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About CR
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Robyn Barberry is the doting wife of her high school sweetheart, the mother of three precocious boys, and the art teacher at St. Joan of Arc school in Aberdeen.
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Thank you Robyn for so eloquently stating some of the obvious reasons this proposed ordinance makes no sense. I intend to be present at the council meeting on the 10th to publicly state my opposition.
Your words are always so inspiring. I also spent 12 years in Catholic school and chose to give my children a Catholic school education. It is the best decision we have ever made!
Dear Teagan,
For almost a year, we have been together. First you lived inside of me; then, in my arms. I haven't left your side for longer than a few hours since the day you were born. On Wednesdays when your brothers were with your grandmother, I had you to myself. You'd nuzzle up to me in your carrier while we shopped for groceries. We were almost as close as when you were in my belly and there was no one else in the world but us. That was our time. No one can ever take those early days away.
Now, it's time for you to share me with the rest of the world. Today is my first day back to work. It's my first day being without you. But, it will be okay.
I teach art to kids in a small Catholic school so that I can provide nourishment for our family and for my spirit. My job could never bring me as much joy as you have in these past six weeks, but if I'm going to be away from you, I may as well be doing something else that I love. When I'm not your mommy, I'm Mrs. Barberry. And I like having both of those names.
I can't carry you around all day while I teach. You'd be too heavy. You'd get messy. And, you're so cute that my young students wouldn't pay attention to me. The girls would coo over you and comment on your outfit like you were a runway star. Most of the boys would ignore you, unless you spit up. (They'd probably like that.)
My students would compete for my attention, too, because I can't stop gazing at you or smelling you or kissing you or brushing my fingertips across your rose petal skin. When I'm at work, I need to focus on my students. But, from time to time I glance over at the photographs of you and your brothers on my desk. They remind me that I'm working to make a better life for you. (It especially helps when my students are acting up!)
Your picture is all I have of you today. The one of you draped in my wedding dress and veil on my desk and the one I took of you yesterday in the coral dress my students' mom made for you. (It's the picture I'd share with my coworkers when they asked about you.) I snapped one last picture of you in your pajamas before getting you dressed.
I drank in every drop of you, Sweet Tea, before your Daddy loaded you up for a fun day at your Lovey's. I kissed you goodbye as Daddy walked out the door. The second he closed the door, I cried, just as I did for each of your brothers. Even though I knew you were heading to another place where you'd be held close and surrounded by love, I wished that I could be the one to share the day with you. I breathed in the milky smell of your pjs (the ones with the little teal and purple birds on them that your brother's teacher gave you.)
Throughout the day, I kept checking the clock and counting the hours until we'd be together again. Your grandmother sent a picture of you to my phone. It made me smile and boosted my energy. Before I knew it, the workday was over and you were back in my arms. I asked about your day. You hummed and purred. That will have to do for now.
As much as I wish I could be there for every moment of your life, I can't. Sometimes the only place where I can hold you is in my heart. I know I'm going to miss some milestones. You may say your first word to a grandparent. A babysitter might be the first witness to your first go-round on a bike. That first tooth might fall out when you're in someone else's class. But, I will be there when you need me instead of someone else. I'll read to you. I'll listen to you practice your recorder (but only if I can wear ear plugs). I'll wait for hours with you at the MVA to get your first license. I'll cheer as you walk across a stage. I'll sob when you down that aisle. If you call, I'll always pick up the phone. And I'll never stop praying for you.
August 29, 2016 02:05
By Robyn Barberry
A few days later, my student had her baby, an adorable little boy named Theo.
That meant there were only two women I knew before me, waiting just a few more weeks – or even days -- to get off the escalator. One delivered a healthy boy three days ago. The other and I are eager for July 9th-ish to meet our fourth babies.
June 27, 2016 02:34
By Robyn Barberry
Frank and Leo probably have no idea that the baby is coming. Or maybe they do… When I lift them my shirt to show them my belly, they say, "Goodnight baby!" in an indignant tone and pull my shirt back down with the kind of tug one uses to close a window shade. They haven't been around many babies, so we will have to practice being gentle and kind, maybe with one of the cute dolls Teagan's already acquired. We also have some great books on the exciting things that happen when you become a big brother. (Frank probably needs a refresher course.) The adjustment is sure to be difficult for them, especially our current "baby," two-and-a-half-year-old Leo, but if I follow our guidance counselor's advice and make time for puzzles, stories, and bubbles with each of them, they'll get the attention they need to feel important and loved.
June 07, 2016 10:49
By Robyn Barberry
May 19, 2016 10:49
By Robyn Barberry
What's it gonna be? Blue or pink?
April 17, 2016 02:23
By Robyn Barberry
Dr. Jennifer German
January 29, 2016 10:56
By Robyn Barberry
January 16, 2016 02:41
By Robyn Barberry
Most women are advised to wait until after 12 weeks to reveal that they are pregnant. At that point, the miscarriage rate drops significantly, which lessens the heartache of having to break the bad news of pregnancy loss.
But what is the alternative? To suffer alone in silence over the loss of an unborn child? Why are we so afraid to talk about miscarriage? Is it the embarrassment that something might be "wrong" with the mother? Or is it the painful reminder of the baby that will never be when a co-worker or a family friend congratulates her without knowing that she is no longer pregnant?
My second pregnancy ended in miscarriage. I told family and friends at 6 weeks that Collin was going to be a big brother. When I went in for the sonogram a few weeks later, the baby's heart was no longer beating and mine was broken. I didn't leave my bed for a week, but the cards and flowers sent by family, friends, classmates (I was in grad school at the time), and students reminded me that my baby and I were in God's hands.
A year later, I was pregnant again. I decided to tell everyone at 8 weeks because I wanted that support again if I lost the baby. I had their prayers for a healthy baby and soon Frank joined our family, followed by Leo. If I had waited the extra month, what would have changed? I'd have to avoid the people closest to me to hide my ceaseless morning sickness. I'd have to dress in my baggiest clothes (maybe even my husband's) to hide my growing belly. (I "show" rather quickly.) And I'd be denying my baby and me prayers and well wishes from people who care, whether things turn out fine or for the worst.
Pregnant women need love and support in the first trimester more than any other time. It's when they're the most vulnerable and feeling their worst, without the visible bump to remind others that they're working overtime to create a human being. These are the days that demand the most of their bodies and their spirits. And they shouldn't be endured alone.
And so, at 8 weeks, I'm letting the world know that I'm expecting my fourth child in the first week of July. I'm aware that I haven't entered the "safe zone," but my symptoms are strong and my hopes are high. I'm trusting God to make the best decisions for me and my family and counting on the people I love to keep my spirits up on days like today when I feel like I was hit by a truck. My raspberry-sized baby and I are not alone in this journey, no matter where it takes us. Please keep us in your prayers.
November 29, 2015 02:38
By Robyn Barberry
October 29, 2013 04:28
By Robyn Barberry
October 23, 2013 12:14
By Robyn Barberry


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a free local newspaper that is delivered to people's homes every week. Most British and US towns and cities have free papers, which contain mostly advertisements and some local news. Some people dislike receiving them and ask for them not to be delivered to their homes.nounjump to other results
free papernoun
BrE ; NAmE
Check pronunciation: free paper

subset: commoncrawl


text: Sorry, this property is not available anymore. Photos Map 2 2 Property Place We bought here Features Bedrooms2Bathrooms2FeaturesRenovatedCharming propertyFull of characterClose to golfSought after areaReception with fireplaceUtility roomAir conditioningWood flooringFitted wardrobesGood rental potentialDouble glazingHabitable space88 m2 Property Description Stylish corner townhouse for sale in Nueva Andalucia, Marbella, situated in the sought after community of El Naranjal which is a white washed village style resort in the heart of the golf valley, featuring cobblestone streets, landscaped gardens and swimming pools. This recently renovated house features a fabulous contemporary design and comprises of a bright open plan living-dining room with a modern fully equipped designer kitchen with high quality appliances, utility, guest cloakroom and a sunny al fresco courtyard terrace accessing gardens. Upstairs houses two double bedrooms with built in wardrobes and two bathrooms, of which the master offers a Juliet balcony with open views of the gardens. Request details This property listing (ref: CSP-TH0361) is an advertisement supplied by Crystal Shore Properties and does not constitute property particulars. While aplaceinthesun.com (APITS Ltd.) requests all advertisers supply correct details, it does not carry out checks on the information supplied and cannot be held responsible for any inaccuracies. Aplaceinthesun.com recommends seeking independent legal advice prior to any overseas property purchase.


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Mega Sale Ends In:
Designed and built by one of the largest garden power tool manufacturers in Europe, this 1200 watt electric lawn mower will get the job done.
