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Purpose:
To investigate the feasibility of using magnetohydrodynamic (MHD) effects for synchronization of magnetic resonance imaging (MRI) with the cardiac cycle.
Materials and Methods:
The MHD effect was scrutinized using a pulsatile flow phantom at B0 = 7.0 T. MHD effects were examined in vivo in healthy volunteers (n = 10) for B0 ranging from 0.05–7.0 T. Noncontrast-enhanced MR angiography (MRA) of the carotids was performed using a gated steady-state free-precession (SSFP) imaging technique in conjunction with electrocardiogram (ECG) and MHD synchronization.
Results:
The MHD potential correlates with flow velocities derived from phase contrast MRI. MHD voltages depend on the orientation between B0 and the flow of a conductive fluid. An increase in the interelectrode spacing along the flow increases the MHD potential. In vivo measurement of the MHD effect provides peak voltages of 1.5 mV for surface areas close to the common carotid artery at B0 = 7.0 T. Synchronization of MRI with the cardiac cycle using MHD triggering is feasible. MHD triggered MRA of the carotids at 3.0 T showed an overall image quality and richness of anatomic detail, which is comparable to ECG-triggered MRAs.
Conclusion:
This feasibility study demonstrates the use of MHD effects for synchronization of MR acquisitions with the cardiac cycle. J. Magn. Reson. Imaging 2012;36:364–372. © 2012 Wiley Periodicals, Inc.
In current clinical cardiovascular MR (CMR) practice cardiac motion is commonly dealt with using ECG based synchronization. However, ECG is corrupted by magneto-hydrodynamic (MHD) effects in magnetic fields. This leads to artifacts in the ECG trace and evokes severe T-wave elevations, which might be misinterpreted as R-waves resulting in erroneous triggering. At (ultra)high field strengths, the propensity of ECG recordings to MHD effects is further pronounced. Pulse oximetry (POX) being inherently sensitive to blood oxygenation provides an alternative approach for cardiac gating. However, due to the travel time of the blood the peak of maximum oxygenation and hence the trigger is delayed by approx. 300 ms with respect to the ECG's R-wave. Also the peak of maximum oxygenation shows a jitter of up to 65 ms. Alternative triggering approaches include acoustic cardiac triggering (ACT). In current clinical practice cardiac gating / triggering commonly relies on using single physiological signals only. Realizing this limitation this study proposes a combined triggering approach which exploits multiple physiological signals including ECG, POX or ACT to track cardiac activity. The feasibility of the coupled approach is examined for LV function assessment at 7.0 T. For this purpose, breath-held 2D-CINE imaging in conjunction with cardiac synchronization was performed paralleled by real time logging of physiological waveforms to track (mis)synchronization between the cardiac cycle and data acquisition. Combinations of the ECG, POX and ACT signals were evaluated and processed in real time to facilitate reliable trigger information.
Background
To demonstrate the applicability of acoustic cardiac triggering (ACT) for imaging of the heart at ultrahigh magnetic fields (7.0 T) by comparing phonocardiogram, conventional vector electrocardiogram (ECG) and traditional pulse oximetry (POX) triggered 2D CINE acquisitions together with (i) a qualitative image quality analysis, (ii) an assessment of the left ventricular function parameter and (iii) an examination of trigger reliability and trigger detection variance derived from the signal waveforms.
Results
ECG was susceptible to severe distortions at 7.0 T. POX and ACT provided waveforms free of interferences from electromagnetic fields or from magneto-hydrodynamic effects. Frequent R-wave mis-registration occurred in ECG-triggered acquisitions with a failure rate of up to 30% resulting in cardiac motion induced artifacts. ACT and POX triggering produced images free of cardiac motion artefacts. ECG showed a severe jitter in the R-wave detection. POX also showed a trigger jitter of approximately Δt = 72 ms which is equivalent to two cardiac phases. ACT showed a jitter of approximately Δt = 5 ms only. ECG waveforms revealed a standard deviation for the cardiac trigger offset larger than that observed for ACT or POX waveforms.
Image quality assessment showed that ACT substantially improved image quality as compared to ECG (image quality score at end-diastole: ECG = 1.7 ± 0.5, ACT = 2.4 ± 0.5, p = 0.04) while the comparison between ECG vs. POX gated acquisitions showed no significant differences in image quality (image quality score: ECG = 1.7 ± 0.5, POX = 2.0 ± 0.5, p = 0.34).
Conclusions
The applicability of acoustic triggering for cardiac CINE imaging at 7.0 T was demonstrated. ACT's trigger reliability and fidelity are superior to that of ECG and POX. ACT promises to be beneficial for cardiovascular magnetic resonance at ultra-high field strengths including 7.0 T.
