chambers. This study investigates the hypothesis that LV segments that have abnormal regional wall motion (WM) on a cardiac MRI scan also have abnormal BP regional ejection fraction (EF) as computed by fully automated quantitation (AQ) of BP data.

    Title Pinhole Versus Parallel-hole Collimators for Parathyroid Imaging: an Intraindividual Comparison.
    Date February 2009
    Journal Journal of Nuclear Medicine Technology
    Excerpt

    This study was undertaken to determine the effects of collimators on the accuracy of preoperative sestamibi parathyroid imaging of the neck.

    Title Medical Education Summits: Building a Solid Foundation for the Future of the Osteopathic Medical Profession.
    Date August 2008
    Journal The Journal of the American Osteopathic Association
    Excerpt

    In January 2006, the inaugural Osteopathic Heritage Foundation Medical Education Summit was held to address key issues confronting the osteopathic medical profession, particularly the physician workforce, student recruitment, and the funding of postdoctoral programs. Building off of the draft statements from the first summit, the Medical Education Summit II addressed issues specifically related to osteopathic graduate medical education. The authors provide a brief outline of the summit process, describe the outcomes from both meetings, and discuss the future goals of osteopathic medical education.

    Title Phantom Experiments to Improve Parathyroid Lesion Detection.
    Date August 2008
    Journal Medical Physics
    Excerpt

    This investigation tested the hypothesis that visual analysis of iteratively reconstructed tomograms by ordered subset expectation maximization (OSEM) provides the highest accuracy for localizing parathyroid lesions using 99mTc-sestamibi SPECT data. From an Institutional Review Board approved retrospective review of 531 patients evaluated for parathyroid localization, image characteristics were determined for 85 99mTc-sestamibi SPECT studies originally read as equivocal (EQ). Seventy-two plexiglas phantoms using cylindrical simulated lesions were acquired for a clinically realistic range of counts (mean simulated lesion counts of 75 +/- 50 counts/pixel) and target-to-background (T:B) ratios (range = 2.0 to 8.0) to determine an optimal filter for OSEM. Two experienced nuclear physicians graded simulated lesions, blinded to whether chambers contained radioactivity or plain water, and two observers used the same scale to read all phantom and clinical SPECT studies, blinded to pathology findings and clinical information. For phantom data and all clinical data, T : B analyses were not statistically different for OSEM versus FB, but visual readings were significantly more accurate than T : B (88 +/- 6% versus 68 +/- 6%, p = 0.001) for OSEM processing, and OSEM was significantly more accurate than FB for visual readings (88 +/- 6% versus 58 +/- 6%, p < 0.0001). These data suggest that visual analysis of iteratively reconstructed MIBI tomograms should be incorporated into imaging protocols performed to localize parathyroid lesions.

    Title Preoperative Parathyroid Scintigraphic Lesion Localization: Accuracy of Various Types of Readings.
    Date July 2008
    Journal Radiology
    Excerpt

    PURPOSE: To retrospectively compare the accuracy of various parathyroid scintigraphy readings for single-gland disease (SGD) and multigland disease (MGD) in patients with primary hyperparathyroidism, with histologic analysis as the reference standard. MATERIALS AND METHODS: Institutional review board approval was obtained for this HIPAA-compliant study. Records of 462 patients with primary hyperparathyroidism who underwent preoperative imaging with a technetium 99m ((99m)Tc) sestamibi and (99m)TcO4- protocol that consisted of early and late pinhole (99m)Tc sestamibi, pinhole thyroid imaging, image subtraction, and single photon emission computed tomography (SPECT) were retrospectively reviewed. An experienced nuclear medicine physician without knowledge of other test results or of the final diagnoses graded images on a scale from 0 (definitely normal) to 4 (definitely abnormal). Early pinhole (99m)Tc sestamibi images, late pinhole (99m)Tc sestamibi images, subtraction images, SPECT images, early and late pinhole (99m)Tc sestamibi images, all planar images, and all images--including SPECT images--were read in seven sessions. Receiver operating characteristic curves were generated for each session and were used to calculate sensitivity, specificity, and accuracy. RESULTS: A total of 534 parathyroid lesions were excised. Of the 462 patients, 409 had one lesion, whereas 53 had multiple lesions. Reading all images together was more accurate (89%, P = .001) than was reading early (79%), late (85%), subtraction (86%), and SPECT (83%) images separately; however, it was not significantly more accurate than reading planar images (88%) or early and late images together (87%). Reading all images was significantly less sensitive in the detection of lesions with a median weight of 600 mg or less than in the detection of lesions with a median weight of more than 600 mg (86% vs 94%, P = .004). Per-lesion sensitivity for reading all images was significantly higher for SGD than for MGD (90% vs 66%, P < .001). Sensitivity of reading all images together in the identification of patients with MGD was 62%. CONCLUSION: Reviewing early, late, and subtraction pinhole images together with SPECT images maximizes parathyroid lesion detection accuracy. Test sensitivity is adversely affected by decreasing lesion weight and MGD.

