www.jmsr.igmpulition.org Impt Ftor 5.84 Inex Copernius Vlue: 83.27 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://x.oi.org/10.18535/jmsr/v5i6.56 Reltionship etween Slie Thikness to Artery Coronry Dignosti Informtion on the Reonstrution of Mximum Intensity Protetion (MIP) Authors Siti Msrohh 1, Sri Mulyti 2, Beniekt Rosi Emningtys 3, Luthfi Rusyi 4, Drmin 5, M. Irwn Ktili 6, Rini Inrti 7 1,2,4,5,6,7 Politeknik Kesehtn, Kemenkes Semrng Jl. Tirto Agung Pelngn, Bnyumnik, Semrng 50239, Inonesi 3 Jogjkrt Pnti Rpih Hospitl ABSTRACT Introution: The seletion of pproprite slie thikness on the proessing of Mximum Intensity Projetion (MIP) is ruil to otin ignosti informtion lerly on the oronry rtery Cri Multi-Slie Compute Tomogrphy (MSCT) exmintion in eteting normlities foun in the oronry rteries. Ojetive: As Mximum Intensity Projetion (MIP) require ertin slie thikness to get the ext informtion to optimlly ignose oronry rtery, this reserh ime t etermining n urte slie thikness to otin ler piture of the oronry rteries require in imge reonstrution. Methos: This type of reserh is quntittive experimentl pproh, using smple of 10 ptients tht unerwent MIP oronry rtery reonstrution on the slie thikness vrition of 5, 10, 15, 20 n 25 mm. The imge of oronry rteries results is ssesse sujetively y 3 riologists to ssess the ignosti informtion y filling out the questionnire. The t nlysis ws one y orreltion test. Result: Sine the result of the p-vlue is 0.024 (p <0.05), it is onlue the existene of signifint reltionship etween the slie thikness with ignosti informtion. Furthermore, the negtive orreltion oeffiient of (0.925),inite tht the reltionship etween slie thikness with ignosti informtion is in opposite iretions mening the thinner the slie thikness the lerer the ignosti informtion n the thiker the slie thikness, the lurre the ignosti informtion. Conlusion: From this stuy it n e onlue tht there is reltionship etween the slie thikness with ignosti informtion on the tretment of oronry rtery MIP with negtive orreltion oeffiient = - 0.925 mening the smller the slie thikness, ignosti informtion on the oronry rteries eome pprent ut the lrger the slie thikness, the resulting ignosti informtion is inresingly unler. MIP reonstrution of the oronry rteries n proue ler ignosti informtion to the slie thikness 5 n 10 mm. Keywors: Mximum Intensity Projetion (MIP), the oronry rteries, slie thikness, MSCT Cri. INTRODUCTION Cri MSCT exmintion is performe to etet ny normlities in the oronry rteries of the hert. This exmintion use the molities 64 slie Multi-Slie Compute Tomogrphy (MSCT) tht is le to provie informtion n nlysis to the hert mximlly so s to provie n ssessment of morphology, ntomy n physiology of the hert, the etils ri strutures n vritions, goo imge resolution Siti Msrohh et l JMSCR Volume 05 Issue 06 June 2017 Pge 23140
n ple of tking n imge in short time s the hert is onstntly moving. Aoring to Bongrtz (2004), the reonstrution of imges tht n e performe in n MSCT Cri inlue Multi-Plnr Reonstrution (MPR), Mximum Intensity Projetion (MIP), Volume Renering Tehnique (VRT), Curve Plnr Reonstrution (CPR), She Surfe Disply (SSD) n Fly Through. The frequent MSCT Cri imge reonstrution is Mximum Intensity Projetion (MIP), whih is the reonstrution proess to fin piture of oronry rtery in terms of Right Coronry Artery (RCA), Left Anterior Desening (LAD), Left Min Artery (LM), Left irumflex (Cx) y regulting the slie thikness. Aoring to Pelerg Roer (2015), uring the MIP proessing, if the slie thikness use is too smll then the etil proue will e less ovious, wheres if the slie thikness use is too ig, smll normlities re not visile tht it is iffiult to see the plque in etil. Thus, the seletion of pproprite slie thikness is very influentil in proviing ignosti informtion require. MIP reonstrution proessing t Pnti Rpih Hospitl ws often one using vriety of slie thikness. Sine in the proessing of the MIP reonstrution there hve een no efinitive guielines for how the slie thikness is use to otin n optiml piture of the oronry rtery, it tkes longer time to rry out the reonstrution of the MIP. Besies the lk of proper slie thikness eletion n ffet the resulting ignosti informtion whih