Magnetic Resonance Imaging (MRI) of moving organs requires synchronization with physiological motion or flow, which dictate the viable window for data acquisition. To meet this challenge, this study proposes an acoustic gating device (ACG) that employs acquisition and processing of acoustic signals for synchronization while providing MRI compatibility, immunity to interferences with electro-magnetic and acoustic fields and suitability for MRI at high magnetic field strengths. The applicability and robustness of the acoustic gating approach is examined in a pilot study, where it substitutes conventional ECG-gating for cardiovascular MR. The merits and limitations of the ACG approach are discussed. Implications for MR imaging in the presence of physiological motion are considered including synchronization with other structure- or motion borne sounds.
Cardiac MR (CMR) is of proven clinical value but also an area of vigorous ongoing research since image quality is not always exclusively defined by signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Recent developments of CMR at 7.0 T have been driven by pioneering explorations into novel multichannel transmit and receive coil array technology to tackle the challenges B1+-field inhomogeneities, to offset specific-absorption rate (SAR) constraints and to reduce banding artifacts in SSFP imaging. For this study, recognition of the benefits and performance of local surface Tx/Rx-array structures recently established at 7.0 T inspired migration to 3.0 T, where RF inhomogeneities and SAR limitations encountered in routine clinical CMR, though somewhat reduced versus the 7.0 T situation, remain significant. For all these reasons, this study was designed to build and examine the feasibility of a local four channel Tx/Rx cardiac coil array for anatomical and functional cardiac imaging at 3.0 T. For comparison, a homebuilt 4 channel Rx cardiac coil array exhibiting the same geometry as the Tx/Rx coil and a Rx surface coil array were used.
High Spatial Resolution 3D MRI of the Larynx Using a Dedicated TX/RX Phased Array Coil at 7.0T
(2010)
MRI holds great potential for elucidating laryngeal and vocal fold anatomy together with the assessment of physiological processes associated in human phonation. However, MRI of human phonation remains very challenging due to the small size of the targeted structures, interfering signal from fat, air between the vocal folds and surrounding muscles and physiological motion. These anatomical/physiological constraints translate into stringent technical requirements in balancing, scan time, image contrast, immunity to physiological motion, temporal resolution and spatial resolution. Motivated by these challenges and limitations this study is aiming at translating the sensitivity gain at ultra-high magnetic fields for enhanced high spatial resolution 3D imaging of the larynx and vocal tract. To approach this goal a dedicated two channel TX/RX larynx coil is being proposed.
The case for a more binding WTO agreement on regulatory principles in telecommunication markets
(1999)
On 1st January 1998, the German telecom market was fully liberalised. Since then genuine competition between market participants has developed, based on a comprehensive legal and regulatory framework that provides for safeguards against unfair competition and market power by Deutsche Telekom. Today, about 10 years after the liberalisation of the telecommunications sector a revision of this regulatory approach has become necessary because at least on three dimensions the situation is quite different from the one 10 years ago: First, with numerous established alternative operators in the market monopolies have been successfully challenged and competition introduced. Second, not only is Cable TV becoming in large parts of Germany a viable alternative for the provision of broadband services but also mobile services are becoming increasingly a substitute for fixed services. Last but not least there are important technological changes under way, requiring huge investments in infrastructure upgrades for next generation networks. In the light of these new developments the question is to which extent the current regulatory approach of severe ex-ante regulatory intervention is still appropriate. Is any part of the network of the former incumbent still a bottleneck? A more light handed regulatory approach might be the right response to this new situation. The paper is organised as follows: The first section will briefly examine the economic rationale for regulating network access. Based on the assumption that regulation is always necessary when bottlenecks exist regulatory principles for an efficient network access regime will be derived. The second section compares the situation of the German market in early 1998 with the one of today. Thereby three dimensions will be considered: the degree of competition, the potential for substitution and technological developments. The third section will define some requirements for the future regulation of telecom markets. Proposals will be elaborated how to ensure competitive telecom markets in the light of new economic and technological challenges.
A key feature of future broadband markets will be diversity of access technologies, meaning that numerous technologies will be exploited for broadband communication. Various factors will affect the success of these future broadband markets, the regulatory policy being one amongst others. So far, a coherent regulatory approach does not exist as to broadband markets. First results of policies so far suggest that less sector-specific regulation is likely to occur. Instead, regulators must ensure that access to networks and services of potentially dominant providers in a relevant broadband market will satisfy requirements for openness and non-discrimination. In this environment the future challenge of regulationg broadband markets will be to set the right incentives for investment into new infrastructures. This paper examines whether there is a need for the regulation of future broadband access markets an if yes, what is the appropriate regulatory tool to do so. Thereby the focus is on the analysis of European broadband markets and the regulatory approaches applied. The first section provides a description of the characteristics of future broadband markets. The second section discusses possible bottlenecks on broadband markets an their regulatory implications. The third section will examine regulatory issues concerning access to broadband networks in more detail. This will be done by comparing the regulatory approaches of European countries and the results in terms of bradband penetration. The final section will give key recommendations for a regulatory strategy on brandband access markets.