    Title Assessment of Left Ventricular Mechanical Dyssynchrony by Phase Analysis of Ecg-gated Spect Myocardial Perfusion Imaging.
    Date February 2008
    Journal Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology
    Excerpt

    Cardiac resynchronization therapy (CRT) has shown benefits in patients with severe heart failure. However, at least 30% of patients selected for CRT by use of traditional criteria (New York Heart Association class III or IV, depressed left ventricular [LV] ejection fraction, and prolonged QRS duration) do not respond to CRT. Recent studies with tissue Doppler imaging have shown that the presence of LV dyssynchrony is an important predictor of response to CRT. Phase analysis has been developed to allow assessment of LV dyssynchrony by gated single photon emission computed tomography myocardial perfusion imaging. This technique uses Fourier harmonic functions to approximate regional wall thickness changes over the cardiac cycle and to calculate the regional onset-of-mechanical contraction phase. Once the onset-of-mechanical contraction phases are obtained 3-dimensionally over the left ventricle, a phase distribution map is formed that represents the degree of LV dyssynchrony. This technique has been compared with other methods of measuring LV dyssynchrony and shown promising results in clinical evaluations. In this review the phase analysis methodology is described, and its up-to-date validations are summarized.

    Title Aoa's Position Against Use of Placebos for Pain Management in End-of-life Care.
    Date January 2008
    Journal The Journal of the American Osteopathic Association
    Excerpt

    A number of organizations have advised against the use of placebo substitution, including the American Pain Society, Agency for Healthcare Policy and Research, World Health Organization, Healthcare Facilities Accreditation Program, Joint Commission on Accreditation of Healthcare Organizations, Education for Physicians on End-of-Life Care Project (cosponsored by the American Medical Association and The Robert Wood Johnson Foundation), American Nursing Association, and the American Society of Pain Management Nurses. This white paper describes the literature and rationale in support of the American Osteopathic Association's (AOA's) position on the controversial subject of the use of placebos for pain management in terminally ill patients.

    Title Diagnosing Prosthetic Vascular Graft Infection with the Antigranulocyte Antibody 99mtc-fanolesomab.
    Date April 2007
    Journal Nuclear Medicine Communications
    Excerpt

    AIM: The objectives of this retrospective investigation were to determine the accuracy of 99mTc-fanolesomab, an antigranulocyte antibody, for diagnosing prosthetic vascular graft infection, ascertain optimum imaging times for this indication, and assess safety of this agent. METHODS: Eighteen patients with 19 prosthetic vascular grafts were included. Indications for graft placement included peripheral vascular disease (8), haemodialysis (7), and aneurysm (4). Patients were imaged 2-5 h and 18-30 h after injection of 555-740 MBq (75-125 microg) 99mTc-fanolesomab. One experienced nuclear physician reviewed images in three separate sessions, early alone, late alone and early plus late images together. When early and late images were read alone, graft activity more intense than native blood pool activity was classified as positive for infection. When early and late images were interpreted together, graft activity which persisted or which increased in intensity over time was classified as positive for infection. Patient records were reviewed for adverse events up to 30 days after injection. RESULTS: Five (26%) prosthetic grafts were infected. Early, late and early plus late imaging were equally sensitive (1.00). Early images were significantly less specific (0.50), than late and early plus late images (0.93) (P<0.05, analysis of proportions). Accuracy of late imaging and early plus late imaging were the same: 0.93. No patient experienced adverse events following radiopharmaceutical injection. CONCLUSIONS: 99mTc-fanolesomab imaging, performed 18-30 h after injection, diagnosed prosthetic vascular graft infection safely and accurately (95%). (Although safety was not an issue in this investigation, following reports of serious, including two fatal, events after administration, 99mTc-fanolesomab was withdrawn from the United States market).