Perfect for medium sized lawns of around 400 sq Metres, the electric lawn mower also includes an EK9 counter balance or tilt resistant technology that provides a more even cut and ensures that the blades are not exposed – for safety reasons. The main housing is made from strong and durable polypropylene and the unit includes a 33 L grass box as well as 10 Metres of power cord
The Grizzly products in our range are constructed to a higher standard than most of the competition and as a result these products all carry a full three year manufacturers guarantee.
Copyright © 2000 - 2016. Shedstore.co.uk is a trading division of Taylored Investments Ltd. All rights Reserved. Shedstore ® is a registered trademark.Taylored Investments Ltd, H1 Coventry Place, Blackpole East, Worcester, WR3 8SG. Telephone 0333 003 0518.
All prices include VAT. *Free delivery area varies by product range, see individual product pages for details. †Restrictions apply, see product lead-time and post code checker for availabilityAll sizes quoted are approximate. Products where shown painted have been decorated for photography purposes only.


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With its special architecture and its endless beaches, Portugal is one of the best destinations in Europe for spending the holiday. Because of the significant distance between the countries, travelling by plane is for sure the best option, but it can be a significant expense if you want to take many suitcases with you. In order to avoid extra fees at the airport, a better option is to send your suitcases with couriers. A way to have access to their services and pay little money is to book the services through Eurosender. Pack as many things as you want, place the order online on our website and we take care of the rest. We assign one of the best carriers to pick-up and deliver the suitcases at your destination, freeing you for travel. Thanks to our online package tracking, you will be able to track your suitcases throughout the duration of the transit.
If you need to ship a package, to send a suitcase or to organize a freight transport from Austria, we can organize the shipping for you together with the courier service providers that we collaborate with. A courier driver will pick up the packages from any city or location in Austria. You only need to prepare your package, suitcase or pallet and have the shipment ready to hand it over to the courier driver. After collection, you can track the progress of your shipment with the online tracking tools.
We help you ship your packages or suitcase to Lisbon, Porto or any other destination in continental Portugal. Moreover, if you vacation is planned in Madeira, we can prepare an economical offer for shipping to Madeira. With the tracking tools, you will be always updated with the last information about the transit of your packages or suitcases.


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Scuderia Ferrari driver Felipe Massa helped kick off this weekend's Formula 1 United States Grand Prix by treating a group of guests to virtual laps of the Circuit Of The Americas (COTA) in Shell's state-of-the-art simulator.
The 2012 season sees Formula 1 racing return to the United States for the first time since 2007 with an all-new venue in Austin, Texas.
To help launch this very special weekend, Massa joined invited media guests from around the world to give them a first glimpse of the 5.5-kilometre (3.4-mile) Grand Prix circuit.Ferrari and its Technical Partner Shell are not used to. The secret of success is being able to anticipate the challenge before you arrive – thus making work done in the simulators and engine test bays critical.
Having worked together since the birth of the FIA Formula 1 World Championship, the pair have encountered many races at unfamiliar tracks and Shell scientists have worked closely with Ferrari engineers to develop innovative products and deliver a premium fuel, which meets one of the most tightly controlled and specific fuel requirements in the racing world.
With the knowledge gained from testing on the track with Ferrari, Shell scientists developed Shell V-Power Premium Gasoline for cars on the road to deliver maximum protection for optimum performance.
Cara Tredget, Shell Ferrari Technology Manager: "We already have a good understanding of the challenge the COTA will give us and have undertaken several virtual long runs in Italy.
We actually run programs to replicate the entire race weekend so, although there is no real substitute for being here, we already know which products are going to give Scuderia Ferrari the best advantage in Texas."
Driving virtual laps of Austin's COTA in Shell's Professional Simulator Experience, Massa brought to life the extreme challenges he, Scuderia Ferrari and Shell will face this weekend around the 20-turn counter-clockwise track.
The new track will join the ranks of some of the most technical on the Formula 1 calendar and his laps proved that the drivers and fans have much to look forward to this weekend.
Felipe Massa, Scuderia Ferrari driver: "The Shell Professional Simulator Experience is one of the most realistic simulators available in the world, so it is fantastic to be able to give people a sneak preview of the new Circuit Of The Americas.
The track is extremely technical with lots of passing opportunities when it widens out, and I think all of the drivers will find this weekend particularly challenging.
We have already driven hundreds of simulated laps of the track in Maranello and the engineers have been working hard to optimize the F2012 for the track.
"Understanding the nature of a new track is always complicated, especially as we have no previous data to study, so we won't know until Sunday exactly what the race has in store.
That is why working with long-standing partners like Shell is so important for our team to try and gain that all important competitive edge."
Shell Motorsport


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Is this restaurant wheelchair accessible?
Is this restaurant appropriate for Kids?
Does this restaurant accept bookings?
Are the prices at this restaurant mid-range / moderate?
Is this a diner?
Is this restaurant good for breakfast?
Is this restaurant good for lunch?
Does this restaurant have tables with seating?
Is this restaurant family-friendly?
Does this restaurant have waiters and waitresses?
Thanks for helping!
this place has moved down Folsom about 2 miles Tolsom and Routier RD
same great food ,same great people and service
Great for breakfast and lunch. Closed for dinner. Offers a wide variety of choices. I had a hamburger and fries while hubby had a Denver omelet and hash browns - both were delivered fairly quickly and were hot
This restaurant is now closed, has been demolished, and a new building is being built in its place. It looks like it could be another restaurant, but it hasn't been identified yet. I hope it's something good.
Well my friends, I can say that this is a great place for breakfast and lunch, I enjoyed the service, but since they moved to there new location it is hard to find. But if you can,go for the morning breakfast.
This is the best food and you get lots of it! Very impressed, been going here for years and never had a bad experience.
They have moved to 110113 Folsom blvd, Rancho Cordova, Ca. Ate breakfast there this morning. Service was great, the atmosphere was joyful. I had the breakfast special, it was the western omelet with biscuit and gravy. Great tasting food, and the service was great. I recommend this restaurant. New location, same great food.
Is a terrrific place for breakfast or lunch. Large amount of food. An old fashioned type of food plain and good. They are open early morning and close at 3 p.m.
Having just travelled 38 hours on a non-stop drive from the Midwest to Sacramento, I was tired, hungry, and craving a good old fashioned hearty breakfast from a local establishment. My host told me he had just the place, and he had been coming here since he was a kid. Great. Let's do it.
He took me to the Waffle...
The food here is very good, but the decor is very out dated. The portions are generous, just wish they were open later than 3:00pm. Not many sit down places to eat in this area.
This place was like an old-fashioned waffle house - my son got the strawberry waffle with whipped cream topping and ate every bite. I ordered an omelot and gave my biscuit w/gravy and hash browns to my son (but he was full) I tasted a bite of the sausage gravy and it was good. the hash browns were cooked well....
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ED Magedson – Founder
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Judge John McCann1 Dorrance Plaza Providence, Rhode Island United States of America
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This report was posted on Ripoff Report on 04/27/2011 09:37 PM and is a permanent record located here: http://www.ripoffreport.com/reports/judge-john-mccann/providence-rhode-island-02903/judge-john-mccann-3rd-disciplinary-complaint-against-judge-john-mccann-and-attorney-steve-722995. The posting time indicated is Arizona local time. Arizona does not observe daylight savings so the post time may be Mountain or Pacific depending on the time of year.
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It only takes a minute to get started. Fill out our simple sign up form and login to the site.
This step is up to you but will drastically boost your chances of people actually reading your profile and contacting you. Introduce yourself, your interests and upload your nicest photo of yourself.
Utilise our website's sophisticated search to discover members who match your criteria. Or just leaf through listings and discover daters that take your fancy.
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We know Marty was outside their home that night. We know he has a motive. We know he's guilty of something. But is it murder?
Everything we learn - about Marty as a man, his affair with Rachel, and the night in question - comes from Marty himself. We want him to be innocent, but the more he tells us, the more we fear he is guilty. And as the twists and turns of the plot unfold, we can't be completely sure.
©2008 David Ellis; (P)2008 Brilliance Audio
Don't love, don't hate. Won't remember. What I did find annoying was the reader reading a "stage" direction and then doing it. Eg. Read: "he sighed", then actually sighing. One of the other - not sure if it is the reader or the director's fault but it was really irritating.
Avid reader (listener). I work in dog rescue in Arkansas, am married and am 62 years old.
Keeps you guessing
First person account was refreshing.
This is an outstanding book with many many twists and turns. The first person account was a refreshing change from most books.
"Gripping and Authentic Legal Thriller"
In the top 20
The character development is impressive, and the legal maneuvering plausible and well-crafted. The frequent flashbacks are deftly handled, elucidating rather than distracting.
In a word, perfect.
Not really a particular moment.
Without any apparent pretension, at its best, the story the story has echoes of Crime and Punishment.
How do authors know these things?
Can't think of anything I've read like it
Very well done
Couldn't stop listening to it, it puts you in the head of a possible killer and walks you through the experience and trial.
