Quality assurance of a system for improved target localization and patient set-up that combines real-time infrared tracking and stereoscopic X-ray imaging.

Science.gov (United States)

Verellen, Dirk; Soete, Guy; Linthout, Nadine; Van Acker, Swana; De Roover, Patsy; Vinh-Hung, Vincent; Van de Steene, Jan; Storme, Guy

2003-04-01

The aim of this study is to investigate the positional accuracy of a prototype X-ray imaging tool in combination with a real-time infrared tracking device allowing automated patient set-up in three dimensions. A prototype X-ray imaging tool has been integrated with a commercially released real-time infrared tracking device. The system, consisting of two X-ray tubes mounted to the ceiling and a centrally located amorphous silicon detector has been developed for automated patient positioning from outside the treatment room prior to treatment. Two major functions are supported: (a) automated fusion of the actual treatment images with digitally reconstructed radiographs (DRRs) representing the desired position; (b) matching of implanted radio opaque markers. Measurements of known translational (up to 30.0mm) and rotational (up to 4.0 degrees ) set-up errors in three dimensions as well as hidden target tests have been performed on anthropomorphic phantoms. The system's accuracy can be represented with the mean three-dimensional displacement vector, which yielded 0.6mm (with an overall SD of 0.9mm) for the fusion of DRRs and X-ray images. Average deviations between known translational errors and calculations varied from -0.3 to 0.6mm with a standard deviation in the range of 0.6-1.2mm. The marker matching algorithm yielded a three-dimensional uncertainty of 0.3mm (overall SD: 0.4mm), with averages ranging from 0.0 to 0.3mm and a standard deviation in the range between 0.3 and 0.4mm. The stereoscopic X-ray imaging device integrated with the real-time infrared tracking device represents a positioning tool allowing for the geometrical accuracy that is required for conformal radiation therapy of abdominal and pelvic lesions, within an acceptable time-frame.

Set-up error in supine-positioned patients immobilized with two different modalities during conformal radiotherapy of prostate cancer

International Nuclear Information System (INIS)

Fiorino, C.; Cattaneo, G.M.; Calandrino, R.; Reni, M.; Bolognesi, A.; Bonini, A.

1998-01-01

Background: Conformal radiotherapy requires reduced margins around the clinical target volume (CTV) with respect to traditional radiotherapy techniques. Therefore, high set-up accuracy and reproducibility are mandatory. Purpose: To investigate the effectiveness of two different immobilization techniques during conformal radiotherapy of prostate cancer with small fields. Materials and methods: 52 patients with prostate cancer were treated by conformal three- or four-field techniques with radical or adjuvant intent between November 1996 and March 1998. In total, 539 portal images were collected on a weekly basis for at least the first 4 weeks of the treatment on lateral and anterior 18 MV X-ray fields. The average number of sessions monitored per patient was 5.7 (range 4-10). All patients were immobilized with an alpha-cradle system; 25 of them were immobilized at the pelvis level (group A) and the remaining 27 patients were immobilized in the legs (group B). The shifts with respect to the simulation condition were assessed by measuring the distances between the same bony landmarks and the field edges. The global distributions of cranio-caudal (CC), posterior-anterior (PA) and left-right (LR) shifts were considered; for each patient random and systematic error components were assessed by following the procedure suggested by Bijhold et al. (Bijhold J, Lebesque JV, Hart AAM, Vijlbrief RE. Maximising set-up accuracy using portal images as applied to a conformal boost technique for prostatic cancer. Radiother. Oncol. 1992;24:261-271). For each patient the average isocentre (3D) shift was assessed as the quadratic sum of the average shifts in the three directions. Results 5 mm equal to 4.4% with respect to the 21.6% of group A (P<0.0001). This value was also better than the corresponding value found in a previously investigated group of 21 non-immobilized patients (Italia C, Fiorino C, Ciocca M, et al. Quality control by portal film analysis of the conformal radiotherapy

Contrast-Enhanced Proton Radiography for Patient Set-up by Using X-Ray CT Prior Knowledge

Energy Technology Data Exchange (ETDEWEB)

Spadea, Maria Francesca, E-mail: mfspadea@unicz.it [Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro (Italy); Fassi, Aurora [Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano (Italy); Zaffino, Paolo [Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro (Italy); Riboldi, Marco; Baroni, Guido [Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano (Italy); Bioengineering Unit—CNAO Foundation, Pavia (Italy); Depauw, Nicolas [Department of Radiation Oncology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts (United States); Centre for Medical Radiation Physics, University of Wollongong, Wollongong (Australia); Seco, Joao [Department of Radiation Oncology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts (United States)

2014-11-01

Purpose: To obtain a contrasted image of the tumor region during the setup for proton therapy in lung patients, by using proton radiography and x-ray computed tomography (CT) prior knowledge. Methods and Materials: Six lung cancer patients' CT scans were preprocessed by masking out the gross tumor volume (GTV), and digitally reconstructed radiographs along the planned beam's eye view (BEV) were generated, for a total of 27 projections. Proton radiographies (PR) were also computed for the same BEV through Monte Carlo simulations. The digitally reconstructed radiograph was subtracted from the corresponding proton image, resulting in a contrast-enhanced proton radiography (CEPR). Michelson contrast analysis was performed both on PR and CEPR. The tumor region was then automatically segmented on CEPR and compared to the ground truth (GT) provided by physicians in terms of Dice coefficient, accuracy, precision, sensitivity, and specificity. Results: Contrast on CEPR was, on average, 4 times better than on PR. For 10 lateral projections (±45° off of 90° or 270°), although it was not possible to distinguish the tumor region in the PR, CEPR offers excellent GTV visibility. The median ± quartile values of Dice, precision, and accuracy indexes were 0.86 ± 0.03, 0.86 ± 0.06, and 0.88 ± 0.02, respectively, thus confirming the reliability of the method in highlighting tumor boundaries. Sensitivity and specificity analysis demonstrated that there is no systematic over- or underestimation of the tumor region. Identification of the tumor boundaries using CEPR resulted in a more accurate and precise definition of GTV compared to that obtained from pretreatment CT. Conclusions: In most proton centers, the current clinical protocol is to align the patient using kV imaging with bony anatomy as a reference. We demonstrated that CEPR can significantly improve tumor visualization, allowing better patient set-up and permitting image guided proton therapy (IGPT)

Cone beam CT evaluation of patient set-up accuracy as a QA tool

DEFF Research Database (Denmark)

Nielsen, Morten; Bertelsen, Anders; Westberg, Jonas

2009-01-01

Purpose. To quantify by means of cone beam CT the random and systematic uncertainty involved in radiotherapy, and to determine if this information can be used for e.g. technical quality assurance, evaluation of patient immobilization and determination of margins for the treatment planning. Patients...... and lateral directions). In the CC direction, the margin has to be 5 mm for the Thorax patients. The total uncertainty on the patient position grows during the treatment course, especially in the CC direction for patients receiving thoracical irradiation. This may stem from problems in the immobilization...... and methods. Eighty four cancer patients have been cone beam CT scanned at treatment sessions 1, 2, 3, 10 and 20. Translational and rotational errors are analyzed. Results and conclusions. For the first three treatment sessions the mean translational error in the AP direction is 1 mm; this indicates a small...

Assessment of Set-up Accuracy in Tangential Breast Treatment Using Electronic Portal Imaging Device

International Nuclear Information System (INIS)

Lee, Byung Koo; Kang, Soo Man

2012-01-01

The aim of this study was to investigate the setup accuracy for tangential breast treatment patients using electronic portal image and 2-D reconstruction image Twenty two patients undergoing tangential breast treatment. To explore the setup accuracy, distances between chosen landmarks were taken as reference parameters. The difference between measured reference parameters on simulation films and electronic portal images (EPIs) was calculated as the setup error. A total of 22 simulation films and 110 EPIs were evaluated. In the tangential fields, the calculated reference parameters were the central lung distance (CLD), central soft-tissue distance (CSTD), and above lung distance (ALD), below lung distance (BLD). In the medial tangential field, the average difference values for these parameters were 1.0, -6.4, -2.1 and 2.0, respectively; and the values were 1.5, 2.3, 4.1 and 1.1, respectively. In the lateral tangential field, the average difference values for these parameters were -1.5, -4.3, -2.7 and -1.3, respectively; and the values were 3.3, 2.1, 2.9 and 2.5, respectively. CLD, CSTD, ALD and BLD in the tangential fields are easily identifiable and are helpful for detecting setup errors using EPIs in patients undergoing tangential breast radiotherapy treatment.

Assessment of Set-up Accuracy in Tangential Breast Treatment Using Electronic Portal Imaging Device

Energy Technology Data Exchange (ETDEWEB)

Lee, Byung Koo [Dept. of Radiation Oncology, Korea University Anam Hospital, Seoul (Korea, Republic of); Kang, Soo Man [Dept. of Radiation Oncology, Korea University Gospel Hospital, Seoul (Korea, Republic of)

2012-09-15

The aim of this study was to investigate the setup accuracy for tangential breast treatment patients using electronic portal image and 2-D reconstruction image Twenty two patients undergoing tangential breast treatment. To explore the setup accuracy, distances between chosen landmarks were taken as reference parameters. The difference between measured reference parameters on simulation films and electronic portal images (EPIs) was calculated as the setup error. A total of 22 simulation films and 110 EPIs were evaluated. In the tangential fields, the calculated reference parameters were the central lung distance (CLD), central soft-tissue distance (CSTD), and above lung distance (ALD), below lung distance (BLD). In the medial tangential field, the average difference values for these parameters were 1.0, -6.4, -2.1 and 2.0, respectively; and the values were 1.5, 2.3, 4.1 and 1.1, respectively. In the lateral tangential field, the average difference values for these parameters were -1.5, -4.3, -2.7 and -1.3, respectively; and the values were 3.3, 2.1, 2.9 and 2.5, respectively. CLD, CSTD, ALD and BLD in the tangential fields are easily identifiable and are helpful for detecting setup errors using EPIs in patients undergoing tangential breast radiotherapy treatment.

Diagnostic accuracy of non-contrast abdominal CT scans performed as follow-up for patients with an established cancer diagnosis: a retrospective study.