    Title How Serious a Problem for Myocardial Perfusion Assessment is Moderate Misregistration Between Spect and Ct?
    Date April 2007
    Journal Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology
    Title Right Ventricular Parameters: Prospect for Routine Assessment by Equilibrium Radionuclide Angiographic Spect.
    Date April 2007
    Journal Nuclear Medicine Communications
    Excerpt

    While left ventricular (LV) function is assessed routinely for heart disease, right ventricular (RV) assessment has attracted relatively little attention due to technical difficulties, even though RV function plays an important role in determining prognosis. This issue of the Communications includes a report that a SPECT ERNA algorithm applied to data for patients with tetralogy of Fallot exhibited RV dysfunction compared to normal subjects, as reported previously using different ERNA SPECT algorithms. That ERNA SPECT methods appear to produce results that are expected of patient group who should exhibit RV abnormalities presents the prospect that such algorithms also could be used to evaluate whether patients undergoing chemotherapy with anthracyclines and other cardiotoxic chemotherapeutic agents become at risk of developing RV, as well as, LV dysfunction. SPECT ERNA may well become the standard test for monitoring RV and LV components of heart disease in managing patients undergoing chemotherapy.

    Title Regarding the Virtues and Limitations of Combining Myocardial Perfusion Spect Data Acquired by Diverse Methods.
    Date February 2007
    Journal Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology
    Title Will the Real Left Ventricular Volume Please Stand Up?
    Date January 2007
    Journal The International Journal of Cardiovascular Imaging
    Title Instrumentation Quality Assurance and Performance.
    Date January 2007
    Journal Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology
    Title First-pass Radionuclide Angiography.
    Date January 2007
    Journal Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology
    Title Comparison Among Tomographic Radionuclide Ventriculography Algorithms for Computing Left and Right Ventricular Normal Limits.
    Date November 2006
    Journal Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology
    Excerpt

    Various algorithms have been developed to compute right ventricular (RV) and left ventricular (LV) end-diastolic volumes, end-systolic volumes, and ejection fractions (EF) from tomographic radionuclide ventriculography (TRV). The aims of this investigation were to establish sex-specific normal limits, to determine whether different algorithms produce the same normal values, and to compare TRV normal limits vs for magnetic resonance imaging values in the literature.

    Title Pet with Fdg-labeled Leukocytes Versus Scintigraphy with 111in-oxine-labeled Leukocytes for Detection of Infection.
    Date April 2006
    Journal Radiology
    Excerpt

    PURPOSE: To compare prospectively the accuracy of positron emission tomography (PET) with leukocytes labeled in vitro with (18)F fluorodeoxyglucose (FDG) versus that of conventional scintigraphy with leukocytes labeled in vitro with (111)In oxine in patients suspected of having infection. MATERIALS AND METHODS: This HIPAA-compliant study had institutional review board approval; informed consent was obtained from all patients. Patients were 25 men and 26 women aged 32-86 years. In vitro labeling of autologous human leukocytes with FDG and (111)In-oxine was performed according to published methods. Labeling efficiencies and cell viability were determined. Imaging was performed 2.5-5.8 hours after injection of 196-315 MBq of FDG-labeled leukocytes and approximately 24 hours after injection of 17-25 MBq of (111)In-oxine-labeled leukocytes. Forty-three (20 men, 23 women; mean age, 59 years; range, 32-86 years) patients could be successfully imaged with both tracers. Six patients were not injected with FDG-labeled leukocytes because of low labeling efficiency (<35%). Two patients were injected with FDG-labeled leukocytes but were not imaged. One reader interpreted all results as positive or negative for infection. Imaging results were compared with final diagnoses. Labeling efficiencies and cell viabilities were compared by using the paired t test. Differences between PET and scintigraphy were determined by using the McNemar test. RESULTS: For the 43 patients who were imaged with both tracers, labeling efficiency of FDG was lower than that of (111)In oxine (72% +/- 8 [standard deviation] vs 90% +/- 5, P < .001). Viability of FDG-labeled leukocytes was not different from that of (111)In-oxine-labeled leukocytes (98% +/- 1 vs 97% +/- 3). There were no differences between FDG PET and (111)In scintigraphy in terms of sensitivity (87% vs 73%), specificity (82% vs 86%), or accuracy (84% vs 81%). CONCLUSION: PET with FDG-labeled leukocytes was comparable to scintigraphy with (111)In-oxine-labeled leukocytes. Further investigation in a larger population with dedicated PET or PET/computed tomography seems warranted.