Love to walk and listen. Commute and listen. I typically enjoy well developed characters mixed with a good mystery.
"Painful. I couldn't wait for it to end."
Honestly, I have no idea.
A classic.
His voice is not universal. It works for the Jack Reacher character since he is an anti hero. For this book, it didn't. It came across as over dramatic in many areas.
The court room portion was actually the best thing about the book. Because there was really no focused character development,when we got to the courtroom scenes it felt like most of the book was a waist of time.
The main character constantly speaking in 3rd person was exhausting and at times confusing. I think that the mystery could have been much better had we cared a little more about the characters. Unfortunately, the outcome ended a bit somber because of that.
Love a good mystery, but don't care much for pure thrillers.
"Terrible plot and sick character"
This story is completely contrived, but I will try not to give anything away in my criticism. It is told in first person. Even though it is written as if he is revealing his inner thoughts, pertinent facts that the protagonist has and actions that he took are deliberately withheld from the reader. It isn't for lack of space; the protagonist's vicarious, sick fantasies are indulged time and again. The many twists toward the end are ridiculous and could be discovered by competent detectives. Further, even while charged with first degree murder, the guy isn't in jail or monitored, but is free to roam and create more mischief. If you appreciate Hannibal Lecter, you may like this story. The superficial self-analysis toward the end is pure Freudian--when all else fails, blame your parents! The polarization among reviewers shows that there is no accounting for taste. The narrator does the best he can with this flawed script; it isn't his fault.
"Another Excellent Ellis Story"
Love this writer. He takes the time to develop characters and interesting story lines that seem to naturally work themselves out instead of a sudden stop and they lived happily ever after ending. Most authors now write short 200 page novels that don't have time to develop. Not this one. I'm really loving "listening" to all his books.
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The Friends of Monroe County Public Library support the mission, vision, and values of the library. The Friends advocate for Monroe County Public Library and support library collections, services, programs, and staff development.
Karen Franks
John Baumert
Friends, Library, nonprofit, 501c3, advocacy, foundation, donations, membership, bookstore, endowment
In the spirit of friendship...
How do you define friendship?
A helping hand? A shoulder to lean on? A steadfast guide and teacher? A library embodies all this—and so much more—to the families and communities it serves.
We are the Friends of the Library (also known as the Monroe County Public Library Foundation). As a nonprofit corporation, we collect and administer the grants, gifts, bequests, and other monies (outside of local tax receipts) that help make the library's many programs such an integral part of our community.
These additional funds help the library buy more books, CDs, movies, and computers.
But that's not all.
We also support some of the community's most cherished programs, including puppet shows, summer reading programs, adult reading workshops and tutoring, and more.
Also Known As
Friends of Monroe County Public Library
Physical Address
303 E Kirkwood Ave
Bloomington, IN 47408
See more addresses
Main Address
303 E Kirkwood Ave
Bloomington, IN 47408 USA
Physical Address
303 E Kirkwood Ave
Bloomington, IN 47408
Libraries, Library Science (B70)
Fund Raising and/or Fund Distribution (B12)
Single Organization Support (B11)
IRS Filing Requirement
This organization is required to file an IRS Form 990 or 990-EZ.
How does this organization make a difference?
Self-reported by organization
The Friends of the Library provides ALL of the extras that make Monroe County Public Library such a vital community resource. We provide funding for all of the programming for children, teens, and adults, including early literacy programs and programs for adult learners including those learning English as a second language. We provide funding for meeting patron requests for materials which usually are the most requested items in the library collection. Library staff are a critical community resource and we provide substantial funding for library staff development and training. The funds provided by the Friends of the Library are essential to our Library being the special, award-winning resource for everyone in the community.
Self-reported by organization
What are the organization's current programs, how do they measure success, and who do the programs serve?
Program 1
Summer Reading Program
The Library's Summer Reading Program is designed to encourage children to stay engaged with learning and reading while having fun over the summer. Summer reading is essential to success in school and enhanced literacy.
Program long term success
Not available
Program success monitored by
Not available
Program success examples
Not available
Population(s) Served
Children and Youth (infants - 19 years.)
Financial information is an important part of gauging the short- and long-term health of the organization.
Sign In or Create Account to view Revenue and Expenses information
The people, governance practices, and partners that make the organization tick.
Karen Franks
John Baumert
Karen Franks
Friends of Monroe County Public Library
Term: Jan 2012 - Dec 2014
GuideStar worked with BoardSource, the national leader in nonprofit board leadership and governance, to create this section, which enables organizations and donors to transparently share information about essential board leadership practices. Self-reported by organization
Does the board conduct a formal orientation for new board members and require all board members to sign a written agreement regarding their roles, responsibilities, and expectations?
Has the board conducted a formal, written assessment of the chief executive within the past year?
Have the board and senior staff reviewed the conflict-of-interest policy and completed and signed disclosure statements in the past year?
Does the board ensure an inclusive board member recruitment process that results in diversity of thought and leadership?
Has the board conducted a formal, written self-assessment of its performance within the past three years?


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ED Magedson – Founder
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Rebecca Blauser2658 Henley Dr Round Rock, Texas United States of America
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This report was posted on Ripoff Report on 09/24/2012 06:46 PM and is a permanent record located here: http://www.ripoffreport.com/reports/rebecca-blauser/round-rock-texas-78681-2240/rebecca-blauser-round-rock-christian-academy-sociopath-and-patholgical-liar-lesbianl-run-946091. The posting time indicated is Arizona local time. Arizona does not observe daylight savings so the post time may be Mountain or Pacific depending on the time of year.
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Establishing dependable methods for keeping blood sugar balanced is challenging for people with Type 2 diabetes. Individuals interested in minimizing the use of medications and finding more natural remedies for their condition should consider using hot tubs to lower their blood sugar.
How Hot Tubs Help
Before using hot tub therapy, make sure your physician approves of this type of treatment for glucose levels and other diabetes-related issues. The next step is learning how hot tubs are beneficial for diabetes patients. It's frustrating to feel dependent on countless medications to stay healthy, so finding alternative ways to improve your health can be liberating and exciting for many people. The list of benefits includes:
- Lower blood pressure. Dr. Philip L. Hooper of McKee Medical Center in Loveland, Colorado, conducted a study where he tested the benefits of hot tub use on a group of diabetic men and women. The results of the study indicated a significant drop in blood glucose levels after subjects committed themselves to 30 minute hot tub soaks 6 days a week for 3 weeks.
- Weight loss. Dr. Hooper's study also tracked an average weight loss of 3.75 pounds for those participating in the hot tub study. Diabetic patients always benefits from any type of weight loss, so this benefit of hot tub therapy is exciting for many people.
- Less stress. Because their blood pressure dropped and they feel healthier, many patients experienced more relaxation and less stress after developing the daily hot tub soaking routine. Warm water immersion is a reliable method for reducing anxiety, which is another health benefit for people with Type 2 diabetes.
Once you are ready to test the waters of hot tub therapy, contact SpaCap to learn more about how you can avoid heavy hot tub covers. You don't want to avoid getting into your spa just because that rigid foam cover got too heavy to lift. Have SpaCap.com build you one of their lightweight hot tub covers so you can get your therapy and enjoy life for years to come.


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Need an FSH Test in Russellville, AL? Simply order online 24/7 and get a fast, affordable FSH Test at a lab near you (Find More Locations):
What is an FSH Test?
The FSH Test, also known as a Follicle Stimulating Hormone test, is a lab test that checks the level of FSH. The FSH Test is used to help guide fertility decisions for people in Russellville, AL.
How much does an FSH Test cost?
Our FSH Test price includes the doctor's order that you need to get tested in Russellville, AL, all lab fees and taxes, and a pdf copy of your results. For current prices, CLICK HERE.
What does an FSH Test report look like?
For an FSH Test sample report, please CLICK HERE.
We are delighted to offer the FSH Test in Russellville, AL.
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Robles captures Pac-10 wrestling title as ASU finishes fifth
Anthony">http://thesundevils.cstv.com/sports/m-wrestl/mtt/robles_anthony00.html">... Robles won the conference title at 125 pounds while Chris">http://thesundevils.cstv.com/sports/m-wrestl/mtt/drouin_chris00.html">Chris Drouin (141) and Eric">http://thesundevils.cstv.com/sports/m-wrestl/mtt/starks_eric00.html">Eric Starks (174) placed second to lead the Arizona State University wrestling team to a fifth-place showing at the 2009 Pac-10 Wrestling Championships being held inside Titan Gym on the CS Fullerton campus Monday night. All 10 of the Sun Devils entered into the tournament placed among the Top 8 in their respective weight classes to help the team score 101.0 points overall.
Boise State repeated as the team champion with six individual champions and 172.5 points while Oregon State (128), CS Bakersfield (124.5), UC Davis (102.5) and ASU rounded out the Top 5. The remaining teams in the nine-team field included Cal Poly (89.5), Stanford (81.5), host CSUF (72.5) and Portland State (32).