Science.gov (United States)

Semaan, Hassan; Bazerbashi, Mohamad F; Siesel, Geoffrey; Aldinger, Paul; Obri, Tawfik

2018-03-01

To determine the accuracy and non-detection rate of cancer related findings (CRFs) on follow-up non-contrast-enhanced CT (NECT) versus contrast-enhanced CT (CECT) images of the abdomen in patients with a known cancer diagnosis. A retrospective review of 352 consecutive CTs of the abdomen performed with and without IV contrast between March 2010 and October 2014 for follow-up of cancer was included. Two radiologists independently assessed the NECT portions of the studies. The reader was provided the primary cancer diagnosis and access to the most recent prior NECT study. The accuracy and non-detection rates were determined by comparing our results to the archived reports as a gold standard. A total of 383 CRFs were found in the archived reports of the 352 abdominal CTs. The average non-detection rate for the NECTs compared to the CECTs was 3.0% (11.5/383) with an accuracy of 97.0% (371.5/383) in identifying CRFs. The most common findings missed were vascular thrombosis with a non-detection rate of 100%. The accuracy for non-vascular CRFs was 99.1%. Follow-up NECT abdomen studies are highly accurate in the detection of CRFs in patients with an established cancer diagnosis, except in cases where vascular involvement is suspected.

An experimental set-up to test heatmoisture exchangers

NARCIS (Netherlands)

N. Ünal (N.); J.C. Pompe (Jan); W.P. Holland (Wim); I. Gultuna; P.E.M. Huygen; K. Jabaaij (K.); C. Ince (Can); B. Saygin (B.); H.A. Bruining (Hajo)

1995-01-01

textabstractObjectives: The purpose of this study was to build an experimental set-up to assess continuously the humidification, heating and resistance properties of heat-moisture exchangers (HMEs) under clinical conditions. Design: The experimental set-up consists of a patient model, measurement

Accuracy of non assisted glenohumeral joint injection in the office setting

Energy Technology Data Exchange (ETDEWEB)

Sidon, Eliezer, E-mail: eli.sidon@gmail.com [Department of Orthopedics, Rabin Medical Center, Beilinson Campus, Petach Tikva 49100 (Israel); Velkes, Steven, E-mail: velkes@yahoo.com [Department of Orthopedics, Rabin Medical Center, Beilinson Campus, Petach Tikva 49100 (Israel); Shemesh, Shai, E-mail: shai.shemesh@gmail.com [Department of Orthopedics, Rabin Medical Center, Beilinson Campus, Petach Tikva 49100 (Israel); Levy, Jakob, E-mail: Jlevy@clalit.org.il [Department of Imaging, Rabin Medical Center, Beilinson Campus, Petach Tikva 49100 (Israel); Glaser, Ernesto, E-mail: glaser.ernesto@gmail.com [Department of Imaging, Rabin Medical Center, Beilinson Campus, Petach Tikva 49100 (Israel); Kosashvili, Yona, E-mail: yonasofi@gmail.com [Department of Orthopedics, Rabin Medical Center, Beilinson Campus, Petach Tikva 49100 (Israel)

2013-12-01

Purpose: The diagnostic and therapeutic success of shoulder joint injection depends on its accuracy. Two recent studies reported high success (93–96%) for non-imaging-assisted anterior injection in anesthetized patients. This study examined the accuracy of anterior shoulder injection in awake patients under conditions similar to the office setting. Methods: The study group consisted of 166 consecutive patients with shoulder pain who underwent diagnostic magnetic resonance arthrography at a tertiary medical center in 2011–2012. As part of the examination, contrast material was injected into the glenohumeral joint via an anterior approach by a certified musculoskeletal radiologist without any image assistance. Success was defined as contrast material limited to the intra-articular joint on the scan, without scatter to the periauricular tissue. Results: A successful injection was verified by magnetic resonance arthography in 163 patients (98.2%). Conclusions: Non-assisted anterior shoulder injection is highly accurate (98.2%) in the hands of an experienced radiologist, even in awake patients.

UpSet: Visualization of Intersecting Sets

Science.gov (United States)

Lex, Alexander; Gehlenborg, Nils; Strobelt, Hendrik; Vuillemot, Romain; Pfister, Hanspeter

2016-01-01

Understanding relationships between sets is an important analysis task that has received widespread attention in the visualization community. The major challenge in this context is the combinatorial explosion of the number of set intersections if the number of sets exceeds a trivial threshold. In this paper we introduce UpSet, a novel visualization technique for the quantitative analysis of sets, their intersections, and aggregates of intersections. UpSet is focused on creating task-driven aggregates, communicating the size and properties of aggregates and intersections, and a duality between the visualization of the elements in a dataset and their set membership. UpSet visualizes set intersections in a matrix layout and introduces aggregates based on groupings and queries. The matrix layout enables the effective representation of associated data, such as the number of elements in the aggregates and intersections, as well as additional summary statistics derived from subset or element attributes. Sorting according to various measures enables a task-driven analysis of relevant intersections and aggregates. The elements represented in the sets and their associated attributes are visualized in a separate view. Queries based on containment in specific intersections, aggregates or driven by attribute filters are propagated between both views. We also introduce several advanced visual encodings and interaction methods to overcome the problems of varying scales and to address scalability. UpSet is web-based and open source. We demonstrate its general utility in multiple use cases from various domains. PMID:26356912

A managed clinical network for cardiac services: set-up, operation and impact on patient care.

Science.gov (United States)

Stc Hamilton, Karen E; Sullivan, Frank M; Donnan, Peter T; Taylor, Rex; Ikenwilo, Divine; Scott, Anthony; Baker, Chris; Wyke, Sally

2005-01-01

To investigate the set up and operation of a Managed Clinical Network for cardiac services and assess its impact on patient care. This single case study used process evaluation with observational before and after comparison of indicators of quality of care and costs. The study was conducted in Dumfries and Galloway, Scotland and used a three-level framework. Process evaluation of the network set-up and operation through a documentary review of minutes; guidelines and protocols; transcripts of fourteen semi-structured interviews with health service personnel including senior managers, general practitioners, nurses, cardiologists and members of the public. Outcome evaluation of the impact of the network through interrupted time series analysis of clinical data of 202 patients aged less than 76 years admitted to hospital with a confirmed myocardial infarction one-year pre and one-year post, the establishment of the network. The main outcome measures were differences between indicators of quality of care targeted by network protocols. Economic evaluation of the transaction costs of the set-up and operation of the network and the resource costs of the clinical care of the 202 myocardial infarction patients from the time of hospital admission to 6 months post discharge through interrupted time series analysis. The outcome measure was different in National Health Service resource use. Despite early difficulties, the network was successful in bringing together clinicians, patients and managers to redesign services, exhibiting most features of good network management. The role of the energetic lead clinician was crucial, but the network took time to develop and 'bed down'. Its primary "modus operand" was the development of a myocardial infarction pathway and associated protocols. Of sixteen clinical care indicators, two improved significantly following the launch of the network and nine showed improvements, which were not statistically significant. There was no difference

Diagnostic accuracy of a step-up imaging strategy in pediatric patients with blunt abdominal trauma

International Nuclear Information System (INIS)

Schuppen, J. van; Olthof, D.C.; Wilde, J.C.H.; Beenen, L.F.M.; Rijn, R.R. van; Goslings, J.C.

2014-01-01

Introduction: Blunt abdominal trauma (BAT) is an important but often unrecognized cause of death in children. Imaging plays a vital role in the early detection of abdominal trauma. The exact role of imaging in the management of BAT in children is still under research. The aim of this study was to assess diagnostic accuracy of a step-up imaging strategy, where the decision to observe or to perform an intervention depends on the vital parameters of the patient, in combination with the presence or absence of free fluid at Focused Assessment with Sonography for Trauma (FAST) and the findings on CT (performed selectively), for pediatric patients presenting to the ED with a blunt abdominal trauma. Methods: Consecutive patients aged ≤16 years admitted between January 2008 and December 2012 to a Dutch level 1 trauma centre were included in this retrospective study. Sensitivity, negative predictive value (NPV) and the negative likelihood ratio (LR−) of the imaging strategy were calculated. Results: The cohort consisted of 122 patients; 66 (54%) patients were discharged home after primary survey, 51 (41%) patients were admitted and observed, 3 (2%) patients underwent transarterial embolization and 2 (2%) patients underwent surgery. Treatment failed in 1 patient, initially selected for observation. The sensitivity of the imaging strategy was 0.833 (0.446–0.990). The NPV and LR− were 0.991 (0.963–1.000) and 0.167 (0.028–0.997), respectively. Conclusion: The step-up imaging strategy that is applied in our academic level 1 trauma centre has a high sensitivity and a high negative predictive value. No clinically relevant injuries were missed without doing unnecessary harm, e.g. radiation or an intervention

Leadership set-up

DEFF Research Database (Denmark)

Thude, Bettina Ravnborg; Stenager, Egon; von Plessen, Christian

2018-01-01

. Findings: The study found that the leadership set-up did not have any clear influence on interdisciplinary cooperation, as all wards had a high degree of interdisciplinary cooperation independent of which leadership set-up they had. Instead, the authors found a relation between leadership set-up and leader...... could influence legitimacy. Originality/value: The study shows that leadership set-up is not the predominant factor that creates interdisciplinary cooperation; but rather, leader legitimacy also should be considered. Additionally, the study shows that leader legitimacy can be difficult to establish...... and that it cannot be taken for granted. This is something chief executive officers should bear in mind when they plan and implement new leadership structures. Therefore, it would also be useful to look more closely at how to achieve legitimacy in cases where the leader is from a different profession to the staff....

Influence of Daily Set-Up Errors on Dose Distribution During Pelvis Radiotherapy

International Nuclear Information System (INIS)

Kasabasic, M.; Ivkovic, A.; Faj, D.; Rajevac, V.; Sobat, H.; Jurkovic, S.

2011-01-01

An external beam radiotherapy (EBRT) using megavoltage beam of linear accelerator is usually the treatment of choice for the cancer patients. The goal of EBRT is to deliver the prescribed dose to the target volume, with as low as possible dose to the surrounding healthy tissue. A large number of procedures and different professions involved in radiotherapy process, uncertainty of equipment and daily patient set-up errors can cause a difference between the planned and delivered dose. We investigated a part of this difference caused by daily patient set-up errors. Daily set-up errors for 35 patients were measured. These set-up errors were simulated on 5 patients, using 3D treatment planning software XiO (CMS Inc., St. Louis, MO). The differences in dose distributions between the planned and shifted ''geometry'' were investigated. Additionally, an influence of the error on treatment plan selection was checked by analyzing the change in dose volume histograms, planning target volume conformity index (CI P TV) and homogeneity index (HI). Simulations showed that patient daily set-up errors can cause significant differences between the planned and actual dose distributions. Moreover, for some patients those errors could influence the choice of treatment plan since CI P TV fell under 97 %. Surprisingly, HI was not as sensitive as CI P TV on set-up errors. The results showed the need for minimizing daily set-up errors by quality assurance programme. (author)

An experimental set-up to test heat-moisture exchangers

NARCIS (Netherlands)

Unal, N.; Pompe, J. C.; Holland, W. P.; Gültuna, I.; Huygen, P. E.; Jabaaij, K.; Ince, C.; Saygin, B.; Bruining, H. A.