    Title Plans for New Conjoint Certificate of Added Qualifications in Hospice and Palliative Medicine.
    Date February 2006
    Journal The Journal of the American Osteopathic Association
    Title One Good Turn Deserves Another.
    Date May 2005
    Journal Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology
    Title Postischemic Stunning After Adenosine Vasodilator Stress.
    Date February 2005
    Journal Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology
    Excerpt

    BACKGROUND: Ischemic left ventricular (LV) dysfunction may occur after exercise but is regarded as uncommon after vasodilator stress. We evaluated the prevalence of LV dysfunction after adenosine stress in relation to reversible perfusion defects and angiographic coronary artery disease (CAD). METHODS AND RESULTS: We studied 86 patients referred for clinically indicated adenosine dual-isotope gated single photon emission computed tomography: 43 with 1 or more reversible perfusion defects (reversible defect group) and 43 age- and sex-matched patients with no known CAD and normal LV perfusion and function (control group). Coronary angiography was performed in 36 of 43 patients (84%) in the reversible defect group. Perfusion was interpreted based on 20-segment/5-point summed rest and stress scores. The extent of reversibility was defined by the summed difference score. LV ejection fraction and volumes at rest and 60 minutes after adenosine and segmental wall thickening were quantified by QGS (Cedars-Sinai Medical Center, Los Angeles, Calif). In patients with extensive reversible perfusion defects (summed difference score > or =8), 8 of 25 (32%) demonstrated depressed post-adenosine LV ejection fraction, abnormal segmental wall thickening, end-systolic dilation, and extensive CAD. CONCLUSION: Adenosine is believed to be less likely than exercise to induce ischemia. However, myocardial stunning occurred in one third of the patients with severe reversible defects, consistent with ischemia.

    Title Diagnosing Infection in the Failed Joint Replacement: a Comparison of Coincidence Detection 18f-fdg and 111in-labeled Leukocyte/99mtc-sulfur Colloid Marrow Imaging.
    Date January 2005
    Journal Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine
    Excerpt