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Explorer 0 Sleeping Bag (Synthetic)
The Alps Mountaineering Explorer is a heavy duty oversized hooded rectangle bag. It uses a 2 layer offset construction to eliminate cold spots. The Explorer uses Techloft Insulation. Techloft Insulation consists of multi hole staple length micro denier fibers that have a siliconized finish for maximum insulation, loft, and compactness. It will keep you toasty on those colder nights when you'd prefer to have more wiggle room than you get with your mummy bag. The contoured hood also helps keep you warmer and keeps your warmth sealed in. For transporting, we include a compression stuff sack. This is a great bag for those frigid nights when you want a good night sleep.
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Duncan Price's Skill
I told Mary Jane Gifford that I had watched her through binoculars at the front of the bus. That wasn't strictly the truth. I saw her, but not through binoculars.
I have a.. skill, I guess. It's certainly not a gift, not the way I looked at it, and the way I looked at everything was different. I could see anything, through anything at some distance. I was almost a walking x- ray machine.
That's why The FBI wanted me so badly. I could see if there were any criminals with guns holed up in a drug lab, from a distance. I could see through smoke and fire.
I wore custom made sunglasses so that I couldn't see any more than normal people. When the sunglasses come off, I could see way more than I wanted to sometimes.
I saw Ms. Gifford put that Goo in an Aspirin bottle. I also saw that it was alive, and probably dangerous. I was busy looking underneath the bus for more of the black substance when I happened to glance up at the hillside.
Mrs. Baxter was puking her guts out, and it's all black Goo! I can't believe I was so stupid. I left her alone, and all that time she was incubating something horrible inside her. I was wearing my sunglasses, that's why I didn't see it.
It embarrassed me to be around women when I wasn't wearing my sunglasses. Although I could see through their clothes, their skin, and right through to the bone, I still felt like a peeping Tom.
I raced up the hill, and by the time I get there, Ms. Gifford had already gotten the Goo out of Mrs. Baxter, and contained it all in her purse. It was all still dormant in there. Apparently, the cold and dark puts it to sleep. That was a good thing to know.
I had to get my hands on that purse, without letting on that I knew what was in there.


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Private Label Web Site Builder With Master Resale Rights
You're getting a complete system for building content rich websites that you can create big time income with. Search engines have changed big time in the last 10 months. They want large amounts of content to give to the people searching through their search engines! And why not? When you or anyone else does a search you deserve to find quality search results. That's what your visitors are going to get at your new websites! Google is going to love you and your websites because their search users are voting for your site with their clicks in the search results. You absolutely can't afford to miss out on this amazing new technology that's yours for the grabbing right now!Visit publisher site: Private Label Web Site Builder With Master Resale Rights
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by Ryan T. Anderson — April 03, 2015
As the loud opposition to Indiana's religious freedom law subsides, plenty of confusion needs to be cleared up.
We need to explain to our friends what religious liberty is, why it matters, and what the consequences are of undermining it or, as is the case with the "fix" enacted in Indiana, restricting its protections.
Now is a good time to take a step back. As Americans approach Passover and Easter, it's worth remembering why religious liberty matters in the first place. For that, we can turn to our Founding Fathers. After all, they were the ones who established a political society unlike any other in all of human history—meant to not merely "tolerate" the religious practice of minorities, but to protect the natural right of all Americans to liberty of conscience and the free exercise of religion.
George Washington, in his Letter to the Hebrew Congregation of Newport, R.I., perhaps said it best:
The citizens of the United States of America have a right to applaud themselves for having given to mankind examples of an enlarged and liberal policy—a policy worthy of imitation. All possess alike liberty of conscience and immunities of citizenship.
It is now no more that toleration is spoken of as if it were the indulgence of one class of people that another enjoyed the exercise of their inherent natural rights, for, happily, the Government of the United States, which gives to bigotry no sanction, to persecution no assistance, requires only that they who live under its protection should demean themselves as good citizens in giving it on all occasions their effectual support.
One of the hallmarks of conscience and religious liberty protections is that they protect people of all faiths, even if their beliefs seem unfounded, flawed, implausible or downright silly.
Recognition of a right to religious freedom does not, however, depend on religious skepticism or relativism. Rather, it rests on the intelligible value of the religious quest—the activities of seeking to understand the truth about ultimate questions and then conforming one's life accordingly, with authenticity and integrity.
People have rights—including the right to pursue religious truth and, within the limits of justice and the common good, to act on their judgments of what truth demands. That's what Religious Freedom Restoration Acts do. They prohibit the government from placing substantial burdens on religious exercise unless the government can show a compelling interest in burdening religious liberty and do so through the least restrictive means.
All people possess these fundamental rights, even when they are, in some respects, in error. Kevin Seamus Hasson, the founder of the Becket Fund, captured this in the title of his book "The Right to Be Wrong." Hasson rightly argues that religious liberty is for A to Z, Anglicans to Zoroastrians.
This basic view of religious liberty has found a place in our civil law. James Madison's "Memorial and Remonstrance" puts the point well: "The Religion then of every man must be left to the conviction and conscience of every man; and it is the right of every man to exercise it as these may dictate. This right is in its nature an unalienable right." Madison argued that it is an "arrogant pretension" to believe that "the Civil Magistrate is a competent Judge of Religious Truth."
The right to religious liberty has its primary force precisely because of a priorduty to pursue the good of religion by seeking out the truth about God and the cosmos. As Madison explained:
The government protects the space for citizens to fulfill this duty according to their own best judgments. Stanford law professor Michael McConnell makes just this point in an essay for the Yale Law Journal:
The Founders got it right. Religious liberty isn't about mere "toleration" from a dominant group that graciously opts not to coerce others. No, it's a natural right, which all must respect within the context of justice and the common good—compelling state interests pursued in least restrictive ways. Indiana'sReligious Freedom Restoration Act would protect just that.
** See the video below to better understand why what Mike Pence did in Indiana has essentially weakened the religious freedom of Indiana citizens by weakening the very protection that the law was designed to insure. Great job Mr Pence!
via What Would the Founders Think About Religious Liberty and Indiana?.


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We ate here twice, each time was very good. Able to watch Euro 2016 match as well. Friendly and efficient staff, very generous portions.
we had the fixed price menu which included a glass of wine. It was excellent value. Pleasant,efficient service
Our meals were nicely prepared local dishes at a reasonable price. Our waitress was friendly and very helpful. She was very attentive even though she was the only server working at a very busy time. House wine was good. No complaints.
Nice place, quality of food great but be careful what you order as they do not speak English and I had something that I still do not know what it was!
we arrived in Cautrets hassled and tired about 9:00pm on a rainy May evening. La Brasserie de bigorre welcomed us in and managed to understand our limited French and we enjoyed a lovely angus beef meal and salad. We will definitely visit this restaurant again
This place was quite busy, but reasonable service & ok or our group of 6 adults & 2 babies - quite child friendly. Some of the food was good, but a couple of our party were not so happy & left most of their mains. Personally I feel as they were too English to accept the French style cuisine. Personally...
This restaurant was just a couple of doors from where we were staying and soon became a firm favourite. On the first night, we asked for a glass of red wine and a glass of rose and the patron came over and chose a couple of wines that would go with our meal. The service is friendly and efficient, the...
Upon arriving as a party of four and ordering four main dishes, the waiter happily went and brought 2 400g steak, a trout, and stuffed peppers in less than 25 minutes. Everything was perfectly cooked and presented. Steaks came upon request, medium and rare, and were exquisite. The side of grilled vegetables and roasted potatoes were unlike any others. The...
Excellent French cooking with a good value Menu of the Day in a typical French style family-run bistro. Efficient service
Hard to believe we went to the same place as all the good reviews. We chose to eat inside which was somewhat drab and without any ambience. The room was dominated by a huge TV, but at least the sound was turned down. Not a good start when we were told they had didn't have the wine we had chosen...
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|Publication number
|Publication type
|Application number
|Publication date
|Jun 21, 1988
|Filing date
|Feb 24, 1987
|Priority date
|Aug 6, 1985
|Fee status
|Publication number
|Van J. Wedeen
|Original Assignee
|The General Hospital Corporation
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (9), Non-Patent Citations (22), Referenced by (31), Classifications (5), Legal Events (7)
|External Links: USPTO, USPTO Assignment, Espacenet
This is a continuation of co-pending application Ser. No. 763,096 filed on Aug. 6, 1985, now abandoned which application is a continuation-in-part of U.S. patent application Ser. No. 640,040, filed Aug. 10, 1984 now U.S. Pat. No. 4,625,169, and assigned to the same assignee as this application.
This invention relates to nuclear magnetic resonance (NMR) imaging.
NMR imaging techniques can be used to form a picture of a cross-section of a three-dimensional object (for example, a human organ) in which its structure is indicated by variations in intensity or color of the picture.