n use Riology Physiin iffiult in giving ignosis. Dignosti informtion on the reonstrution MIP Cri MSCT exmintion is prtiulrly neessry to speify the tions of ri theteriztion so it is ruil to otin optiml imge proessing in the oronry rteries. Consequently, further ssessment on the most urte of the slie thikness is neessry to get n optiml oronry rtery preview in MIP proessing. This reserh ims t etermining the reltionship etween slie thikness t Intensity Projetion Mximum Proessing (MIP) of the oronry rteries to ignosti informtion on Cri MSCT exmintion n to etermine the pproprite slie thikness on the proessing of Mximum Intensity Projetion (MIP) Cri MSCT to proue the est ignosti informtion. METHOD This type of reserh is quntittive reserh with n experimentl pproh. The popultion use is the Cri MSCT ptients with smple of 10 ptients t the Cri MSCT MIP proessing with slie thikness 5, 10, 15, 20 n 25 mm. The sujets of this stuy re the ignosti informtion otine from the proessing of MIP with slie thikness of 5,10, 15, 20, n 25 mm y 3 riologist otors ting responents who hve servie of 5 yers n ove n e ompetent to provie n ssessment of Cri MSCT exmintion. Informtion of ntomil imge re MIP proessing results in oronry rtery inlue: Right Coronry Artery (RCA), Left Min (LM), Left Anterior Desening (LAD) n Left Cirumflex (Lx). Dignostis informtion is one y ssessing the lrity of imge ntomy of the rtery oronry y soring 1-3 with tegories ler, quite ovious n less ovious. Controlle vriles in this stuy re - 64 slie CT sn plne, exposition ftors, FOV, winow with, winow level while inepenent vriles re slie thikness of 5, 10, 15, 20, n 25 mm. The epenent vrile is the ignosti informtion of the oronry rtery MIP proessing onsisting of RCA, LAD, LM n LCx. The test results were then nlyze y using orreltion nlysis to fin out the reltionship etween slie thikness t MIP proessing of the oronry rteries with ignosti informtion. The reserh eision is tht Ho will e rejete if the p-vlue < 0.05 t the 95% onfiene level mening tht the slie thikness is orrelte to the proessing of Mximum Intensity Projetion Siti Msrohh et l JMSCR Volume 05 Issue 06 June 2017 Pge 23141
(MIP) of the oronry rteries to ignosti informtion on Cri MSCT exmintion. Ho epte if p-vlue > 0.05, whih mens tht slie thikness hs no reltion to the proessing Mximum Intensity Projetion (MIP) of the oronry rteries to ignosti informtion on Cri MSCT exmintion. RESULTS 1. Chrteristis of Smple The smple in this stuy is ten (10) ptients who request Cri MSCT exmintion. All smples in the tegory re ults ge 50-60 yers with ignosis Meil Chek Up, Coronry Artery Disese ( CAD ) n left hest pin. 2. Desription of Reserh Results After exmintion of Cri MSCT in ptients, the reonstrution MIP in the oronry rteries ws performe. Lter, it ws shown the results of MIP proessing riogrphs with vrious slie thikness of 5, 10, 15, 20, n 25 mm.. MIP proessing on eh oronry rtery with slie thikness of 5 mm. RCA. LM. LAD. Cx. MIP proessing on eh oronry rtery with slie thikness of 15 mm. RCA. LM. LAD. Cx. MIP proessing on eh oronry rtery with slie thikness of 20 mm. RCA. LM. LAD. Cx. MIP proessing on eh oronry rtery with slie thikness of 10 mm. RCA. LM. LAD. Cx e. MIP proessing on eh oronry rtery with slie thikness of 25 mm Siti Msrohh et l JMSCR Volume 05 Issue 06 June 2017 Pge 23142
. RCA. LM. LAD. Cx MIP proessing riogrph results re then psse to the riologist to give n ssessment on oronry rtery lrity of ignosti informtion y filling out questionnire provie. From questionnire, frequeny of ssessment re generte s follows: Tle 1. Frequeny Repitultion Assessment on MIP proessing ignosti informtion for eh oronry rtery Slie Artery ovious less not thikness oronry ovious ovious 5 mm RCA 97 % 3 % 0 % LAD 97 % 3 % 0 % LM 100 % 0 % 0 % LCx 100 % 0 % 0 % 10 mm RCA 97 % 3 % 0 % LAD 97 % 3 % 0 % LM 97 % 3 % 0 % LCx 70 % 30 % 0 % 15 mm RCA 83 % 17 % 0 % LAD 80 % 20 % 0 % LM 13 % 77 % 10 % LCx 7 % 77 % 16 % 20 mm RCA 63 % 37 % 0 % LAD 57 % 43 % 0 % LM 0 % 53 % 47 % LCx 0 % 50 % 50 % 25 mm RCA 50 % 37 % 13 % LAD 47 % 37 % 16 % LM 0 % 13 % 87 % LCx 0 % 7 % 93 % After proessing MIP oronry rteries on slie thikness of 5 mm, 10 mm, 15 mm, 20 mm, n 25 mm n se on t otine from