    The objectives of this study were to investigate (18)F-FDG imaging, using a coincidence detection system, for diagnosing prosthetic joint infection and to compare it with combined (111)In-labeled leukocyte/(99m)Tc-sulfur colloid marrow imaging in patients with failed lower extremity joint replacements. METHODS: Fifty-nine patients--with painful, failed, lower extremity joint prostheses, 40 hip and 19 knee--who underwent (18)F-FDG, labeled leukocyte, and bone marrow imaging, and had histopathologic and microbiologic confirmation of the final diagnosis, formed the basis of this investigation. (18)F-FDG images were interpreted as positive for infection using 4 different criteria: criterion 1: any periprosthetic activity, regardless of location or intensity; criterion 2: periprosthetic activity on the (18)F-FDG image, without corresponding activity on the marrow image; criterion 3: only bone-prosthesis interface activity, regardless of intensity; criterion 4: semiquantitative analysis--a lesion-to-background ratio was generated, and the cutoff value yielding the highest accuracy for determining the presence of infection was determined. Labeled leukocyte/marrow images were interpreted as positive for infection when periprosthetic activity was present on the labeled leukocyte image without corresponding activity on the marrow image. RESULTS: Twenty-five (42%) prostheses, 14 hip and 11 knee, were infected. The sensitivity, specificity, and accuracy of (18)F-FDG, by criterion, were as follows: criterion 1: 100%, 9%, 47%; criterion 2: 96%, 35%, 61%; criterion 3: 52%, 44%, 47%; criterion 4: 36%, 97%, 71%. The sensitivity, specificity, and accuracy of labeled leukocyte/marrow imaging were 100%, 91%, and 95%, respectively. WBC/marrow imaging, which was more accurate than any of the (18)F-FDG criteria for all prostheses, as well as for hips and knees separately, was significantly more sensitive than criterion 3 (P < 0.001) and criterion 4 (P < 0.001) and was significantly more specific than criterion 1 (P < 0.001), criterion 2 (P < 0.001), and criterion 3 (P < 0.001). CONCLUSION: Regardless of how the images are interpreted, coincidence detection-based (18)F-FDG imaging is less accurate than, and cannot replace, labeled leukocyte/marrow imaging for diagnosing infection of the failed prosthetic joint.

    Title Results of a Survey of Inaugural Class Graduates of a College of Osteopathic Medicine.
    Date March 2003
    Journal The Journal of the American Osteopathic Association
    Excerpt

    The purpose of this study was to determine where the graduates of an inaugural class of a college of osteopathic medicine came from, what influenced their school selection, how their osteopathic medical school experience affected them, and how they chose what and where they would study after graduation as well as where they would practice. These data have significant implications for the osteopathic profession and its future recruitment efforts into the profession and into its postgraduate programs.

    Title More on End-of-life Care.
    Date August 2002
    Journal The Journal of the American Osteopathic Association
    Title Approach to Optimal Care at End of Life.
    Date December 2001
    Journal The Journal of the American Osteopathic Association
    Excerpt

    At no other time in any patient's life is the team approach to care more important than at the end of life. The demands and challenges of end-of-life care (ELC) tax all physicians at some point. There is no other profession that is charged with this ultimate responsibility. No discipline in medicine is immune to the issues of end-of-life care except perhaps, ironically, pathology. This presentation addresses the issues, options, and challenges of providing optimal care at the end of life. It looks at the principles of ELC, barriers to good ELC, and what patients and families expect from ELC. Barriers to ELC include financial restrictions, inadequate care-givers, community support, legal issues, legislative issues, training needs, coordination of care, hospice care, and transitions for the patients and families. The legal aspects of physician-assisted suicide is presented as well as the approach of the American Osteopathic Association to ensure better education for physicians in the principles of ELC.

    Title Evaluation of Osteoporosis.
    Date April 2000
    Journal The Journal of the American Osteopathic Association
    Excerpt

    Osteoporosis is a silent epidemic that is preventable and treatable. Few people are currently having osteoporosis diagnosed early enough to receive the benefit of prevention. Therefore, most present with a fracture as the first clinical manifestation of the disease. The physician taking a history must have a high index of suspicion for osteoporosis. All women should be counseled about risk factors for osteoporosis. The diagnosis of this disease includes an evaluation of bone mineral density by radiologic technique. The osteopathic physician is uniquely well trained to recognize and diagnose osteoporosis.

    Title Family Perceptions of Future Programming Needs in a Sample of Individuals with Mental Retardation.
    Date October 1999
    Journal Psychological Reports
    Excerpt

    The present study examined parents' perceived programming needs of their children with mental retardation. Parents (44 mothers, 8 fathers) of individuals attending programming in an agency for mental retardation responded to a telephone survey. Analysis showed parents were most concerned about future housing needs. A significant difference was found between older and younger parents in their perception of future needs.