One common technique for forming such an image uses a first magnetic field pulse having a linear gradient along a z-axis (Gz) to select the "slice" corresponding to the desired cross-section, a second pulse (called a phase-encoding pulse) having a linear gradient along the y-axis (Gy) to encode nuclei at different y-axis positions with different precessional phases, and a third linear gradient pulse (called a frequency-encoding pulse) along the x-axis (Gx) to encode nuclei at different x-axis positions with different frequencies. An appropriately modulated RF signal generator imposes a 90� RF pulse followed (after an appropriate interval) by a 180� pulse. The resulting time-dependent resonance spin-echo signal is measured and stored. The process is repeated to obtain a family of spin-echo signals each based upon a different magnitude of phase-encoding gradient Gy. The family represents a two-dimensional array of time-dependent information. A two-dimensional Fourier transformation of the spin-echo signal array produces a two-dimensional array of frequency-domain data which can be displayed as an image of the selected slice.
In addition to such images of the structure of organs, it has been suggested that NMR techniques be used in analyzing flow characteristics. For example, information about the flow of blood in an artery could be useful in analyzing deformities of the wall of the artery.
Moran, "A Flow Velocity Zeugmatographic Interlace for NMR Imaging in Humans", Magnetic Resonance Imaging, 1983, discloses adding to the usual imaging gradients, a special sequence of gradient pulses (for example, along the z-axis) to encode the nuclei with information about their velocity which can then be recaptured by Fourier transformation. The special gradient pulses are arranged to eliminate any dependence of the velocity-encoded information on spatial location. The article suggests using the imaginary component of the resulting data as an image of flow-current-density, and the ratios of the real to imaginary components of the data as an image of specific-flow-density.
In addition to cross-sectional images, NMR techniques have been used to produce three-dimensional projection images in which the data for a stack of cross-sectional slices are effectively added together. Macovski, "Selective Projective Imaging: Applications to Radiography and NMR," IEEE Transactions on Medical Imaging, Vol. MI-1, No. 1, pp. 42-44, July, 1982, discloses selective projective imaging in which subtraction of unwanted image components is proposed to be used in displaying moving blood without displaying the surrounding tissue. In particular, Macovski proposes to use a temporal subtraction approach in which data would be acquired at two different portions of the heart cycle corresponding to different velocities in the vessel and the data would be subtracted in order to cancel all static material and visualize the vessels.
Carr, H. Y., and Purcell, E. M., 1954 Phys. Rev. 94, p. 630, recognized that the motion of nuclei in a magnetic gradient will modify their phases in a way which is reflected in a shift in phase at the center of the spin echo.
The general feature of the invention is in forming an image representative of fluid flow in a vessel situated within a matrix (where the fluid flows with a first velocity profile at a first time and with a second velocity profile, different from the first velocity profile, at a second time) by stimulating the fluid, vessel, and matrix to produce a time-dependent magnetic resonance signal; producing data from the signal; introducing into the data phase information indicative of the velocity of the fluid as of a given time; extracting the phase information as a data set representative of a projection image of the fluid, vessel, and matrix as of that given time; generating two such data sets corresponding to two projection images respectively as of the first and second times corresponding to the first and second velocity profiles; combining the data sets to form a resulting data set; and displaying the resulting data set as the image representative of the fluid flow in the vessel.
Preferred embodiments of the invention include the following features. A sequence of RF and magnetic gradient pulses is imparted to the fluid, vessel, and matrix beginning at a predetermined time to produce the resonance signal, and the sequences used to generate the two data sets are identical. The first velocity profile includes a first range of velocities, the second velocity profile includes a second range of velocities higher than the first range, and phases are imparted to protons in the fluid with respect to the first velocity profile that are within a predetermined angle of the phases imparted to protons in the vessel and matrix, and random phases are imparted to protons in the fluid with respect to the second velocity profile. The phase shifts are imparted in protons in the fluid at a rate of 2π radians for a predetermined velocity level of the fluid that is higher than the first range of velocities and lower than the second range of velocities. The fluid is blood, the first range of velocities are the velocities of blood flowing in diastole, and the second range of velocities are the velocities of blood flowing in systole. The first data set is based on the occurrence of diastole (e.g., follows a QRS complex by 10 milliseconds), and the second time follows diastole by a predetermined interval (between 100 and 300 milliseconds after QRS complex) based on the location of the vessel relative to the heart. The pulse sequence is a two-dimensional Fourier transform spin echo pulse sequence, that includes 90� and 180� RF pulses, and a pair of magnetic gradient pulses along an axis of the vessel, the gradient pulses comprising a compensating pulse preceding the 180� RF pulse and a readout pulse following the 180� RF pulse, the two magnetic gradient pulses being of magnitudes and durations such that for static protons the phase shift imposed by one gradient pulse is exactly canceled by the phase shift imposed by the other gradient pulse. The spin echo occurs no later than 15 milliseconds after the 90� RF pulse. The vessel is an artery. The matrix is a tissue. The fluid flow is pulsatile. The data produced from the resonance signal is Fourier transformed data.
The resulting projection image has high contrast and high resolution. The vascular system is shown in detail while the static matrix is suppressed.
The projection images are easily obtained without requiring special velocity-encoding gradient pulses in addition to the phase-encoding and frequency-encoding pulses. The images are produced from the readily available real component of the Fourier-transformed data.
Other advantages and features of the invention will become apparent from the following description of the preferred embodiment, and from the claims.
We first briefly describe the drawings.
FIG. 1 is an isometric view of a short segment of a blood vessel and surrounding tissue;
FIG. 2 is a block diagram of NMR apparatus;
FIG. 3 is a block diagram of portions of the computer processor of FIG. 2;
FIG. 4 is a flow chart of data gathering and processing and display steps;
FIG. 5 is a timing chart (not to scale) of a pulse sequence for slice-selective imaging;
FIG. 6 is a graph of spin-echo signal data;
FIG. 7 is an image of two parallel tubes respectively containing static fluid and moving fluid;
FIG. 8 shows images of bifurcating tubes respectively containing moving fluid and static fluid, and recombining tubes containing moving fluid;
FIG. 9 shows images of constricted tubes respectively containing moving fluid and static fluid;
FIG. 10 is a timing chart of a pulse sequence for projection imaging;
FIG. 11 shows projection images of a bifurcating tube which contains moving fluid and is immersed in a container of water;
FIG. 12 shows a projection image of a rotating disk.
FIG. 13 is a timing chart (not to scale) of a pulse sequence for subtractive projective imaging.
FIG. 14 is an isometric diagram of projective imaging.
FIGS. 15, 16 are isometric diagrams of the proton phases in diastole and systole voxels.
FIGS. 17 through 23, 25, and 26 are projection images of human subjects.
FIG. 24 is an x-ray image corresponding to FIGS. 25, 26.
FIGS. 27, 28 show block diagrams of portions of the structure of FIG. 3.
Referring to FIG. 1, blood vessel 10 lies within a matrix of tissue 12 and carries blood flowing in the direction indicated by arrow 14. The velocity of the blood in direction tends to vary depending on how close it is to wall 16 of vessel 10. For example, in certain types of laminar flow the velocity of the blood is smallest at wall 16 and increases to a maximum at the central axis x of vessel 10. Thus, for a particular imaginary planar slice 18 (having a particular location along axis z) the blood velocity component in the x direction might vary from small to large to small as one traverses the slice from one wall to the opposite wall in a direction indicated by axis y.
Referring to FIG. 2, nuclear magnetic resonance apparatus 30 has a magnet 32 for imposing a uniform constant magnetic field Bo on vessel 10 and tissue 12. A Gz gradient coil 34 (arranged to provide a linear magnetic field gradient along the z-axis) is connected to a Gz driver 36, which can provide selected levels of power at selected times to coil 34. Likewise, Gx gradient coil 38 and Gy gradient coil 40, which can provide linear magnetic field gradients respectively along the x-axis and y-axis, are respectively connected to Gx driver 42 and Gy driver 44, for providing power to the coils.
An RF antenna 50 (arranged to transmit and receive an RF signal to and from blood vessel 10 and tissue 12) is connected to modulator 52 which is in turn connected to an RF signal generator 54 and is arranged to impose an RF signal at a selected frequency and at selected times upon vessel 10 and tissue 12. RF antenna 50 is also connected via amplifier 57 to demodulator 58, which is arranged to demodulate received signals (from vessel 10 and tissue 12) into quadrature real and imaginary components (indicated by the doubling of line 60).
Computer processor 70 is connected via I/O interface 71 to Gx, Gy, and Gz, drivers 42, 44, 36, to control the magnitude and timing of the linear gradient pulses imposed along the three axes upon vessel 10 and tissue 12, and to signal generator 54 to control the frequency, magnitude, and timing of the RF pulses.