1995-01-01

The purpose of this study was to build an experimental set-up to assess continuously the humidification, heating and resistance properties of heat-moisture exchangers (HMEs) under clinical conditions. The experimental set-up consists of a patient model, measurement systems and a ventilator. Surgical

Effectiveness of Goal-Setting Telephone Follow-Up on Health Behaviors of Patients with Ischemic Stroke: A Randomized Controlled Trial.

Science.gov (United States)

Wan, Li-Hong; Zhang, Xiao-Pei; Mo, Miao-Miao; Xiong, Xiao-Ni; Ou, Cui-Ling; You, Li-Ming; Chen, Shao-Xian; Zhang, Min

2016-09-01

Adopting healthy behaviors is critical for secondary stroke prevention, but many patients fail to follow national guidelines regarding diet, exercise, and abstinence from risk factors. Compliance often decreases with time after hospital discharge, yet few studies have examined programs promoting long-term adherence to health behaviors. Goal setting and telephone follow-up have been proven to be effective in other areas of medicine, so this study evaluated the effectiveness of a guideline-based, goal-setting telephone follow-up program for patients with ischemic stroke. This was a multicenter, assessor-blinded, parallel-group, randomized controlled trial. Ninety-one stroke patients were randomized to either a control group or an intervention group. Intervention consisted of predischarge education and 3 goal-setting follow-up sessions conducted by phone. Data were collected at baseline and during the third and sixth months after hospital discharge. Six months after discharge, patients in the intervention group exhibited significantly higher medication adherence than patients in the control group. There were no statistically significant differences in physical activity, nutrition, low-salt diet adherence, blood pressure monitoring, smoking abstinence, unhealthy use of alcohol, and modified Rankin Scale (mRS) scores between the 2 groups. Goal-setting telephone follow-up intervention for ischemic stroke patients is feasible and leads to improved medication adherence. However, the lack of group differences in other health behavior subcategories and in themRS score indicates a need for more effective intervention strategies to help patients reach guideline-recommended targets. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Fast evaluation of patient set-up during radiotherapy by aligning features in portal and simulator images

International Nuclear Information System (INIS)

Bijhold, J.; Herk, M. van; Vijlbrief, R.; Lebesque, J.V.

1991-01-01

A new fast method is presented for the quantification of patient set-up errors during radiotherapy with external photon beams. The set-up errors are described as deviations in relative position and orientation of specified anatomical structures relative to specified field shaping devices. These deviations are determined from parameters of the image transformations that make their features in a portal image align with the corresponding features in a simulator image. Knowledge of some set-up parameters during treatment simulation is required. The method does not require accurate knowledge about the position of the portal imaging device as long as the positions of some of the field shaping devices are verified independently during treatment. By applying this method, deviations in a pelvic phantom set-up can be measured with a precision of 2 mm within 1 minute. Theoretical considerations and experiments have shown that the method is not applicable when there are out-of-plane rotations larger than 2 degrees or translations larger than 1 cm. Inter-observer variability proved to be a source of large systematic errors, which could be reduced by offering a precise protocol for the feature alignment. (author)

A managed clinical network for cardiac services: set-up, operation and impact on patient care

Directory of Open Access Journals (Sweden)

Karen E. Hamilton

2005-09-01

Full Text Available Purpose: To investigate the set up and operation of a Managed Clinical Network for cardiac services and assess its impact on patient care. Methods: This single case study used process evaluation with observational before and after comparison of indicators of quality of care and costs. The study was conducted in Dumfries and Galloway, Scotland and used a three-level framework. Process evaluation of the network set-up and operation through a documentary review of minutes; guidelines and protocols; transcripts of fourteen semi-structured interviews with health service personnel including senior managers, general practitioners, nurses, cardiologists and members of the public. Outcome evaluation of the impact of the network through interrupted time series analysis of clinical data of 202 patients aged less than 76 years admitted to hospital with a confirmed myocardial infarction one-year pre and one-year post, the establishment of the network. The main outcome measures were differences between indicators of quality of care targeted by network protocols. Economic evaluation of the transaction costs of the set-up and operation of the network and the resource costs of the clinical care of the 202 myocardial infarction patients from the time of hospital admission to 6 months post discharge through interrupted time series analysis. The outcome measure was different in National Health Service resource use. Results: Despite early difficulties, the network was successful in bringing together clinicians, patients and managers to redesign services, exhibiting most features of good network management. The role of the energetic lead clinician was crucial, but the network took time to develop and ‘bed down’. Its primary “modus operand” was the development of a myocardial infarction pathway and associated protocols. Of sixteen clinical care indicators, two improved significantly following the launch of the network and nine showed improvements, which were

Accuracy in Robot Generated Image Data Sets

DEFF Research Database (Denmark)

Aanæs, Henrik; Dahl, Anders Bjorholm

2015-01-01

In this paper we present a practical innovation concerning how to achieve high accuracy of camera positioning, when using a 6 axis industrial robots to generate high quality data sets for computer vision. This innovation is based on the realization that to a very large extent the robots positioning...... error is deterministic, and can as such be calibrated away. We have successfully used this innovation in our efforts for creating data sets for computer vision. Since the use of this innovation has a significant effect on the data set quality, we here present it in some detail, to better aid others...

Set-up errors analyses in IMRT treatments for nasopharyngeal carcinoma to evaluate time trends, PTV and PRV margins

Energy Technology Data Exchange (ETDEWEB)

Mongioj, Valeria (Dept. of Medical Physics, Fondazione IRCCS Istituto Nazionale Tumori, Milan (Italy)), e-mail: valeria.mongioj@istitutotumori.mi.it; Orlandi, Ester (Dept. of Radiotherapy, Fondazione IRCCS Istituto Nazionale Tumori, Milan (Italy)); Palazzi, Mauro (Dept. of Radiotherapy, A.O. Niguarda Ca' Granda, Milan (Italy)) (and others)

2011-01-15

Introduction. The aims of this study were to analyze the systematic and random interfractional set-up errors during Intensity Modulated Radiation Therapy (IMRT) in 20 consecutive nasopharyngeal carcinoma (NPC) patients by means of Electronic Portal Images Device (EPID), to define appropriate Planning Target Volume (PTV) and Planning Risk Volume (PRV) margins, as well as to investigate set-up displacement trend as a function of time during fractionated RT course. Material and methods. Before EPID clinical implementation, an anthropomorphic phantom was shifted intentionally 5 mm to all directions and the EPIs were compared with the digitally reconstructed radiographs (DRRs) to test the system's capability to recognize displacements observed in clinical studies. Then, 578 clinical images were analyzed with a mean of 29 images for each patient. Results. Phantom data showed that the system was able to correct shifts with an accuracy of 1 mm. As regards clinical data, the estimated population systematic errors were 1.3 mm for left-right (L-R), 1 mm for superior-inferior (S-I) and 1.1 mm for anterior-posterior (A-P) directions, respectively. Population random errors were 1.3 mm, 1.5 mm and 1.3 mm for L-R, S-I and A-P directions, respectively. PTV margin was at least 3.4, 3 and 3.2 mm for L-R, S-I and A-P direction, respectively. PRV margins for brainstem and spinal cord were 2.3, 2 and 2.1 mm and 3.8, 3.5 and 3.2 mm for L-R, A-P and S-I directions, respectively. Set-up error displacements showed no significant changes as the therapy progressed (p>0.05), although displacements >3 mm were found more frequently when severe weight loss or tumor nodal shrinkage occurred. Discussion. These results enable us to choose margins that guarantee with sufficient accuracy the coverage of PTVs and organs at risk sparing. Collected data confirmed the need for a strict check of patient position reproducibility in case of anatomical changes

Set-up for differential manometers testing

International Nuclear Information System (INIS)

Ratushnyj, M.I.; Galkin, Yu.V.; Nechaj, A.G.

1985-01-01

Set-up characteristic for controlling and testing metrological characteristics of TPP and NPP differential manometers with extreme pressure drop upto 250 kPa is briefly described. The set-up provides with automatic and manual assignment of values of gauge air pressure with errors of 0.1 and 0.25% correspondingly. The set-up is supplied with standard equipment to measure output signals. Set-up supply is carried out by a one-phase alternating current circuit with 220 V. Air supply is carried out by O.4-0.6 MPa. pressure of a pneumatic system. Application of the set-up increases operating efficiency 5 times while checking and turning differential manometers

Registration of synthetic tomographic projection data sets using cross-correlation

International Nuclear Information System (INIS)

Fitchard, E.E.; Aldridge, J.S.; Reckwerdt, P.J.; Mackie, T.R.

1998-01-01

Tomographic registration, a method that makes possible accurate patient registration directly from projection data, consists of three processing steps: (i) manual coarse positioning, (ii) tomographic projection set acquisition, and (iii) computer mediated refined positioning. In the coarse positioning stage, the degree of patient alignment is comparable with that achieved with the standard radiotherapy set-up. However, the accuracy requirements are somewhat more relaxed in that meticulous alignment of the patient using external laser indicators is not necessary. Instead, tomographic projection sets are compared with planning CTs in order to achieve improved patient set-up. The projection sets are cross-correlated to obtain the best-fit translation and rotation offsets. The algorithm has been tested on synthetic data with the incorporation of varying amounts of Gaussian pseudo-random noise. These tests demonstrate the algorithm's stability and also confirm that alignment can be achieved with an accuracy of less than one projection pixel. (author)

Follow-up of ischemic cardiopathy, an essential moment in the communication between in-patient and out-patient setting: problems and opportunities

Directory of Open Access Journals (Sweden)

Italo Paolini

2008-12-01

Full Text Available It is known that the transition from the inpatient to the outpatient setting is a critical time. Evidence suggests that contact between patients and providers (i.e., physicians, nurse practitioners, and physician assistants during this interval may be crucial for appropriate treatment modifications and recognition of errors in treatment. Ambulatory follow-up provides opportunities for clinical assessment, patient education, and medication review, which may in turn improve outcomes. However, little is known about the appropriate timing and type of follow-up that is necessary following hospitalization for AMI. In Italian System of Heath contact between general pratictioner and specialists, after dicharge, is critical moment for management of chronic pharmacological and non pharmacological therapy. If professional approaches are not integrated can reduce patients compliance and effectiveness of therapies themselves. Good management of chronic cardiovascular disease requires attention to stenghtening the continuity of information and management of patients.