    Title Left Ventricular Function and Perfusion from Gated Spect Perfusion Images: an Integrated Method.
    Date May 1999
    Journal Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine
    Excerpt

    A new technique for computing left ventricular function, including left ventricular volumes, mass and ejection fraction, has been developed. This method is a logical extension of the results of a standard perfusion quantification technique; thus, it allows integration of perfusion and functional information. METHODS: Anatomically based models of the endocardial and epicardial surfaces are generated using the myocardial samples for which perfusion values are quantified, for all frames in the cardiac cycle. With these surface points, left ventricular chamber volume and myocardial volume can be computed. A computer simulation was used to determine the sensitivity of the approach to the assumptions of the model. Validation of volume, mass and ejection fraction was performed with correlative MR studies, and ejection fraction and left ventricular volumes were further investigated using correlative first-pass studies. RESULTS: Automated processing was successful in 96% of the cases analyzed. End diastolic volume, end systolic volume, left ventricular mass and left ventricular ejection fraction correlated with MRI with r = 0.97, 0.99, 0.87, and 0.85, respectively. Ejection fraction from tomography correlated with first-pass values with r = 0.82, and end diastolic and end systolic volumes from tomography correlated with first-pass values with r = 0.85 and r = 0.91, respectively. CONCLUSION: The new integrated approach is accurate and robust for computing both perfusion and function from perfusion tomograms.

    Title Fast Stress and Rest Acquisitions for Technetium-99m-sestamibi Separate-day Spect.
    Date May 1995
    Journal Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine
    Excerpt

    Abbreviated acquisition protocols were designed for stress and rest to decrease stress and rest SPECT image acquisition times but maintain the high count density of 99mTc-sestamibi separate-day cardiac images. METHODS: Scan findings were compared visually and quantitatively with standard SPECT for 12 rest and 32 stress patient studies. RESULTS: Of 29 stress defects detected by standard SPECT, 27 were present with the fast technique; of 8 resting SPECT defects, all were detected with fast SPECT. Two stress and no resting false-positive defects occurred with fast SPECT. Linear correlations (r) between standard and fast quantitative defect extent and severity were 0.76 and 0.86, respectively for stress SPECT, and 0.88 and 0.96 for rest SPECT. Stress fast defects were slightly less severe (p = 0.02) than those observed using standard acquisition. CONCLUSION: We conclude that these fast protocols for separate-day 99mTc-MIBI SPECT accurately detect and characterize perfusion defects and provide a means to improve patient tolerance and increase laboratory throughput.

    Title Simultaneous Biplane First-pass Radionuclide Angiocardiography Using a Scintillation Camera with Two Perpendicular Detectors.
    Date November 1994
    Journal Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine
    Excerpt

    Generally performed in a single anterior or right anterior oblique (RAO) view, first-pass radionuclide angiocardiography (RNA) is limited due to its inability to evaluate septal and posterior wall motion.

    Title Atypical Measles: a Diagnostic Conundrum.
    Date December 1991
    Journal The Journal of the American Osteopathic Association
    Excerpt

    Atypical measles syndrome has been reported extensively in the pediatric medical literature. However, the clinical picture in the adult is similar to that of many other diseases, making the diagnosis elusive. The case reported here was unusually morbid. The patient, a young man, had been in excellent health until the onset of a perplexing syndrome. When seen by the author, he had been ill for 1 week with chills, pharyngitis, and vomiting; later, a nonpruritic, maculopapular rash developed. Symptoms progressed to pneumonitis and hepatitis. A rubeola titer was obtained and was found to be considerably elevated. Because of the high titer and the fact that the patient had been immunized against measles in early childhood, the diagnosis was atypical measles syndrome. Two theories are offered to explain the pathogenesis of this disease.

    Title Accuracy and Reproducibility of Left Ventricular Ejection Fraction Measurements Using an Ambulatory Radionuclide Left Ventricular Function Monitor.
    Date June 1991
    Journal Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine
    Excerpt