Processor 70 is also connected via I/O interface 71 to demodulator 58 to receive the real and imaginary components of the demodulated received RF signal.
Processor 70 is further connected to a memory 72 (which stores software to control the operation of the system and data representing the received RF signals), to a CRT 74 (which displays images representing the received RF signal, as well as information needed by the operator to control the system), and to a keyboard 76 (by which the operator can enter data and information to control the entire operation of the system). A camera 75 attached to CRT 74 takes photographs of the displayed images.
Referring to FIG. 3, processor 70 includes Gz pulse magnitude and timing control 90 which is connected to trigger Gz driver 36 to apply selected levels of gradient at selected times. Likewise Gx and Gy pulse magnitude and timing controls 92, 94 are connected to trigger respectively Gx and Gy drivers 42, 44.
Similarly RF signal generator frequency, magnitude, and timing control 96 is connected to trigger RF signal generator 54 to provide an RF pulse having a selected frequency and magnitude, at selected times.
Controls 90, 92, 94, 96 are all connected to a sequencer 100 which provides the necessary specific magnitude, timing, and frequency parameters at the proper times for a given NMR field pulse sequence.
Sequencer 100 is connected to a user-entered parameter processor 102 which receives parameters from the keyboard and converts them to a form usable by sequencer 100.
Sequencer 100 is also connected to control an A-to-D converter 104 which is in turn connected to demodulator 58 to digitize the real and imaginary components of the received RF signal. A sampler 106 is connected to the converter 104 to sample the digitized signal components and to memory 72 to store the samples for later processing.
A Fourier transform element 108 is connected to memory 72 for performing a complex two-dimensional Fourier transform on a family of received signal samples to produce real and imaginary components of a two-dimensional array of data in the frequency domain. The parameters in accordance with which the Fourier transform is performed are received from processor 102 based on user entered information.
A display controller 110 is connected to Fourier transform element 108 to organize and process the frequency domain data into image information for delivery to CRT 74, again in accordance with parameters received from processor 102 as provided by the user.
Sequencer 100 is also connected to gating circuitry 112 which provides signals enabling the sequencer to synchronize successive pulse sequences to occur at the same point in successive heart beats.
The invention can be implemented by appropriately connecting and configuring available hardware and by specifying operating parameters for available related software, in accordance with the foregoing and following description (for example, NMR imaging hardware and software available from Technicare Corporation, Solon, Ohio, or similar systems available from other vendors).
Referring to FIGS. 4, 5, in order to generate blood velocity profile images corresponding to planar slice 18 (FIG. 1), vessel 10 is oriented as nearly as possible to lie in the x-y plane with the predominant direction of its axis lying along the x-axis, and the system parameters are configured to perform two series of steps, one for data gathering and the other for processing and display. In the data gathering series (120), the blood pulse timing is first determined (122). At a preselected time (t1) relative to the blood pulse a signal pulse sequence is begun (124) by applying a slice selective field gradient pulse Gz (1) (126). While the slice selective gradient is being applied, a 90� RF pulse is applied during the period between times t2 and t3 (126). The effect of the Gz and RF pulses is to excite only those nuclei within planar slice 18, the slice of interest. During the period between times t3 and t4 a gradient Gz (2) of opposite polarity to Gz (1) is applied. At time t4, a refocusing gradient pulse Gx (1) is applied (128). At time t5, a 180� RF signal pulse is applied (130) to flip the magnetization vector of the nuclei, causing their phases to tend to reconverge.
In the interval between times t6 and t7 a linear phase-encoding pulse gradient Gy at a selected level (e.g., level Gy (1) on FIG. 5) is applied (132) to encode the nuclei along the y-axis with different phases. Immediately thereafter and during the interval between times t7 and t8, a linear frequency-encoding gradient "read" pulse Gx (2) is applied (134) which imparts different frequencies to different nuclei along the x-axis. Pulse Gx (2) is timed to occur over an interval which spans the spin-echo signal 136, whose center point occurs at te.
The time durations of the Gx, Gy, and Gz gradient pulses are shown only schematically in FIG. 5. Preferably pulse Gy is about two to three times as long as pulse Gz, and pulse Gx is about 5 to 20 times as long as pulse Gy. Thus for Gz between 1 and 2 milliseconds, Gy would be between 2 and 3 milliseconds, and Gx between 10 and 20 milliseconds. It can be shown (as suggested in the Hahn article cited above) that the phase shift in a spin echo experiment depends on the square of the time duration of the gradient pulse. The contribution of the x-axis gradient pulse and hence of the velocity component along the x-axis is thus caused to dominate the total phase shift. For example, with Gx lasting 10 times longer than Gy, the x-axis velocity will be weighted by a factor of 100 in the phase shift.
Referring again to FIGS. 4, 5, spin-echo signal 136 is sensed, A-to-D converted and sampled, and the samples (representing a time sequence of signal amplitude levels) are stored (138). That completes the data gathering steps for one time dependent set of signal samples. (The identical steps can be repeated several times with the results being averaged to improve the signal-to-noise ratio.)
A family of such signal sample sets is obtained by repeating the steps a number of times, each time using a different magnitude for the phase-encoding gradient pulse Gy. Thus, between iterations, the level of Gy is reset and a delay period is allowed to pass (140) before the next iteration begins. The delay period can be selected to synchronize each iteration with the heart beat.
Once the family of signal sample sets are taken and stored, they are processed and displayed (150). A complex two-dimensional Fourier transformation is performed (152) to give spatially dependent real and imaginary components in the frequency domain for a two-dimensional array of pixels, and the real component array is displayed (154) as an image representative of the velocity profile of the blood over planar slice 18. In the image, the intensity represents the real part of the complex image datum at each pixel. The midpoint of the greyscale represents the zero value. Data with real parts greater than zero (corresponding to phase angles with positive cosines) give an image intensity value greater than the zero value. Data with negative real parts give image values less than the zero value.
Referring to FIG. 6, in performing the Fourier transformation, the set of signal samples which are used for the computation span a time interval whose center time (ts) is different by a small offset amount 160 from the center of the spin-echo signal (te). The effect of the offset in the Fourier transformation process is that the image data is multiplied by a phase factor that depends linearly on the frequency-encoded coordinate, x. For each sampling interval (e.g., 30 microseconds) within the offset amount there is produced 180� of total background phase variation across the image in the x direction. The result is a striping of the image which improves readability.
Information about the motion of the blood through vessel 10 during the course of each pulse sequence can be shown to be carried through to the Fourier transformed spatially dependent data in the form of apparent phase shifts, whose magnitudes depend on the velocities of the nuclei. The real component of the Fourier transformed data preserves this phase shift information, so that a display of the real component will show variations in the phase shift in a pattern which will reflect the velocity profile within vessel 10. By orienting the length of the blood vessel along the same axis (the x-axis) as the frequency encoding gradient pulse, and by making the frequency encoding gradient pulse longer than the phase encoding pulse, the resulting Fourier transformed image data is made more sensitive to velocity along the x-axis than along the y-axis. Offsetting the sample interval relative to the center of the spin-echo signal has the effect of adding a linearly increasing phase shift in the x-axis direction which produces a highly useful striping of the image as explained below. Placing the phase-encoding pulse Gy close in time to the frequency-encoding pulse Gx reduces any error which might occur as a result of the nuclei changing position between the two pulses.
In one example, a velocity profile image was formed of water flowing through a 7/16" inside diameter tube. Flow was constant, gravity driven, and calibrated with a Mettler top-loading scale. The water was doped with CuSO4 to have a relaxation constant T1 of approximately 300 milliseconds at 20 megaherz. The tube was placed in the magnetic field with its axis aligned with the direction of the frequency-encoding gradient (i.e., along the x-axis). Because the flow was constant, rather than pulsatile, the pulse sequences were not gated to flow pulses, but were simply repeated every 300 milliseconds. The frequency encoding gradient strength was 6�103 Hz/cm. The resulting phase shift as a function of velocity of the nuclei can be calculated as 8.2 radians/cm/sec. The ratio depends on the pulse sequence which is preferably arranged so that the ratio will produce an image with striping which is useful for the flow velocities of interest. Ratios of at least 0.2 radians/cm/sec. appear to be useful. The magnet was a 1.44 T. (61.5 MHz) 8 cm superconducting magnet (fabricated by Technicare, Solon, Ohio).
Referring to FIG. 7, the upper half 170 is a display of the real component of the Fourier transformed data resulting from fluid flow in the tube, while the lower half 172 resulted from an identical tube with the fluid not flowing.