Automation and robotization of the set-up and treatment for patients treated for a brain and base of the skull tumor

International Nuclear Information System (INIS)

Noel, G.; Ferrand, R.; Feuvret, L.; Meyroneinc, S.; Mazeron, J.J.; Boisserie, G.; Mazeron, J.J.

2003-01-01

Progresses of the three-dimensional imageries and of the software of planning systems makes that the radiotherapy of the tumours of brain and the base of skull is increasingly precise. The set-up of the patients and the positioning of the beams are key acts whose realization can become extremely tiresome if the requirement of precision increases. This precision very often rests still on the visual comparison of digital images. In the near future, the development of the automated systems controlled by robots should allow a noticeable improvement of the precision, safety and speed of the patient set-up. (author)

How to set up a psychodermatology clinic.

Science.gov (United States)

Aguilar-Duran, S; Ahmed, A; Taylor, R; Bewley, A

2014-07-01

Psychodermatology is a recognized subspecialty, but lack of awareness among dermatologists and limitation of resources make the management of these patients challenging. Clinicians are often unsure about the practicalities of setting up a psychodermatology service. There is confusion about which model is best suited to which service, and about the development of a psychodermatology multidisciplinary team. To identify the necessary steps in setting up a psychodermatology clinic. The study was based on the experience of a UK-based psychodermatology unit and the recently published standards by the UK Psychodermatology Working Party. The type of service provision will depend on the type of patients seen in the unit. The core team will be composed of a psychodermatologist and a psychologist. Access to a psychiatrist is essential if patients present with primary psychiatric conditions or primary cutaneous conditions with suicidal or other psychiatric risks. Adequate training of the healthcare staff is advised. The premises and time allocation should be adequate, and this translates into higher tariffs. Using business care tariffs for people with mental health conditions might be more appropriate, as the consultations are longer and involve more members of staff; however, the overall cost remains lower than if these patients were seen in a general dermatology service or in the community. Psychodermatology services are globally limited, and yet the demand for psychodermatology care is high. There is evidence that dedicated psychodermatology services are cost-effective. Healthcare professionals need to be aware of the steps necessary to establish and maintain psychodermatology services. © 2014 British Association of Dermatologists.

Setting up virtual private network

International Nuclear Information System (INIS)

Huang Hongmei; Zhang Chengjun

2003-01-01

Setting up virtual private network for business enterprise provides a low cost network foundation, increases enterprise's network function and enlarges its private scope. The text introduces virtual private network's principal, privileges and protocols that use in virtual private network. At last, this paper introduces several setting up virtual private network's technologies which based on LAN

Setting up virtual private network

International Nuclear Information System (INIS)

Huang Hongmei; Zhang Chengjun

2003-01-01

Setting up virtual private network for business enterprise provides a low cost network foundation, increases enterprise network function and enlarges its private scope. This text introduces virtual private network principal, privileges and protocols applied in virtual private network. At last, this paper introduces several setting up virtual private network technologies which is based on LAN

Portal imaging to assess set-up errors, tumor motion and tumor shrinkage during conformal radiotherapy of non-small cell lung cancer

International Nuclear Information System (INIS)

Erridge, Sara C.; Seppenwoolde, Yvette; Muller, Sara H.; Herk, Marcel van; Jaeger, Katrien de; Belderbos, Jose S.A.; Boersma, Liesbeth J.; Lebesque, Joos V.

2003-01-01

Purpose: To investigate patient set-up, tumor movement and shrinkage during 3D conformal radiotherapy for non-small cell lung cancer. Materials and methods: In 97 patients, electronic portal images (EPIs) were acquired and corrected for set-up using an off-line correction protocol based on a shrinking action level. For 25 selected patients, the orthogonal EPIs (taken at random points in the breathing cycle) throughout the 6-7 week course of treatment were assessed to establish the tumor position in each image using both an overlay and a delineation technique. The range of movement in each direction was calculated. The position of the tumor in the digitally reconstructed radiograph (DRR) was compared to the average position of the lesion in the EPIs. In addition, tumor shrinkage was assessed. Results: The mean overall set-up errors after correction were 0, 0.6 and 0.2 mm in the x (left-right), y (cranial-caudal) and z (anterior-posterior) directions, respectively. After correction, the standard deviations (SDs) of systematic errors were 1.4, 1.5 and 1.3 mm and the SDs of random errors were 2.9, 3.1 and 2.0 mm in the x-, y- and z-directions, respectively. Without correction, 41% of patients had a set-up error of more than 5 mm vector length, but with the set-up correction protocol this percentage was reduced to 1%. The mean amplitude of tumor motion was 7.3 (SD 2.7), 12.5 (SD 7.3) and 9.4 mm (SD 5.2) in the x-, y- and z-directions, respectively. Tumor motion was greatest in the y-direction and in particular for lower lobe tumors. In 40% of the patients, the projected area of the tumor regressed by more than 20% during treatment in at least one projection. In 16 patients it was possible to define the position of the center of the tumor in the DRR. There was a mean difference of 6 mm vector length between the tumor position in the DRR and the average position in the portal images. Conclusions: The application of the correction protocol resulted in a significant

Analysis and Compensation for Gear Accuracy with Setting Error in Form Grinding

Directory of Open Access Journals (Sweden)

Chenggang Fang

2015-01-01

Full Text Available In the process of form grinding, gear setting error was the main factor that influenced the form grinding accuracy; we proposed an effective method to improve form grinding accuracy that corrected the error by controlling the machine operations. Based on establishing the geometry model of form grinding and representing the gear setting errors as homogeneous coordinate, tooth mathematic model was obtained and simplified under the gear setting error. Then, according to the gear standard of ISO1328-1: 1997 and the ANSI/AGMA 2015-1-A01: 2002, the relationship was investigated by changing the gear setting errors with respect to tooth profile deviation, helix deviation, and cumulative pitch deviation, respectively, under the condition of gear eccentricity error, gear inclination error, and gear resultant error. An error compensation method was proposed based on solving sensitivity coefficient matrix of setting error in a five-axis CNC form grinding machine; simulation and experimental results demonstrated that the method can effectively correct the gear setting error, as well as further improving the forming grinding accuracy.

A Monte Carlo calculation of the pionium break-up probability with different sets of pionium target cross sections

International Nuclear Information System (INIS)

Santamarina, C; Schumann, M; Afanasyev, L G; Heim, T

2003-01-01

Chiral perturbation theory predicts the lifetime of pionium, a hydrogen-like π + π - atom, to better than 3% precision. The goal of the DIRAC experiment at CERN is to obtain and check this value experimentally by measuring the break-up probability of pionium in a target. In order to accurately measure the lifetime one needs to know the relationship between the break-up probability and the lifetime to 1% accuracy. We have obtained this dependence by modelling the evolution of pionic atoms in the target using Monte Carlo methods. The model relies on the computation of the pionium-target-atom interaction cross sections. Three different sets of pionium-target cross sections with varying degrees of complexity were used: from the simplest first-order Born approximation involving only the electrostatic interaction to a more advanced approach, taking into account multiphoton exchanges and relativistic effects. We conclude that, in order to obtain the pionium lifetime to 1% accuracy from the break-up probability, the pionium-target cross sections must be known with the same accuracy for the low excited bound states of the pionic atom. This result has been achieved, for low Z targets, with the two most precise cross section sets. For large Z targets only the set accounting for multiphoton exchange satisfies the condition

Evaluation of RSA set-up from a clinical biplane fluoroscopy system for 3D joint kinematic analysis.

Science.gov (United States)

Bonanzinga, Tommaso; Signorelli, Cecilia; Bontempi, Marco; Russo, Alessandro; Zaffagnini, Stefano; Marcacci, Maurilio; Bragonzoni, Laura

2016-01-01

dinamic roentgen stereophotogrammetric analysis (RSA), a technique currently based only on customized radiographic equipment, has been shown to be a very accurate method for detecting three-dimensional (3D) joint motion. The aim of the present work was to evaluate the applicability of an innovative RSA set-up for in vivo knee kinematic analysis, using a biplane fluoroscopic image system. To this end, the Authors describe the set-up as well as a possible protocol for clinical knee joint evaluation. The accuracy of the kinematic measurements is assessed. the Authors evaluated the accuracy of 3D kinematic analysis of the knee in a new RSA set-up, based on a commercial biplane fluoroscopy system integrated into the clinical environment. The study was organized in three main phases: an in vitro test under static conditions, an in vitro test under dynamic conditions reproducing a flexion-extension range of motion (ROM), and an in vivo analysis of the flexion-extension ROM. For each test, the following were calculated, as an indication of the tracking accuracy: mean, minimum, maximum values and standard deviation of the error of rigid body fitting. in terms of rigid body fitting, in vivo test errors were found to be 0.10±0.05 mm. Phantom tests in static and kinematic conditions showed precision levels, for translations and rotations, of below 0.1 mm/0.2° and below 0.5 mm/0.3° respectively for all directions. the results of this study suggest that kinematic RSA can be successfully performed using a standard clinical biplane fluoroscopy system for the acquisition of slow movements of the lower limb. a kinematic RSA set-up using a clinical biplane fluoroscopy system is potentially applicable and provides a useful method for obtaining better characterization of joint biomechanics.

How patients can improve the accuracy of their medical records.