    The accuracy and reproducibility of a new ambulatory radionuclide detector system (the VEST) for ejection fraction measurement has not been fully validated. Thirty-six subjects, (19 volunteers and 17 patients) underwent repetitive bicycle exercise using sequences of both VEST monitoring and gamma camera imaging. A high intraclass correlation was noted for both absolute ejection fraction [0.84 (0.56, 0.95)] and delta ejection fraction [0.87 (0.63, 0.96)] during repeat VEST monitoring. The intraclass correlation for ejection fraction was comparable for data averaged over 30 sec versus 2 min. These correlations compared favorably to those obtained for assessment of absolute and delta ejection fraction as derived by gamma camera determination by the same computer operator (intraobserver variability), two different computer operators (interobserver variability), and during repeat exercise using gamma camera imaging. In concordance, correlations between VEST and gamma camera measurements were relatively high for both absolute ejection fraction (0.78 [0.61, 0.88]) and delta ejection fraction (0.63 [0.39, 0.79]). Thus, the VEST represents a reproducible means of measuring ejection fraction change during dynamic physical activity. Its accuracy in ejection fraction measurements is similar to gamma camera imaging during exercise testing.

    Title Validation of a Cardiac Risk Factor Index for Noncardiac Surgery in a Community Osteopathic Hospital.
    Date June 1987
    Journal The Journal of the American Osteopathic Association
    Title Normal Limits of Gated Blood Pool Spect Count-based Regional Cardiac Function Parameters.
    Date
    Journal The International Journal of Cardiovascular Imaging
    Excerpt

    PURPOSE: Computations of left and right ventricular (LV and RV) gated blood pool SPECT (GBPS) ejection fraction (EF) have been well validated against other imaging modalities. As GBPS images depict the entire extent of both blood pools, it is possible to compute not only global but also regional biventricular function parameters, which have the prospect of being clinically useful for planning cardiac resynchronization therapy. This investigation sought to establish LV and RV count-based GBPS regional functional normal limits and to quantify their reproducibility. METHODS AND MATERIALS: Count-versus-time curves were fit to third-order Fourier series for each of 17 LV and RV sub-volumes to compute global and regional EF, timing, phase and dyssynchrony parameters. Algorithms were applied to data for 40 normal controls (NLs) and 15 patients with CHF. To assess reproducibility, data were reprocessed a second time, blinded to initial calculations. RESULTS: There were no statistically significant differences between any initial and reprocessed LV or RV parameters for NLs or patients with CHF. Percent of subjects categorized as abnormal were the same for initial and reprocessed parameters (McNemar's differences = 0-7%, P > 0.05 for each parameter). Most parameters were significantly different for patients with CHF versus NLs. Normal limits for the new technique agreed well with the literature for other imaging methods, and RV normal limits closely paralleled LV limits. CONCLUSION: GBPS global and regional LV and RV normal limits are reproducible, and application of these normal limits to patients with CHF results in reproducible detection of functional abnormalities.

    Title Gated Myocardial Perfusion Spect Asynchrony Measurements in Patients with Left Bundle Branch Block.
    Date
    Journal The International Journal of Cardiovascular Imaging
    Excerpt

    Purpose This investigation sought to determine which newly available asynchrony parameter derived from gated myocardial perfusion SPECT (GMPS) systolic wall thickening data best distinguishes patients with left bundle branch block (LBBB) from normal subjects. Methods and materials Emory Cardiac Toolbox (ECTb) algorithms were used to compute left ventricular (LV) global and regional function and perfusion indices with regional contraction phases for 20 patients with LBBB, and in 9 control (CTL) subjects who had no function or perfusion abnormalities. Histogram plots of phase frequencies versus R-R interval times included phase standard deviation (SD), bandwidth (BW), skewness and kurtosis. Z-score asynchrony measures were derived for phases sampled using the conventional 17-segment model. Results In CTLs contraction occurred nearly simultaneously in all segments, while LBBBs exhibited a wide variety of heterogeneous contraction patterns. Global parameters that differed between LBBBs versus CTLs included EF, end-systolic volume and end-diastolic volume, and asynchrony measures that were different included BW, phase SD and z-scores. Z-scores most strongly discriminated LBBBs from CTLs (93% of cases correctly predicted, logistic regression chi(2) = 29.7, P < 0.0001). Z-scores, phase SD and lateral-septal wall timing were highly reproducible (r = 0.99, 0.99 and r = 0.87, respectively), with no significant inter-observer differences. Conclusion While traditional global function parameters were different in LBBBs and CTLs, asynchrony parameters characterized LBBB most strongly.