The lower half image 172 shows a stripe pattern with the stripes orthogonal to the x-axis. The stripes represent a background phase which increases linearly with distances along the x-axis. Each black or white stripe represents a background phase shift of 180� (π radians). In upper half image 170, the phase shift due to the motion of the fluid is superimposed over the linear background phase shift. Thus the image gives an easily seen representation that the velocity along the central axis of the tube is higher than along the wall (because at the central axis the phase shift per unit length along the x-axis is greater). Further, because each stripe represents 180� of phase shift, it is possible to measure the difference between the phases at the wall and at the central axis at one position (174) along the x-axis by counting the number of stripes which must be traversed along the central x-axis in order to reach the stripe which begins at line 174 at the wall of the tube. Here there are 3 stripes between points 176, 178, which amounts to a 3π radians phase shift which translates to a maximum flow velocity of 1.2 cm/sec (3π radians= 1.2 cm/sec) or an average flow velocity of 8.2 radians/cm/sec 0.6 cm/sec, which is within 15% of the mechanically calibrated average velocity.
The display format enables direct inference from striping of data phase with a precision of �90�, which is acceptable if small compared with typical phase shifts being studied. By using pulse sequences whose magnitude and duration produce relatively high phase shift/velocity ratios, phase shifts of many times 360� can be obtained.
Referring to FIG. 8, in another example, the phase image produced by non-moving fluid in a bifurcating tube is shown in the lower left (180), and produces a set of parallel stripes representing the background phase offset. When the fluid is moving (182), the stripe pattern is shifted to reflect the velocity profile of the fluid. An image of fluid moving through tubes which recombine is shown in the upper right of FIG. 8 (184). In FIG. 8, the tube diameter is 1/2", and flow rate is 100 cc/min. The maximum phase shift discernible on the images is 10π radians corresponding to a maximum velocity of 3.83 cm/sec. The maximum expect velocity (based on fluid mechanics) is 4.0 cm/sec., within about 2% of the measured figure.
Referring to FIG. 9 in another example, images of a 3/16" inside diameter tube with a 3/32 inch stenosis (constriction) are shown for non-moving (190) and moving fluid (192).
In the images of moving fluid, velocity is inferred from the displacement of the stripes left or right, with the slopes of the stripes representing changes in flow velocity. Phase stripes which show forward concavity thus do not imply retrograde flow, but rather the existence of higher shear rates near the central axis compared with the tube wall (as in laminar flow).
Pixels where the phase becomes indistinct correspond to points where the velocity gradient is high enough that different velocity values coexist within one pixel. Interference of the resulting phases causes loss of signal, an effect which can be reduced by increasing the spatial resolution. Alternately, as explained below, such interference can be exploited to produce high contrast projection images of blood flow.
Introduction of a background phase offset into the imaging phase enhances the readability of phase shifts for four reasons. First, phase shifts can be calculated in two ways: stripe count or X displacement. Accuracy and precision are improved by this redundancy. Second, two-dimensional Fourier transform images have better resolution in X than in Y which gives the X displacement method the advantage. Third, background offset exposes any imperfections in the background phase, enabling correction by the reader. Fourth, in consequence of the first three advantages, phase offset enables the implementation of pulse sequences with higher characteristic velocity/phase shift ratios, reducing the importance of any residual phase ambiguity.
The system can also be used to generate so-called projection images, in which data from a number of stacked planar slices are effectively accumulated into one array. For example, a projection image of FIG. 1 would represent not only slice 18 but slices above and below it along the z-axis.
Referring to FIG. 10, the pulse sequence for taking a set of samples for a projection image begins at time q1 with the start of a long frequency-encoding gradient pulse 200. No slice-selective gradient pulse Gz is used since the image is not meant to be slice-selective. At time q2 (while the Gx pulse continues) a 90� RF pulse is imposed, followed by a 180� pulse at time q3, and a phase encoding gradient pulse 202 beginning at time q4. The spin-echo signal is centered at time qe. Gradient pulse 200 ends at time q5, after which a delay occurs before the next pulse sequence begins. Thus, the projection images are obtained without either slice selection or z-axis encoding.
The Fourier transformation of the sets of data samples is performed without imposing the background phase offset used for the slice-selective images. Instead, the data component 90� away from the phase of the stationary nuclei in the object being imaged is the one used to form the image. This in effect suppresses the contribution of the stationary nuclei to the final image, while emphasizing the contribution of the moving nuclei. A greater than 90% reduction in stationary nuclei signal intensity has been achieved, permitting the imaging of flow velocities greater than 10 cm/sec with vessel diameter to total diameter ratios greater than 1/20.
Referring to FIG. 11, the upper portion 210 shows a projection image of a bifurcating and recombining tube through which fluid is flowing at 300 cc/min. The 1/2" inside diameter tubing lies within an 8"�10"�12" cavity of stationary water. The measured maximum phase shift is 5π radians which implies a maximum velocity of Vmax, =6.44 cm/sec. The expected value of Vmax is 12.0 cm/sec, illustrating that projection imaging underestimates velocities. In this case, however, it would be more reasonable to expect projection images to represent the average velocity, Vavg, rather than Vmax since the entire tube diameter contributes to the observed phase shift. In this experiment Vavg =6.0 cm/sec, close to the observed velocity value.
FIG. 12 is another example of projection imaging, this time of a rotating disc, with the axis of rotation aligned with the z-axis. The disc is composed of water-saturated towels inside a plastic container 20 cm in diameter and 1.5 cm thick. The disk is rotating at 30 rpm corresponding to a maximum tangential velocity of 10π cm/sec. A rigid body rotating in the x-y plane at frequency w has the property that at any point (x,y), the velocity V(x,y)=2π/w/ (y,-x). Therefore the x velocity component is proportional to y, and points of equal phase shift lie on horizontal lines (constant y) because they sustain equal x velocities. The pulse sequence was repeated every 300 msec, te =10.0 msec, the frequency encoding gradient was Gx =3�103 Hz/cm and the calculated ratio of phase to velocity was
P(te)/Vx =0.28 radians/cm/sec.
At 30 cm/sec, this corresponds to a total phase shift of 3π radians which is in reasonable accord with the experiment. This demonstrates that high velocity can yield good signal intensity without spatial distortion.
Projection imaging is highly efficient, enabling three-dimensional volume to be surveyed in times characteristic of two-dimensional imaging experiments.
In another technique for generating projection images, two distinct sets of data are accumulated, then subtracted to form a resulting image. The two data sets are derived in such a manner that, for static portions of tissue, the data are identical and cancel, while for moving portions (such as blood) the two data sets differ. One data set is taken during systole, the other during diastole. In the resulting image the blood, and implicitly the vessels in which it flows, are seen clearly, while the static tissue is suppressed.
Referring to FIG. 13, the pulse sequences (a two-dimensional Fourier transform sequence) begins at a time s1 when the QRS complex occurs in the electrocardiogram (ECG). At time s2, after an appropriate gate delay whose duration is based (in a manner described below) on whether the data is being taken for systole or diastole, a 90� RF pulse is imposed. Thereafter, in the interval between s3 and s4, a compensating gradient pulse Gx is applied simultaneously with a phase encoding pulse Gy at a selected one of 256 different levels. Next, at time s5 (i.e., 4.5 milliseconds after s2 or half the 9 millisecond interval between s2 and the echo signal--se) a 180� RF pulse is imposed. The spin echo signal is spanned by a frequency encoding readout gradient pulse Gx (equivalent to 1,000 Hz/cm) in the interval between S6 and S7. The spin echo signal is centered at time se. The readout period occurs between s8 and s9.
The combined effect of the compensating Gx pulse and the readout Gx pulse, which straddle the 180� RF pulse is to cause no net phase component to be imparted to static protons but to cause a net phase component to be imparted to each moving proton. The net component depends on the fact that because the proton moves to a new x position in the time between the occurrences of the two Gx pulses, it is subjected to different magnitudes of phase shifting by the two Gx pulses; those magnitudes (which in static protons would be equal and therefore cancel) do not cancel.
Following the readout period with respect to one pulse sequence, a new pulse sequence (using a different value for the Gy gradient) is begun at time S10 upon the occurrence of the next QRS complex. A succession of 256 pulse sequences one for each different value of Gy is used with a gate delay appropriate to diastole to obtain a first data set. A second succession of 256 pulse sequences is used with a gate delay appropriate to systole to obtain a second data set. The pulse sequences used to obtain the two data sets are identical. Referring to FIG. 27, the respective gating delays for systole and diastole are both provided by gating circuitry 112 to a switch 113 that passes the appropriate delay to sequencer 100. Referring to FIG. 28, processor 70 performs a two-dimensional complex Fourier analysis (in element 108) of the resulting two arrays, producing two corresponding images of the same subject respectively gated to diastole and systole 109, 111. The images are subtracted from each other (in element 115) to obtain a clear resulting blood flow image of high contrast and high resolution in which the static tissue is suppressed. In practice, it has been found necessary to weight the two data sets before subtraction in order to maximize the cancellation of the static proton signals and hence the image contrast. The weighting has been done empirically by applying different weights to a background region of the data sets until the minimum background image intensity is obtained.