the responents, the ignosti informtion of oronry rtery looks ovious when proesse with the slie thikness of 5 mm n 10 mm. Bse on t from responents, it is on the slie thikness of 5 mm n 10 mm oronry rtery otin the iggest perentge of ignosti informtion s of 99.17 % n 90.8 %. This wy, oronry rteries MIP proessing will get lerly emrte ignosti informtion whih is on the slie thikness of 5 mm n 10 mm. After ll, the t ollete from the three responents, re then nlyze with sttistil tests to etermine the reltionship etween the slie thikness on the proessing Mximum Intensity Projetion (MIP) of the oronry rteries to ignosti informtion on Cri MSCT exmintion. The sttistil nlysis pplies orreltion test with the i of SPSS softwre version 16 to etermine the reltionship of slie thikness with ignosti informtion. As the t were normlly istriute, Person orreltion test on eh oronry rtery ws performe. Bse on the results of Person orreltion test using SPSS the following results were otine. Tle 2, Person Correltion Test Results in the oronry rteries Slie Person thikness Correltion 1 -.925* (mm) Sig. (2-tile).024 N 5 5 Informsi Person Dignosti Correltion -.925* 1 Sig. (2-tile).024 N 5 5 *. Correltion is signifint t the 0.05 level (2-tile). The tle ove shows the vlue of P-vlue generte is smller thn 0.024 α = 0:05, so it n e interprete tht there is ny signifint or meningful reltionship etween the slie thikness with ignosti informtion. With the existene of signifint reltionship, then Ho is rejete n H is epte. Furthermore, from the sttistil t, it is otine the oeffiient orreltion of (0.925) where the vlue is greter thn 0.75, whih mens tht the orreltion etween the slie thikness with ignosti Siti Msrohh et l JMSCR Volume 05 Issue 06 June 2017 Pge 23143
informtion is strong. The orreltion oeffiient is negtive whih mens tht the reltionship slie thikness with ignosti informtion is in opposite iretions initing the thinner slie thikness the lerer the ignosti informtion n the thiker the slie thikness, the unler the ignosti informtion. DISCUSSION 1. The reltionship etween the slie thikness on Mximum Intensity Proessing Projetion (MIP) of the oronry rteries to ignosti informtion on Cri MSCT exmintion. Bse on sttistil test results, the p-vlue generte is 0.024. As the vlue is smller thn α = 0,05, it is onlue tht there is reltionship etween the slie thikness on the proessing of Mximum Intensity Projetion (MIP) of the oronry rteries to ignosti informtion on Cri MSCT exmintion. This fining is onsistent with the theory of Buoff et.l (2006) stting tht Mximum Intensity Projetion (MIP) is three-imensionl reonstrution use to view the oy tissue until the possile mximum intensity. MIP imge presents series of imges tht form the sl s single imge. A numer of imges inlue in the sl n e regulte n etermine y the thikness of the sl. Sttistil tests show the orreltion oeffiient of - (0.925) whih mens tht the slie thikness is strongly orrelte to ignosti informtion s the orreltion oeffiient is more thn 0.75 n negtive vlue inites the reltionship etween the slie thikness with ignosti informtion in opposite iretions. This mens tht the smller the slie thikness the lerer the ignosti informtion, otherwise the greter the slie thikness the more unler the resulte from ignosti informtion. 2. Using the right slie thikness on the proessing of Mximum Intensity Projetion (MIP) to otin ignosti informtion Due to time onstrints, this reserh uses vrition of 5 mm slie thikness, so tht the uthor i not onut reserh with slie thikness elow 5 mm. Bse on the results of the ssessment from three responents to lrify the informtion ignosti oronry rteries with slie thikness vritions in proessing MIP Cri MSCT exmintion, in vrition of 5 mm slie thikness, it is otine perentge of votes oronry rtery ignosti informtion whih seeme oviously hs the gretest perentge of 99.17%. Similrly, in vrition of 10 mm slie thikness, it is otine perentge of oronry rtery ignosti informtion whih seeme oviously hs the gretest perentge of 90.83%. In vrition 15 mm slie thikness, it is otine perentge of oronry rtery ignosti informtion tht looks quite oviously hs the gretest perentge of 55%. In 20 mm vrition slie thikness, it is otine perentge of oronry