Market data for the German telecom market shows that Deutsche Telekom as the former incumbent is constantly loosing shares on all arkets for voice telephony: the market for local calls, the market for long-distance calls and the market for international calls. At the same time prices decline steadily with the latest trend being that operators offer voice services free of charge, the costs of which are covered by a monthly subscription charge. Against this background the paper examines the state of policy and regulatory reform in the telecommunications sector in Germany almost 10 years after the liberalisation of the fixed telecommunications market. Thereby the focus is on the analysis of the competitive conditions that have been established on the German market for voice telephony services. If these retail markets are competitive, there might be a need to remove remaining regulatory provisions. In the new environment of converging markets the future challenge of regulating fixed telecom markets might be to ensure that access to the network and/or services of a potentially dominant provider in a relevant market will satisfy requirements for openness and non-discrimination.
Working paper distributed at 2nd Annual Next Generation Telecommunications Conference 2009, 13th – 14th October 2009, Brussels 14 pages Abstract Governments all over Europe are in the process of adopting new broadband strategies. The objective is to create modern telecommunications networks based on powerful broadband infrastructures". In doing so, they aim for innovative and investment-friendly concepts. For instance, in a recently published consultation paper on the subject the German regulator BNetzA declared that it will take “greater account of … reducing risks, securing the investment and innovation power, providing planning certainty and transparency – in order to support and advance broadband rollout in Germany”. It further states that when regulating wholesale rates it has to be ensured that “… adequate incentives for network rollout are provided on the one hand, while sustainable and fair competition is ensured on the other”. Also an EC draft recommendation on regulated network access is about to set new standards for the regulation of next generation access networks. According to the recommendation the prices of new assets shall be based on costs plus a projectspecific risk premium to be included in the costs of capital for the investment risk incurred by the operator. This approach has been criticised from various sides. In particular it has been questioned whether such an approach is adequate to meet the objectives of encouraging both competition and investment into next generation access networks. Against this background, the concept of “long term risk sharing contracts” has been proposed recently as an approach which does not only incorporate the various additional risks involved in the deployment of NGA infrastructure, but has several other advantages. This paper will demonstrate that the concept allows for competition to evolve at both the retail and wholesale level on fair, objective, non-discriminatory and transparent terms and conditions. Moreover, it ensures the highest possible investment incentive in line with socially desirable outcome. The paper is organised as follows: The next section will briefly outline the importance of encouraging competition and investment in an NGA-environment. The third section will specify the design of long term risk sharing contracts in view of achieving these objectives. The fourth section will examine potential problems associated with the concept. In doing so a way of how to deal with them will be elaborated. The last section will look at arguments against long term risk sharing contracts. It will be shown that these arguments are not strong enough to build a case against introducing such contracts.
To give the exchange of goods and services between the European Union (EU) and the United States (U.S.) new momentum the two parties are currently negotiating the transatlantic free trade agreement Transatlantic Trade and Investment Partnership (TTIP). The aim is to create the largest free trade area in the world. The agreement, once entered into force, will oblige EU countries and the U.S. to further liberalize their markets.
The negotiations on TTIP include a chapter on Electronic Communications/ Telecommunications. The challenge therein will be securing commitments for market access to Electronic Communications services. At the same time, these commitments must reflect the legitimate need for consumer protection issues. The need to reduce Electronic Communications-related non-tariff barriers to trade between the Parties is due to the fact that these markets are heavily regulated. Without transnational rules as to regulations national governments can abuse these regulations to deter the market entry by new (foreign) suppliers. Thus the free trade agreement TTIP affects in many respects regulatory provisions on and access to Electronic Communications markets. The objective of this paper is therefore to examine to what extend the regulatory principles for Electronic Communications markets envisaged under TTIP will result in trade facilitation and regulatory convergence between the EU and the U.S.
As to this question the result of the analysis is that the chapter on Electronic Communications will be an important step towards facilitating trade in Electronic Communications services. At the same time some regulatory convergence will take place, but this convergence will not lead to a (full) harmonization of regulations. Rather the norm, also after TTIP negotiations will have been concluded successfully, will be mutual recognition of different regulatory regimes. Different regulations being the optimal policy response in different market settings will continue to exist. Moreover, it is very unlikely that such regulatory principles for the Electronic Communications sector are a vehicle for a race to the bottom in levels of consumer protection.