    Title Correspondence Between Gated Spect and Cardiac Magnetic Resonance Quantified Myocardial Wall Thickening.
    Date
    Journal The International Journal of Cardiovascular Imaging
    Excerpt

    Left ventricular (LV) wall thickening (WT) assessed from myocardial perfusion (MP) gated SPECT data has been reported to be a marker of functional recovery following myocardial damage. However, the accuracy of WT measurements obtained in the clinical setting rarely has been validated against an independent quantitative reference standard. The purpose of this investigation was to assess the degree to which quantified MP WT agrees with cardiac magnetic resonance (CMR) WT measurements, and to determine whether quantitation is as accurate as visual analysis in detecting abnormal regional WT. MP and ECG-gated True-FISP CMR data were analyzed for 20 patients evaluated after myocardial infarction (age 60 ± 11 years; 95% males). An experienced observer visually graded MP WT on a 5-point scale while viewing MP cines. MP WT was quantified using "Emory Cardiac Toolbox" (ECTb) algorithms. MP algorithms isolated myocardial counts and generated polar maps of WT. CMR data were analyzed by Medis "MASS" software. Manually drawn endocardial and epicardial contours were used to compute WT on CMR. CMR data also were processed for 10 age-matched normal volunteers to define the CMR WT threshold of abnormality. All computations were sampled into conventional 17 ACC/AHA LV wall segments. Receiver operating characteristics (ROC) curve analysis provided discrimination thresholds for optimal accuracy, which subsequently were used to dichotomize the MP methods. WT abnormalities also were assessed for the 3 major arterial territories, and for total numbers of abnormal segments per patient. 25% of all segments had abnormally low WT by CMR. While MP quantitation underestimated CMR WT values for segments with normal WT (26 ± 13% vs. 56 ± 28%, P < 0.0001), measurements were similar for segments with abnormal WT (4 ± 12% vs. 5 ± 9%, P = 0.45). On a segment-by-segment basis, detection of abnormal WT was more accurate by quantitative than visual analysis both for continuous variables (ROC area = 88 ± 2% vs. 80 ± 3%, P < 0.0001) and for dichotomized methods (83% vs. 76%, P = 0.04). Agreement of MP versus CMR for discriminating segments with normal from abnormal WT was significantly better for quantitative than visual analysis (κ = 0.59 vs. 0.40, P < 0.0001), with strongest agreement for left anterior descending artery territories (κ = 0.72). Total numbers of segments with abnormal WT per patient demonstrated significant correlation with CMR (r = 0.83, P < 0.0001). MP quantified LV ejection fractions and volumes also correlated well with CMR (r = 0.87 and 0.90, respectively). Quantified MP WT measurements correlated significantly with CMR values, and discriminated segments with abnormal WT from segments with normal WT more accurately than visual analysis. Therefore, quantification should be performed when analyzing regional WT by scintigraphy.

    Title Nurses' Scope of Practice.
    Date
    Journal The New England Journal of Medicine
    Excerpt

    To the Editor: The Perspective articles "Broadening the Scope of Nursing Practice" by Fairman et al.(1) and "Nurses for the Future" by Aiken(2) highlight the need to use the best available evidence when considering how to ensure that patients have access to health care. The truth is, however, that the Institute of Medicine (IOM) recommendations are not sufficiently evidence-based. The IOM itself acknowledged that "as the IOM committee considered how best to inform health care workforce policy and development, it realized it could not answer several basic questions about the workforce numbers and composition that will be needed by 2025." . . .

    Similar doctors nearby

    Dr. Norbertus Robben

    Dermatology
    22 years experience
    Havertown, PA

    Dr. Margo Weishar

    Dermatology
    26 years experience
    Spring House, PA

    Dr. Sallie Stadlen

    Internal Medicine
    22 years experience
    Paoli, PA

    Dr. Anthony Bonagura

    Anesthesiology
    20 years experience
    Blue Bell, PA

    Dr. George Talbot

    Internal Medicine
    35 years experience
    Wayne, PA

    Dr. Paul Panebianco

    Internal Medicine
    36 years experience
    Turnersville, NJ
    Search All Similar Doctors