Science.gov (United States)

Dullabh, Prashila M; Sondheimer, Norman K; Katsh, Ethan; Evans, Michael A

2014-01-01

Assess (1) if patients can improve their medical records' accuracy if effectively engaged using a networked Personal Health Record; (2) workflow efficiency and reliability for receiving and processing patient feedback; and (3) patient feedback's impact on medical record accuracy. Improving medical record' accuracy and associated challenges have been documented extensively. Providing patients with useful access to their records through information technology gives them new opportunities to improve their records' accuracy and completeness. A new approach supporting online contributions to their medication lists by patients of Geisinger Health Systems, an online patient-engagement advocate, revealed this can be done successfully. In late 2011, Geisinger launched an online process for patients to provide electronic feedback on their medication lists' accuracy before a doctor visit. Patient feedback was routed to a Geisinger pharmacist, who reviewed it and followed up with the patient before changing the medication list shared by the patient and the clinicians. The evaluation employed mixed methods and consisted of patient focus groups (users, nonusers, and partial users of the feedback form), semi structured interviews with providers and pharmacists, user observations with patients, and quantitative analysis of patient feedback data and pharmacists' medication reconciliation logs. (1) Patients were eager to provide feedback on their medications and saw numerous advantages. Thirty percent of patient feedback forms (457 of 1,500) were completed and submitted to Geisinger. Patients requested changes to the shared medication lists in 89 percent of cases (369 of 414 forms). These included frequency-or dosage changes to existing prescriptions and requests for new medications (prescriptions and over-the counter). (2) Patients provided useful and accurate online feedback. In a subsample of 107 forms, pharmacists responded positively to 68 percent of patient requests for

SU-F-P-18: Development of the Technical Training System for Patient Set-Up Considering Rotational Correction in the Virtual Environment Using Three-Dimensional Computer Graphic Engine

Energy Technology Data Exchange (ETDEWEB)

Imura, K [Division of Quantum Radiation Science, Department of Health Science, Graduate School of Medical Science, Kyushu University, Fukuoka (Japan); Fujibuchi, T; Hirata, H [Department of Health Science, Graduate School of Medical Science, Kyushu University, Fukuoka (Japan); Kaneko, K [Innovation Center for Educational Resource, Kyushu University, Fukuoka (Japan); Hamada, E [Cancer Treatment Center, Tobata Kyoritsu Hospital, Kitakyushu (Japan)

2016-06-15

Purpose: Patient set-up skills in radiotherapy treatment room have a great influence on treatment effect for image guided radiotherapy. In this study, we have developed the training system for improving practical set-up skills considering rotational correction in the virtual environment away from the pressure of actual treatment room by using three-dimensional computer graphic (3DCG) engine. Methods: The treatment room for external beam radiotherapy was reproduced in the virtual environment by using 3DCG engine (Unity). The viewpoints to perform patient set-up in the virtual treatment room were arranged in both sides of the virtual operable treatment couch to assume actual performance by two clinical staffs. The position errors to mechanical isocenter considering alignment between skin marker and laser on the virtual patient model were displayed by utilizing numerical values expressed in SI units and the directions of arrow marks. The rotational errors calculated with a point on the virtual body axis as the center of each rotation axis for the virtual environment were corrected by adjusting rotational position of the body phantom wound the belt with gyroscope preparing on table in a real space. These rotational errors were evaluated by describing vector outer product operations and trigonometric functions in the script for patient set-up technique. Results: The viewpoints in the virtual environment allowed individual user to visually recognize the position discrepancy to mechanical isocenter until eliminating the positional errors of several millimeters. The rotational errors between the two points calculated with the center point could be efficiently corrected to display the minimum technique mathematically by utilizing the script. Conclusion: By utilizing the script to correct the rotational errors as well as accurate positional recognition for patient set-up technique, the training system developed for improving patient set-up skills enabled individual user to

SU-F-P-18: Development of the Technical Training System for Patient Set-Up Considering Rotational Correction in the Virtual Environment Using Three-Dimensional Computer Graphic Engine

International Nuclear Information System (INIS)

Imura, K; Fujibuchi, T; Hirata, H; Kaneko, K; Hamada, E

2016-01-01

Purpose: Patient set-up skills in radiotherapy treatment room have a great influence on treatment effect for image guided radiotherapy. In this study, we have developed the training system for improving practical set-up skills considering rotational correction in the virtual environment away from the pressure of actual treatment room by using three-dimensional computer graphic (3DCG) engine. Methods: The treatment room for external beam radiotherapy was reproduced in the virtual environment by using 3DCG engine (Unity). The viewpoints to perform patient set-up in the virtual treatment room were arranged in both sides of the virtual operable treatment couch to assume actual performance by two clinical staffs. The position errors to mechanical isocenter considering alignment between skin marker and laser on the virtual patient model were displayed by utilizing numerical values expressed in SI units and the directions of arrow marks. The rotational errors calculated with a point on the virtual body axis as the center of each rotation axis for the virtual environment were corrected by adjusting rotational position of the body phantom wound the belt with gyroscope preparing on table in a real space. These rotational errors were evaluated by describing vector outer product operations and trigonometric functions in the script for patient set-up technique. Results: The viewpoints in the virtual environment allowed individual user to visually recognize the position discrepancy to mechanical isocenter until eliminating the positional errors of several millimeters. The rotational errors between the two points calculated with the center point could be efficiently corrected to display the minimum technique mathematically by utilizing the script. Conclusion: By utilizing the script to correct the rotational errors as well as accurate positional recognition for patient set-up technique, the training system developed for improving patient set-up skills enabled individual user to

Essential Requirements to Setting up an Aesthetic Practice

OpenAIRE

Sachdev, Mukta; Britto, Gillian R

2014-01-01

Aesthetic dermatology is becoming a vital and popular branch of medicine. This article aims to guide dermatologists to set up a professional and ethical aesthetic practice. Dermatologists should have an integrated practice of clinical dermatology, dermatosurgery and cosmetic dermatology. Ethical practice is the gold standard for any medical field, especially with dermatologists, who should avoid doing unnecessary procedures. Proper patient counselling and addressing the patients′ concerns is ...

Duty to speak up in the health care setting a professionalism and ethics analysis.

Science.gov (United States)

Topazian, Rachel J; Hook, C Christopher; Mueller, Paul S

2013-11-01

Staff and students working in health care settings are sometimes reluctant to speak up when they perceive patients to be at risk for harm. In this article, we describe four incidents that occurred at our institution (Mayo Clinic). In two of them, health care professionals failed to speak up, which resulted in harm; in the other two, they did speak up, which prevented harm and improved patient care. We analyzed each scenario using the Physician's Charter on Medical Professionalism and prima facie ethics principles to determine whether principles were violated or upheld. We conclude that anyone who works in a health care setting has a duty to speak up when a patient faces harm. We also provide guidance for health care institutions on promoting a culture in which speaking up is encouraged and integrated into routine practice.

Evaluation of accuracy of B-spline transformation-based deformable image registration with different parameter settings for thoracic images

International Nuclear Information System (INIS)

Kanai, Takayuki; Kadoya, Noriyuki; Ito, Kengo

2014-01-01

Deformable image registration (DIR) is fundamental technique for adaptive radiotherapy and image-guided radiotherapy. However, further improvement of DIR is still needed. We evaluated the accuracy of B-spline transformation-based DIR implemented in elastix. This registration package is largely based on the Insight Segmentation and Registration Toolkit (ITK), and several new functions were implemented to achieve high DIR accuracy. The purpose of this study was to clarify whether new functions implemented in elastix are useful for improving DIR accuracy. Thoracic 4D computed tomography images of ten patients with esophageal or lung cancer were studied. Datasets for these patients were provided by DIR-lab (dir-lab.com) and included a coordinate list of anatomical landmarks that had been manually identified. DIR between peak-inhale and peak-exhale images was performed with four types of parameter settings. The first one represents original ITK (Parameter 1). The second employs the new function of elastix (Parameter 2), and the third was created to verify whether new functions improve DIR accuracy while keeping computational time (Parameter 3). The last one partially employs a new function (Parameter 4). Registration errors for these parameter settings were calculated using the manually determined landmark pairs. 3D registration errors with standard deviation over all cases were 1.78 (1.57), 1.28 (1.10), 1.44 (1.09) and 1.36 (1.35) mm for Parameter 1, 2, 3 and 4, respectively, indicating that the new functions are useful for improving DIR accuracy, even while maintaining the computational time, and this B-spline-based DIR could be used clinically to achieve high-accuracy adaptive radiotherapy. (author)

Contrast-enhanced spectral mammography improves diagnostic accuracy in the symptomatic setting.

Science.gov (United States)

Tennant, S L; James, J J; Cornford, E J; Chen, Y; Burrell, H C; Hamilton, L J; Girio-Fragkoulakis, C

2016-11-01

To assess the diagnostic accuracy of contrast-enhanced spectral mammography (CESM), and gauge its "added value" in the symptomatic setting. A retrospective multi-reader review of 100 consecutive CESM examinations was performed. Anonymised low-energy (LE) images were reviewed and given a score for malignancy. At least 3 weeks later, the entire examination (LE and recombined images) was reviewed. Histopathology data were obtained for all cases. Differences in performance were assessed using receiver operator characteristic (ROC) analysis. Sensitivity, specificity, and lesion size (versus MRI or histopathology) differences were calculated. Seventy-three percent of cases were malignant at final histology, 27% were benign following standard triple assessment. ROC analysis showed improved overall performance of CESM over LE alone, with area under the curve of 0.93 versus 0.83 (p<0.025). CESM showed increased sensitivity (95% versus 84%, p<0.025) and specificity (81% versus 63%, p<0.025) compared to LE alone, with all five readers showing improved accuracy. Tumour size estimation at CESM was significantly more accurate than LE alone, the latter tending to undersize lesions. In 75% of cases, CESM was deemed a useful or significant aid to diagnosis. CESM provides immediately available, clinically useful information in the symptomatic clinic in patients with suspicious palpable abnormalities. Radiologist sensitivity, specificity, and size accuracy for breast cancer detection and staging are all improved using CESM as the primary mammographic investigation. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Evaluation of accuracy of B-spline transformation-based deformable image registration with different parameter settings for thoracic images.

Science.gov (United States)

Kanai, Takayuki; Kadoya, Noriyuki; Ito, Kengo; Onozato, Yusuke; Cho, Sang Yong; Kishi, Kazuma; Dobashi, Suguru; Umezawa, Rei; Matsushita, Haruo; Takeda, Ken; Jingu, Keiichi

2014-11-01

Deformable image registration (DIR) is fundamental technique for adaptive radiotherapy and image-guided radiotherapy. However, further improvement of DIR is still needed. We evaluated the accuracy of B-spline transformation-based DIR implemented in elastix. This registration package is largely based on the Insight Segmentation and Registration Toolkit (ITK), and several new functions were implemented to achieve high DIR accuracy. The purpose of this study was to clarify whether new functions implemented in elastix are useful for improving DIR accuracy. Thoracic 4D computed tomography images of ten patients with esophageal or lung cancer were studied. Datasets for these patients were provided by DIR-lab (dir-lab.com) and included a coordinate list of anatomical landmarks that had been manually identified. DIR between peak-inhale and peak-exhale images was performed with four types of parameter settings. The first one represents original ITK (Parameter 1). The second employs the new function of elastix (Parameter 2), and the third was created to verify whether new functions improve DIR accuracy while keeping computational time (Parameter 3). The last one partially employs a new function (Parameter 4). Registration errors for these parameter settings were calculated using the manually determined landmark pairs. 3D registration errors with standard deviation over all cases were 1.78 (1.57), 1.28 (1.10), 1.44 (1.09) and 1.36 (1.35) mm for Parameter 1, 2, 3 and 4, respectively, indicating that the new functions are useful for improving DIR accuracy, even while maintaining the computational time, and this B-spline-based DIR could be used clinically to achieve high-accuracy adaptive radiotherapy. © The Author 2014. Published by Oxford University Press on behalf of The Japan Radiation Research Society and Japanese Society for Radiation Oncology.