The pulse sequence of FIG. 13 is designed to generate velocity-dependent proton phase shifts in the blood of 1 cycle per meter per second. This is accomplished, in particular, by arranging the echo time (i.e., the interval between s2 and se) to be no greater than 15 milliseconds, preferably no greater than 10 milliseconds. This value results in the relative preservation of the blood proton signal for diastolic flow velocities (which are, e.g., typically less than 0.1 meters per second) because the velocity imposed phase shifts are quite small and the blood proton phases reinforce each other in the projected image. Conversely, the value of 1 cycle per meter per second produces a relative loss of the blood proton signal for systolic flow velocities (which are typically between 0.5 and 1.5 meter per second) because the velocity imposed phase shifts are large enough to cause a randomization of and hence cancellation of phases in the projection image. When the systole and diastole images are subtracted, the static tissue phases (which are identical in the two images) cancel while the blood phase in diastole remains highly visible as an indicator of blood flow.
Referring to FIG. 14, each projected image lies in an x-y plane 200 which includes a grid of 256 by 256 pixels (e.g., pixel 202, shown out of scale) in an area of 50 cm by 50 cm. Each pixel represents a projection of the proton signal from all protons in a voxel (volume element) 204 located at the same x and y coordinates as the resulting pixel 202 but spanning all z coordinate values in a sample that includes tissue 206, an artery 208, and moving blood 210 within the artery. Voxel 204 thus includes portions 212, 214, 216, 218, 220, that lie respectively in tissue, vessel, blood, vessel, and tissue.
Referring to FIG. 15, in each projective pixel 202, the resulting proton signal 230 has two constituents: a larger coherent part originating in the stationary background material 212, 214, 218, 220, and a smaller part originating in the blood protons 216 whose coherence depends on the flow velocity. At diastolic flow velocities the imaging pulse sequence produces phase shifts smaller than 0.1 cycle. In that case, the blood proton signal behaves coherently (as represented by the phase arrows in section 216 of FIG. 15, which point in generally the same direction) and adds to the background signal to form an additive resulting proton signal 230.
Referring to FIG. 16, in systole, peak velocities generate phase shifts of 0.5 to 1.5 cycles in moving blood protons 216. Each voxel 204, however, intersects the blood in vessel 208 along a chord of points (section 216 in FIG. 16) and so all velocities between zero and the maximum are sampled by partial volume averaging. This range of velocities yields a blood signal which behaves incoherently (as represented by the randomly directed phase arrows in segment 216 of FIG. 16) and makes little or no contribution to the net proton signal 232 for the pixel 202. Systole signal 232 is thus considerably smaller than diastole signal 230 (FIG. 15).
This subtractive projective imaging technique is performed in a 0.6 T (25 MHz, proton) superconducting imaging system (Technicare Corporation, Solon, Ohio). The brief duration of the data acquisition window (6 msec between S8 and S9 in FIG. 13) requires a comparatively large readout gradient Gx of 0.25 Gauss per centimeter (corresponding to 1 kHz per centimeter, proton) and the use of a correspondingly broadband time-domain signal filter (50 kHz). To produce the two images for diastole and systole, data acquisition times for both data sets average 8 minutes (512 cardiac cycles in subjects with a normal pulse).
Artifacts caused by patient movement between the two data sets could be reduced by interleaving the systole and diastole pulse sequences, but the time between successive pulse sequences would have to be increased to accommodate the time required to switch the gating, thus increasing the aggregate time required for data acquisition. Respiratory artifacts could be removed by timing the pulse sequences to occur at the same times relative to the respiration cycles.
For example, FIGS. 17, 18, and 19 show respectively the diastolic, systolic, and resulting subtraction flow images of a human chest in a 45� right oblique projection in which the x coordinate (FIG. 14) appears vertically. The diastolic and systolic gate delays (S1 to S2 in FIG. 13) were respectively 10 and 150 milliseconds. Blood vessels seen in the flow image (FIG. 19) are labeled aa (ascending aorta), da (descending aorta), pa (pulmonary artery), pas (right pulmonary segmental branches), rca and lca (right and left carotid arteries), rsc and lsc (right and left subclavian arteries).
In another example, FIGS. 20, 21, 22, 23 show systolic (FIGS. 20, 22) and resulting flow images (FIGS. 21, 23) of thighs (FIGS. 20, 21) and knees (FIGS. 22, 23) of a human subject, projective to the coronal plane. The x coordinate is vertical. Diastolic gate delays of 10 msec were used for both knees and thighs; systolic delays of 250 and 300 msec were used at the thighs and knees respectively in this individual (height 180 cm). Arrows mark the superficial (sf) and deep (df) femoral arteries of the thigh and the popliteal (pop), anterior tibial (ta), posterior tibial (tp), and peroneal (per) of the knee and calf.
In another example, FIGS. 24, 25, 26 show x-ray (FIG. 24) and NMR systolic and flow (FIGS. 25, 26) images of atherosclerotic occlusions of the superficial femoral arteries, using gate delays of 10 (diastolic) and 300 (systolic) milliseconds. Arterial segments are marked as for FIGS. 17, 18, 19. Proximal and distal points of occluded segments are marked "0. prox" and "0. dist" (FIG. 24). The appearance of the popliteal arteries reconstituted by collateral flow images implies they are pulsatile (as was confirmed by Doppler ultrasound examination). The poor appearance of the right proximal superficial femoral artery is consistent with angiographically proven poor runoff in this vessel.
In these examples, one image parameter was tailored for each application: the systolic gate delay. Apart from individuals with ventricular dysrhythmias, the QRS complex itself coincides with arterial diastole so the diastole gating delay is always set at 10 milliseconds regardless of the location of the artery within the body. However, the arrival time of peak systolic flow is variable. In normal individuals arrival times increase with distance from the heart. Disease processes may either retard the pulse wave (e.g., aneurysm, occlusion) or accelerate it (e.g., nonocclusive atherosclerosis). The systolic gate delay was selected empirically in each case by performing between 1 and 4 brief (1 minute) low resolution (64�256 pixels) localization images. Typically the gate delay is between 100 and 300 milliseconds. Best results were obtained by exploring the likely range of gate delays in 50 msec increments.
Several factors will affect the contrast of the subtraction image, including the following. First, because the fraction of velocity which produces phase shifts (and hence contrast) varies as the cosine of the angle between the direction of blood flow and the x axis, vessels oriented at large angles to the x axis may be unobserved in the flow image due to an undiminished systolic signal. Two resulting flow images could be acquired, separated by a 90� rotation in the x-y plane. Each vessel will have a satisfactory orientation in at least one of these images. Second, flow contrast may be undercut by substantial diastolic flow velocities (greater than 0.1 meter per second) which reduce the diastolic blood signal. Doppler ultrasound data have shown that such diastolic flows occur at certain anatomic locations, notably in the arterial supplies of the brain and the visceral organs. Maximum contrast could be recouped by a diastolic acquisition with reduced phase shift. Third, a portion of the arterial blood protons are replaced during each interpulse interval (between s7 and s10 in FIG. 13) by unsaturated protons formerly outside the RF coil (proton refreshment). The saturated proton signal is less intense than the unsaturated proton signal by a factor [1-exp(s7 -s10)],/T1blood, (where T1 denotes the longitudinal relaxation time). Affected arterial segments will have proportionally enhanced intensity in the flow image. Whether gating is systolic or diastolic, the interval between successive pulse sequences represents one cardiac cycle. Therefore, the physical locations in the vessel that are subject to proton replacement are well-defined. Image subtraction will subtract saturated protons in one data set from saturated protons in the other data set, and will likewise subtract unsaturated from unsaturated. Relative to image subtraction, proton refreshment thus resembles a static variable such as proton density more than a dynamic variable such as phase contrast.
Vascular imaging in the projective format efficient. Neither tomography nor existing 3-dimensional imaging techniques can present such detailed anatomy from such large territories in so compact and accessible a form. Projective imaging also yields purely technical benefits. Magnetic resonance imaging times grow exponentially with the dimensionality of the experiment. Though projective images are sensitive throughout a 3-dimensional volume, their data acquisition and processing requirements are those of 2-dimensional imaging. A related economy of this method is its reliance on completely conventional imaging pulse sequences and reconstruction. From a clinical standpoint, the non-invasiveness of this method may allow its application outside the compass of current indications for angiography. An example might be the periodic assessment of arterial bypass grafts. Pulsatility, the ultimate source of contrast, tells something more specific about functional capability than simple patency.
Other embodiments are within the following claims. Veins in which blood flow is pulsatile (or any vessel containing pulsatile flow of a fluid) can also be imaged.
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|U.S. Classification
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|International Classification
|Cooperative Classification
|European Classification
|Feb 7, 1989
|Certificate of correction
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|Fee payment
Year of fee payment: 4
|Jan 30, 1996
|Maintenance fee reminder mailed
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|Lapse for failure to pay maintenance fees
|Sep 3, 1996
|Expired due to failure to pay maintenance fee
Effective date: 19960626