rtery ignosti informtion tht seems ler enough to hve perentge of 50.83%. In 25 mm vrition slie thikness, it is otine perentge of oronry rtery ignosti informtion tht looks lerly hs perentge of 61.7%. Bse on the ssessment of oronry rtery ignosti informtion on the proessing of ignosti informtion, it is otine MIP the ler MIP proessing with slie thikness of 5 mm n 10 mm i.e with perentge of 99.17% n 90.83%. However, MIP proessing on the slie thikness of 15 mm genertes perentge of 55% whih flls uner the tegory of ler enough ignosti informtion. This is in line with Pelerg (2015) stte tht if uring the proessing of MIP, slie thikness use is too smll then the etil proue is less ovious, wheres if the slie thikness use is too lrge, it n show stenosis ut the smll normlities re not visile, n it is iffiult to see the plque etils. Aoring to the uthor this nlysis in orne with the theory tht in orer to get n overview of the ignosti informtion of the oronry rteries n lerly emrte on Cri MSCT exmintion, MIP proessing with Siti Msrohh et l JMSCR Volume 05 Issue 06 June 2017 Pge 23144
pproprite slie thikness is require. This ws eviene in the results of the ssessment perentge of responents. In the MIP proessing with slie thikness of 5 mm n 10 mm, responents stte tht the ignosti informtion of the oronry rteries ws evient. Wheres the MIP proessing with 25 mm slie thikness mjority of responents stte tht the ignosti informtion of the oronry rtery seeme unler. Aoring to Bongrtz (2004), the reonstrution of the MIP is use to see the piture of the oronry rteries y justing the thikness of the imge of the piture. Bse on the t otine n supporte with the theory, the ovious MIP proessing is with slie thikness of 5 mm n 10 mm in the re of RCA, LAD, LM, n LCx. In the MIP proessing with slie thikness of 15 mm RCA n LAD oronry rtery re still lerly visile, while the LM oronry rtery n Cx re seen quite lerly. In the MIP proessing with slie thikness of 20 mm, RCA n LAD oronry rtery re still lerly visile n quite lerly, while the LM oronry rtery n LCx seem enough ler n unler. In the MIP proessing with slie thikness of 25 mm RCA n LAD oronry rtery looks pretty ler, while the LM oronry rtery n LCx re not lerly visile. Bse on this stuy n the t otine, the uthors onlue tht the oronry rtery MIP proessing to otin the right ignosti informtion is y using slie thikness of 5 mm n 10 mm s with these slie thikness, the ignosti informtion of the oronry rtery wlls re visile n lerly emrte. If the slie thikness use is too lrge then smll normlities will not e visile. Thus, to get n optiml ignosti informtion uring the Cri MSCT exmintion in riology servies, it is visle to use MIP proessing of the oronry rteries with slie thikness of 5 mm n 10 mm. CONCLUSION Bse on the reserh tht hs een one tht there ws signifint ssoition of oronry rtery MIP proessing using the slie thikness vritions. The reltionship etween the slie thikness with the ignosti informtion is very strong n in opposite iretion tht the thinner the slie thikness, the lerer the ignosti informtion proue, while the thiker the slie thikness, then the unlerer the ignosti informtion generte. MIP proessing of the oronry rteries on MSCT Cri exmintion with slie thikness of 5, 10 n 15 mm generte quite ler n ovious ignosti informtion while 20 n 25 mm MIP proessing of the oronry rteries on MSCT Cri exmintion proue the unler imge. This wy, it is onlue tht the size of the slie thikness whih n generte ignosti informtion on oronry rtery MIP proessing to proue the emrte oronry rtery wlls is the slie thikness of 5 mm to 10 mm. BIBLIOGRAPHY 1. Bongrtz G. S.J. Goling, A.G. Jurik, M. Leonri. 2004, Europen Guielines for Multislie Compute Tomogrphy. Fune y the Europen Commission. 2. Buoff MJ, Ahenh S, Blumenthl RS, Crr JJ, Golin JG, Greenln P, et l. Assessment of oronry rtery isese y ri ompute tomogrphy: sientifi sttement from the Amerin Hert Assoition Committee on Criovsulr Imging n Intervention, Counil on Criovsulr Riology n Intervention, n Committee on Cri Imging, Counil on Clinil Criology. Cirultion. 2006;114:1761 91 3. Pelerg, Roert. 2015. Cri Angiogrphy Mnul. Seon Eition. Springer New York USA Siti Msrohh et l JMSCR Volume 05 Issue 06 June 2017 Pge 23145