Impact of patient-specific factors, irradiated left ventricular volume, and treatment set-up errors on the development of myocardial perfusion defects after radiation therapy for left-sided breast cancer

International Nuclear Information System (INIS)

Evans, Elizabeth S.; Prosnitz, Robert G.; Yu Xiaoli; Zhou Sumin; Hollis, Donna R.; Wong, Terence Z.; Light, Kim L.; Hardenbergh, Patricia H.; Blazing, Michael A.; Marks, Lawrence B.

2006-01-01

Purpose: The aim of this study was to assess the impact of patient-specific factors, left ventricle (LV) volume, and treatment set-up errors on the rate of perfusion defects 6 to 60 months post-radiation therapy (RT) in patients receiving tangential RT for left-sided breast cancer. Methods and Materials: Between 1998 and 2005, a total of 153 patients were enrolled onto an institutional review board-approved prospective study and had pre- and serial post-RT (6-60 months) cardiac perfusion scans to assess for perfusion defects. Of the patients, 108 had normal pre-RT perfusion scans and available follow-up data. The impact of patient-specific factors on the rate of perfusion defects was assessed at various time points using univariate and multivariate analysis. The impact of set-up errors on the rate of perfusion defects was also analyzed using a one-tailed Fisher's Exact test. Results: Consistent with our prior results, the volume of LV in the RT field was the most significant predictor of perfusion defects on both univariate (p = 0.0005 to 0.0058) and multivariate analysis (p = 0.0026 to 0.0029). Body mass index (BMI) was the only significant patient-specific factor on both univariate (p = 0.0005 to 0.022) and multivariate analysis (p = 0.0091 to 0.05). In patients with very small volumes of LV in the planned RT fields, the rate of perfusion defects was significantly higher when the fields set-up 'too deep' (83% vs. 30%, p = 0.059). The frequency of deep set-up errors was significantly higher among patients with BMI ≥25 kg/m 2 compared with patients of normal weight (47% vs. 28%, p = 0.068). Conclusions: BMI ≥25 kg/m 2 may be a significant risk factor for cardiac toxicity after RT for left-sided breast cancer, possibly because of more frequent deep set-up errors resulting in the inclusion of additional heart in the RT fields. Further study is necessary to better understand the impact of patient-specific factors and set-up errors on the development of RT

Windows VPN Set Up | High-Performance Computing | NREL

Science.gov (United States)

Windows VPN Set Up Windows VPN Set Up To set up Windows for HPC VPN, here are the steps: Download your version of Windows. Note: We only support the the Endian Connect software when connecting to the a VPN connection to the HPC systems. Windows Version Connect App Windows 10

SU-E-T-258: Development of a New Patient Set-Up Monitoring System Using Force Sensing Resistor (FSR) Sensor for the Radiation Therapy

International Nuclear Information System (INIS)

Cho, M; Kim, T; Kang, S; Kim, D; Kim, K; Shin, D; Suh, T

2015-01-01

Purpose: The purpose of this work is to develop a new patient set-up monitoring system using force sensing resistor (FSR) sensors that can confirm pressure of contact surface and evaluate its feasibility. Methods: In this study, we focused on develop the patient set-up monitoring system to compensate for the limitation of existing optical based monitoring system, so the developed system can inform motion in the radiation therapy. The set-up monitoring system was designed consisting of sensor units (FSR sensor), signal conditioning devices (USB cable/interface electronics), a control PC, and a developed analysis software. The sensor unit was made by attaching FSR sensor and dispersing pressure sponge to prevent error which is caused by concentrating specific point. Measured signal from the FSR sensor was sampled to arduino mega 2560 microcontroller, transferred to control PC by using serial communication. The measured data went through normalization process. The normalized data was displayed through the developed graphic user interface (GUI) software. The software was designed to display a single sensor unit intensity (maximum 16 sensors) and display 2D pressure distribution (using 16 sensors) according to the purpose. Results: Changes of pressure value according to motion was confirmed by the developed set-up monitoring system. Very small movement such as little physical change in appearance can be confirmed using a single unit and using 2D pressure distribution. Also, the set-up monitoring system can observe in real time. Conclusion: In this study, we developed the new set-up monitoring system using FSR sensor. Especially, we expect that the new set-up monitoring system is suitable for motion monitoring of blind area that is hard to confirm existing optical system and compensate existing optical based monitoring system. As a further study, an integrated system will be constructed through correlation of existing optical monitoring system. This work was supported by

SU-E-T-258: Development of a New Patient Set-Up Monitoring System Using Force Sensing Resistor (FSR) Sensor for the Radiation Therapy

Energy Technology Data Exchange (ETDEWEB)

Cho, M; Kim, T; Kang, S; Kim, D; Kim, K; Shin, D; Suh, T [The Catholic University of Korea College of Medicine, Seoul (Korea, Republic of)

2015-06-15

Purpose: The purpose of this work is to develop a new patient set-up monitoring system using force sensing resistor (FSR) sensors that can confirm pressure of contact surface and evaluate its feasibility. Methods: In this study, we focused on develop the patient set-up monitoring system to compensate for the limitation of existing optical based monitoring system, so the developed system can inform motion in the radiation therapy. The set-up monitoring system was designed consisting of sensor units (FSR sensor), signal conditioning devices (USB cable/interface electronics), a control PC, and a developed analysis software. The sensor unit was made by attaching FSR sensor and dispersing pressure sponge to prevent error which is caused by concentrating specific point. Measured signal from the FSR sensor was sampled to arduino mega 2560 microcontroller, transferred to control PC by using serial communication. The measured data went through normalization process. The normalized data was displayed through the developed graphic user interface (GUI) software. The software was designed to display a single sensor unit intensity (maximum 16 sensors) and display 2D pressure distribution (using 16 sensors) according to the purpose. Results: Changes of pressure value according to motion was confirmed by the developed set-up monitoring system. Very small movement such as little physical change in appearance can be confirmed using a single unit and using 2D pressure distribution. Also, the set-up monitoring system can observe in real time. Conclusion: In this study, we developed the new set-up monitoring system using FSR sensor. Especially, we expect that the new set-up monitoring system is suitable for motion monitoring of blind area that is hard to confirm existing optical system and compensate existing optical based monitoring system. As a further study, an integrated system will be constructed through correlation of existing optical monitoring system. This work was supported by

The application of a low-cost 3D depth camera for patient set-up and respiratory motion management in radiotherapy

Science.gov (United States)

Tahavori, Fatemeh

Respiratory motion induces uncertainty in External Beam Radiotherapy (EBRT), which can result in sub-optimal dose delivery to the target tissue and unwanted dose to normal tissue. The conventional approach to managing patient respiratory motion for EBRT within the area of abdominal-thoracic cancer is through the use of internal radiological imaging methods (e.g. Megavoltage imaging or Cone-Beam Computed Tomography) or via surrogate estimates of tumour position using external markers placed on the patient chest. This latter method uses tracking with video-based techniques, and relies on an assumed correlation or mathematical model, between the external surrogate signal and the internal target position. The marker's trajectory can be used in both respiratory gating techniques and real-time tracking methods. Internal radiological imaging methods bring with them limited temporal resolution, and additional radiation burden, which can be addressed by external marker-based methods that carry no such issues. Moreover, by including multiple external markers and placing them closer to the internal target organs, the effciency of correlation algorithms can be increased. However, the quality of such external monitoring methods is underpinned by the performance of the associated correlation model. Therefore, several new approaches to correlation modelling have been developed as part of this thesis and compared using publicly-available datasets. Highly competitive results have been obtained when compared against state-of-the-art methods. Marker-based methods also have the disadvantages of requiring manual set-up time for marker placement and patient positioning and potential issues with reproducibility of marker placement. This motivates the investigation of non-contact marker-free methods for use in EBRT, which is the main topic of this thesis. The Microsoft Kinect is used as an example of a low-cost consumer grade 3D depth camera for capturing and analysing external

Follow-up of patients with rheumatic heart diseases in the outpatient setting

Directory of Open Access Journals (Sweden)

B S Belov

2009-01-01

Full Text Available The major tasks of a follow-up of patients with rheumatic cardiac defects (RCD are formulated on the basis of the recommendations of international and national scientific associations. At the same time, a clinicianXs experience and judgments play an important role in supervising patients with chronic rheumatic heart disease and RCD.

Mortality Predicted Accuracy for Hepatocellular Carcinoma Patients with Hepatic Resection Using Artificial Neural Network

Directory of Open Access Journals (Sweden)

Herng-Chia Chiu

2013-01-01

Full Text Available The aim of this present study is firstly to compare significant predictors of mortality for hepatocellular carcinoma (HCC patients undergoing resection between artificial neural network (ANN and logistic regression (LR models and secondly to evaluate the predictive accuracy of ANN and LR in different survival year estimation models. We constructed a prognostic model for 434 patients with 21 potential input variables by Cox regression model. Model performance was measured by numbers of significant predictors and predictive accuracy. The results indicated that ANN had double to triple numbers of significant predictors at 1-, 3-, and 5-year survival models as compared with LR models. Scores of accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC of 1-, 3-, and 5-year survival estimation models using ANN were superior to those of LR in all the training sets and most of the validation sets. The study demonstrated that ANN not only had a great number of predictors of mortality variables but also provided accurate prediction, as compared with conventional methods. It is suggested that physicians consider using data mining methods as supplemental tools for clinical decision-making and prognostic evaluation.

Mortality Predicted Accuracy for Hepatocellular Carcinoma Patients with Hepatic Resection Using Artificial Neural Network

Science.gov (United States)

Chiu, Herng-Chia; Ho, Te-Wei; Lee, King-Teh; Chen, Hong-Yaw; Ho, Wen-Hsien

2013-01-01

The aim of this present study is firstly to compare significant predictors of mortality for hepatocellular carcinoma (HCC) patients undergoing resection between artificial neural network (ANN) and logistic regression (LR) models and secondly to evaluate the predictive accuracy of ANN and LR in different survival year estimation models. We constructed a prognostic model for 434 patients with 21 potential input variables by Cox regression model. Model performance was measured by numbers of significant predictors and predictive accuracy. The results indicated that ANN had double to triple numbers of significant predictors at 1-, 3-, and 5-year survival models as compared with LR models. Scores of accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) of 1-, 3-, and 5-year survival estimation models using ANN were superior to those of LR in all the training sets and most of the validation sets. The study demonstrated that ANN not only had a great number of predictors of mortality variables but also provided accurate prediction, as compared with conventional methods. It is suggested that physicians consider using data mining methods as supplemental tools for clinical decision-making and prognostic evaluation. PMID:23737707

Epidemiological study of clinical characteristics of patients with PCOS attending infertility clinic and awareness of PCOS in a rural set up

OpenAIRE

Shubhada Jajoo; Riju Angik

2013-01-01

Background: Polycystic ovarian syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age group. It is a common diagnosis in women presenting with infertility. All the dimensions of PCOS have not been completely explored. In this study we studied the clinical features of PCOS and comparing with non-PCOS infertility patients and simultaneously studied the prevalence of PCOS in infertility patients and its awareness in a rural set up. Methods: It is a prospect...

Surface imaging, portal imaging, and skin marker set-up vs. CBCT for radiotherapy of the thorax and pelvis

International Nuclear Information System (INIS)

Pallotta, Stefania; Bucciolini, Marta; Vanzi, Eleonora; Marrazzo, Livia; Simontacchi, Gabriele; Paiar, Fabiola; Ceroti, Marco; Livi, Lorenzo

2015-01-01

The aim of this study was to compare surface imaging, portal imaging, and skin marker set-up in radiotherapy of thoracic and pelvic regions, using cone beam computed tomography (CBCT) data as the gold standard. Twenty patients were included in this study. CBCT, surface acquisition (SA), and two orthogonal portal images (PI) were acquired during the first four treatment sessions. Patient set-up corrections, obtained by registering the planning CT with CBCT, were used as the gold standard. Registration results of the PI and SA were evaluated and compared with those obtained with CBCT. The advantage derived from using SA or PI verification systems over a skin marker set-up was also quantified. A statistically significant difference between PI and SA (in favour of PI) was observed in seven patients undergoing treatment of the pelvic region and in two patients undergoing treatment of the thoracic region. The use of SA or PI, compared with a skin marker set-up, improved patient positioning in 50% and 57 % of the thoracic fractions, respectively. For pelvic fractions, the use of PI was beneficial in 73 % of the cases, while the use of SA was beneficial in only 45 %. Patient positioning worsened with SA, particularly along longitudinal and vertical directions. PI yielded more accurate registration results than SA for both pelvic and thoracic fractions. Compared with the skin marker set-up, PI performances were superior to SA for pelvic fractions while comparable results were obtained for thoracic fractions. (orig.) [de

Diagnostic accuracy of dual energy CT angiography in patients with diabetes mellitus

International Nuclear Information System (INIS)

Schabel, C.; Bongers, M.N.; Syha, R.; Ketelsen, D.; Homann, G.; Notohamiprodjo, M.; Nikolaou, K.; Bamberg, F.; Thomas, C.

2015-01-01

Peripheral arterial disease (PAD) represents a major and highly prevalent complication in patients with diabetes mellitus. The diagnostic, non-invasive work-up by computed tomography angiography (CTA) is limited in the presence of extensive calcification. The aim of the study was to determine the diagnostic accuracy of dual energy CTA (DE-CTA) for the detection and characterization of PAD in patients with diabetes mellitus. In this study 30 diabetic patients with suspected or known PAD were retrospectively included in the analysis. All subjects underwent DE-CTA (Somatom Definition Flash, Siemens Healthcare, Erlangen, Germany) prior to invasive angiography, which served as the reference standard. Blinded analysis included assessment of the presence and degree of peripheral stenosis on curved multiplanar reformatting (MPR) and maximum intensity projections (MIP). Conventional measures of diagnostic accuracy were derived. Among the 30 subjects included in the analysis (83 % male, mean age 70.0 ± 10.5 years, 83 % diabetes type 2), the prevalence of critical stenosis in 331 evaluated vessel segments was high (30 %). Dual energy CT identified critical stenoses with a high sensitivity and good specificity using curved MPR (100 % and 93.1 %, respectively) and MIP images (99 % and 91.8 %, respectively). In stratified analysis, the diagnostic accuracy was higher for stenosis pertaining to the pelvic and thigh vessels as compared with the lower extremities (curved MPR accuracy 97.1 % vs. 99.2 vs. 90.9 %; respectively, p < 0.001). The use of DE-CTA allows reliable detection and characterization of peripheral arterial stenosis in patients with diabetes mellitus with higher accuracy in vessels in the pelvic and thigh regions compared with the vessels in the lower legs. (orig.) [de

Evaluation of errors set-up and setting margins calculation in treatments 3-D conformal radiotherapy; Evaluacion de errores de set-up y calculo de margenes de configuracion en tratamientos de radioterapia CONFORMADA 3-D

Energy Technology Data Exchange (ETDEWEB)

Donis, S.; Robayna, B.; Gonzalez, A.; Hernandez Armas, J.

2011-07-01

The use of IGRT techniques provide knowledge of the mistakes made in the positioning of a patient, to population studies and estimate the margins for each population.In this paper we evaluate the errors of set-up in 3 different locations and from these margins are calculated configuration (SM).

Cone beam CT-based set-up strategies with and without rotational correction for stereotactic body radiation therapy in the liver.

Science.gov (United States)

Bertholet, Jenny; Worm, Esben; Høyer, Morten; Poulsen, Per

2017-06-01

Accurate patient positioning is crucial in stereotactic body radiation therapy (SBRT) due to a high dose regimen. Cone-beam computed tomography (CBCT) is often used for patient positioning based on radio-opaque markers. We compared six CBCT-based set-up strategies with or without rotational correction. Twenty-nine patients with three implanted markers received 3-6 fraction liver SBRT. The markers were delineated on the mid-ventilation phase of a 4D-planning-CT. One pretreatment CBCT was acquired per fraction. Set-up strategy 1 used only translational correction based on manual marker match between the CBCT and planning CT. Set-up strategy 2 used automatic 6 degrees-of-freedom registration of the vertebrae closest to the target. The 3D marker trajectories were also extracted from the projections and the mean position of each marker was calculated and used for set-up strategies 3-6. Translational correction only was used for strategy 3. Translational and rotational corrections were used for strategies 4-6 with the rotation being either vertebrae based (strategy 4), or marker based and constrained to ±3° (strategy 5) or unconstrained (strategy 6). The resulting set-up error was calculated as the 3D root-mean-square set-up error of the three markers. The set-up error of the spinal cord was calculated for all strategies. The bony anatomy set-up (2) had the largest set-up error (5.8 mm). The marker-based set-up with unconstrained rotations (6) had the smallest set-up error (0.8 mm) but the largest spinal cord set-up error (12.1 mm). The marker-based set-up with translational correction only (3) or with bony anatomy rotational correction (4) had equivalent set-up error (1.3 mm) but rotational correction reduced the spinal cord set-up error from 4.1 mm to 3.5 mm. Marker-based set-up was substantially better than bony-anatomy set-up. Rotational correction may improve the set-up, but further investigations are required to determine the optimal correction

Positioning accuracy for lung stereotactic body radiotherapy patients determined by on-treatment cone-beam CT imaging

Science.gov (United States)

Richmond, N D; Pilling, K E; Peedell, C; Shakespeare, D; Walker, C P

2012-01-01

Stereotactic body radiotherapy for early stage non-small cell lung cancer is an emerging treatment option in the UK. Since relatively few high-dose ablative fractions are delivered to a small target volume, the consequences of a geometric miss are potentially severe. This paper presents the results of treatment delivery set-up data collected using Elekta Synergy (Elekta, Crawley, UK) cone-beam CT imaging for 17 patients immobilised using the Bodyfix system (Medical Intelligence, Schwabmuenchen, Germany). Images were acquired on the linear accelerator at initial patient treatment set-up, following any position correction adjustments, and post-treatment. These were matched to the localisation CT scan using the Elekta XVI software. In total, 71 fractions were analysed for patient set-up errors. The mean vector error at initial set-up was calculated as 5.3±2.7 mm, which was significantly reduced to 1.4±0.7 mm following image guided correction. Post-treatment the corresponding value was 2.1±1.2 mm. The use of the Bodyfix abdominal compression plate on 5 patients to reduce the range of tumour excursion during respiration produced mean longitudinal set-up corrections of −4.4±4.5 mm compared with −0.7±2.6 mm without compression for the remaining 12 patients. The use of abdominal compression led to a greater variation in set-up errors and a shift in the mean value. PMID:22665927

Accuracy of Setting Work-pieces on Automatic Lines with Pallet-fixtures

Directory of Open Access Journals (Sweden)

L. A. Kolesnikov

2015-01-01

Full Text Available The accuracy of positioning surfaces to be processed on automatic lines with pallet-fixtures essentially depends on the setting error of the pallet-fixtures with work-pieces in ready-to-work position.The applied methods for calculating the setting error do not give a complete picture of the possible coordinates of the point when in the pallet is displaced in different directions.The aim of the work was to determine an accuracy of the setting work-pieces on automatic lines with pallets-fixtures, using a computational and analytical method, to improve a manufacturing precision of parts.The currently used methods to calculate the setting error do not give a complete picture of the possible coordinates of the point of the pallet displacement in different directions. The paper offers a method of equivalent mechanism to determine all the variety of options for displacements in the horizontal plane with a diverse combination of angular and plane-parallel displacements.Using a four-bar linkage, as an equivalent mechanism, allows us to define a zone of the possible positions of any point of the work-piece pallet platform, as the zone bounded by the coupler curve. In case the gaps in the nodes of the two fixtures are equal the zone of possible positions of the point in the parallel displacement of the platform is determined by the circumference and at an angular displacement by the ellipse.The obtained analytical dependences allow us to determine the error at the stage of design with the certain gaps in the fixture nodes.The above method of calculation makes it possible to define a zone of the appropriate placement of the work-piece on its platform for the specified parameters of the pallet to meet conditions for ensuring the coordinate accuracy of the processed axes of holes.

Learning Data Set Influence on Identification Accuracy of Gas Turbine Neural Network Model

Science.gov (United States)

Kuznetsov, A. V.; Makaryants, G. M.

2018-01-01

There are many gas turbine engine identification researches via dynamic neural network models. It should minimize errors between model and real object during identification process. Questions about training data set processing of neural networks are usually missed. This article presents a study about influence of data set type on gas turbine neural network model accuracy. The identification object is thermodynamic model of micro gas turbine engine. The thermodynamic model input signal is the fuel consumption and output signal is the engine rotor rotation frequency. Four types input signals was used for creating training and testing data sets of dynamic neural network models - step, fast, slow and mixed. Four dynamic neural networks were created based on these types of training data sets. Each neural network was tested via four types test data sets. In the result 16 transition processes from four neural networks and four test data sets from analogous solving results of thermodynamic model were compared. The errors comparison was made between all neural network errors in each test data set. In the comparison result it was shown error value ranges of each test data set. It is shown that error values ranges is small therefore the influence of data set types on identification accuracy is low.

Retrospective Analysis of the Accuracy of Ultrasound-Guided Magnetic Resonance Arthrogram Injections of the Hip in the Office Setting.

Science.gov (United States)

Jernick, Michael; Walker Gallego, Edward; Nuzzo, Michael

2017-12-01

Ultrasound (US)-guided intra-articular hip injections have been proposed in the literature to be accurate, reliable, and safe alternatives to fluoroscopy-guided injections. To evaluate the accuracy of US-guided magnetic resonance (MR) arthrogram injections of the hip performed in the office setting by a single orthopaedic surgeon and elucidate the potential effects that patient age, sex, and body mass index (BMI) have on contrast placement. Case series; Level of evidence, 4. From a review of the senior author's office database, 89 patients (101 hips) who had US-guided MR arthrogram injections performed between December 2014 and June 2016 were identified. Official radiology reports were evaluated to determine whether extra-articular contrast was noted. Patient variables, including BMI, age, and sex, were evaluated between patients who had inappropriately placed contrast and those who did not. Of the 101 hip injections, there were 6 cases that demonstrated inadequate contrast placement within the joint, likely secondary to extravasation or incorrect placement; however, an MR arthrogram was adequately interpreted in all cases. There were no significant differences noted between those with appropriate versus inappropriate contrast placement when evaluating BMI ( P = .57), age ( P = .33), or sex ( P = .67), and neither group had an adverse event. US-guided injections are safe and accurate alternatives to fluoroscopy-guided injections in the office setting, with 94% accuracy. Furthermore, BMI, age, and sex did not play a statistically significant role among patients with inappropriately placed contrast.

Accuracy of Lagrange-sinc functions as a basis set for electronic structure calculations of atoms and molecules

International Nuclear Information System (INIS)

Choi, Sunghwan; Hong, Kwangwoo; Kim, Jaewook; Kim, Woo Youn

2015-01-01

We developed a self-consistent field program based on Kohn-Sham density functional theory using Lagrange-sinc functions as a basis set and examined its numerical accuracy for atoms and molecules through comparison with the results of Gaussian basis sets. The result of the Kohn-Sham inversion formula from the Lagrange-sinc basis set manifests that the pseudopotential method is essential for cost-effective calculations. The Lagrange-sinc basis set shows faster convergence of the kinetic and correlation energies of benzene as its size increases than the finite difference method does, though both share the same uniform grid. Using a scaling factor smaller than or equal to 0.226 bohr and pseudopotentials with nonlinear core correction, its accuracy for the atomization energies of the G2-1 set is comparable to all-electron complete basis set limits (mean absolute deviation ≤1 kcal/mol). The same basis set also shows small mean absolute deviations in the ionization energies, electron affinities, and static polarizabilities of atoms in the G2-1 set. In particular, the Lagrange-sinc basis set shows high accuracy with rapid convergence in describing density or orbital changes by an external electric field. Moreover, the Lagrange-sinc basis set can readily improve its accuracy toward a complete basis set limit by simply decreasing the scaling factor regardless of systems

Determination and evaluation of intra fractional and set-up changes during radiotherapy to the cervical carcinoma using cone beam computed tomography

International Nuclear Information System (INIS)

Pathak, Pankaj; Kumar, Rajesh; Birbiya, Narendra; Mishra, Praveen Kumar; Singh, Manisha; Mishra, Pankaj Kumar

2017-01-01

To confirm the accuracy of the location of the Fudicial markings in relation to the actual isocentre of the irradiated volume due to Intra-fractional and Set-Up changes in Cancer Cervix with the help of Cone Beam computed Tomography (CBCT)

PENURUNAN WAKTU SET-UP UNTUK PENINGKATAN EFEKTIFITAS PADA PT. X

Directory of Open Access Journals (Sweden)

Hendri Hendri

2015-06-01

Full Text Available PT. X bergerak dalam industri manufuktur yang memproduksi komponen otomotif yang  salah satu prosesnya adalah pembuatan bearing. Saat ini, persaingan dalam dunia bisnis semakin ketat. Situasi ini membuat organisasi untuk memperbaiki diri dengan penurunan waktu set-up supaya dapat menghilangkan pemborosan sehingga peningkatan efektifitas dapat dicapai. Untuk melakukan penurunan waktu set-up dalam penelitian ini menggunakan metode Single Minute Exchange of Dies (SMED. SMED adalah salah satu metoda improvement dari Lean Manufacturing yang digunakan untuk mempercepat waktu yang dibutuhkan untuk melakukan setup pergantian dari memproduksi satu jenis produk ke model produk lainnya. Penelitian ini bertujuan untuk mengetahui waktu Set up, serta mengetahui cara memperbaiki dan menurunkan waktu set up. Setelah dilakukan penelitian diketahui total waktu set up atau change over serta dilakukan perbaikan pada tiga titik yakni memindakan enam aktivitas internal menjadi aktivitas eksernal yang aktivitasnya dipersingkat, mengganti cara kerja setting/pengencangan baut dari cara manual ke alat bantu pengencangan dengan bantuan tekanan udara (pneumatic, dan mengganti cara kerja setting/penyetelan manual menjadi penyetelan dengan mengunakan block gauge. Secara keseluruhan terjadi penurunan waktu set up yang signifikan. Dengan demikian terjadi peningkatan efektifitas dengan menghilangkan pemborosan waktu set up sehinga terjadi peningkatan jumlah produksi per jam.

Can patients report patient safety incidents in a hospital setting? A systematic review.

Science.gov (United States)

Ward, Jane K; Armitage, Gerry

2012-08-01

Patients are increasingly being thought of as central to patient safety. A small but growing body of work suggests that patients may have a role in reporting patient safety problems within a hospital setting. This review considers this disparate body of work, aiming to establish a collective view on hospital-based patient reporting. This review asks: (a) What can patients report? (b) In what settings can they report? (c) At what times have patients been asked to report? (d) How have patients been asked to report? 5 databases (MEDLINE, EMBASE, CINAHL, (Kings Fund) HMIC and PsycINFO) were searched for published literature on patient reporting of patient safety 'problems' (a number of search terms were utilised) within a hospital setting. In addition, reference lists of all included papers were checked for relevant literature. 13 papers were included within this review. All included papers were quality assessed using a framework for comparing both qualitative and quantitative designs, and reviewed in line with the study objectives. Patients are clearly in a position to report on patient safety, but included papers varied considerably in focus, design and analysis, with all papers lacking a theoretical underpinning. In all papers, reports were actively solicited from patients, with no evidence currently supporting spontaneous reporting. The impact of timing upon accuracy of information has yet to be established, and many vulnerable patients are not currently being included in patient reporting studies, potentially introducing bias and underestimating the scale of patient reporting. The future of patient reporting may well be as part of an 'error detection jigsaw' used alongside other methods as part of a quality improvement toolkit.

Galvanic cells: setting up the Daniell cell.

OpenAIRE

Milla González, Miguel

2008-01-01

With the reagents (0.05M copper nitrate solution, 0.05M zinc nitrate solution) and material (glassware, potentiometer, electric wire) availabe in the laboratory, the user must set up the Daniell cell. Different configurations can be possible if the half cells are filled with either electrolyte solution. The cell connections to the measuring device can also be changed. In all instances, an explanation of the set up cell is obtained as well as of the measured potential difference.

DCE-MRI of the breast in a stand-alone setting outside a complementary strategy - results of the TK-study

Energy Technology Data Exchange (ETDEWEB)

Kaiser, Clemens G.; Krammer, J.; Wasser, K.; Schoenberg, S.O. [University Medical Centre Mannheim, Medical Faculty Mannheim-University of Heidelberg, Institute of Clinical Radiology and Nuclear Medicine, Mannheim (Germany); Reich, C.; Kaiser, W.A. [Friedrich-Schiller-University Hospital Jena, Institute of Diagnostic and Interventional Radiology I, Jena (Germany); Dietzel, M. [Friedrich-Alexander-University Hospital Erlangen-Nuernberg, Department of Neuroradiology, Erlangen (Germany); Baltzer, P.A.T. [Medical University Vienna, Institute of Radiology and Nuclear Medicine, Vienna (Austria)

2015-06-01

To evaluate the accuracy of MRI of the breast (DCE-MRI) in a stand-alone setting with extended indications. According to the inclusion criteria, breast specialists were invited to refer patients to our institution for DCE-MRI. Depending on the MR findings, patients received either a follow-up or biopsy. Between 04/2006 and 12/2011 a consecutive total of 1,488 women were prospectively examined. Of 1,488 included patients, 393 patients were lost to follow-up, 1,095 patients were evaluated. 124 patients were diagnosed with malignancy by DCE-MRI (76 TP, 48 FP, 971 TN, 0 FN cases). Positive cases were confirmed by histology, negative cases by MR follow-ups or patient questionnaires over the next 5 years in 1,737 cases (sensitivity 100 %; specificity 95.2 %; PPV 61.3 %; NPV 100 %; accuracy 95.5 %). For invasive cancers only (DCIS excluded), the results were 63 TP; 27 FP; 971 TP and 0 FN (sensitivity 100 %; specificity 97.2 %; PPV 70 %; NPV 100 %; accuracy 97.5 %). The DCE-MRI indications tested imply that negative results in DCE-MRI reliably exclude cancer. The results were achieved in a stand-alone setting (single modality diagnosis). However, these results are strongly dependent on reader experience and adequate technical standards as prerequisites for optimal diagnoses. (orig.)

DCE-MRI of the breast in a stand-alone setting outside a complementary strategy - results of the TK-study

International Nuclear Information System (INIS)

Kaiser, Clemens G.; Krammer, J.; Wasser, K.; Schoenberg, S.O.; Reich, C.; Kaiser, W.A.; Dietzel, M.; Baltzer, P.A.T.

2015-01-01

To evaluate the accuracy of MRI of the breast (DCE-MRI) in a stand-alone setting with extended indications. According to the inclusion criteria, breast specialists were invited to refer patients to our institution for DCE-MRI. Depending on the MR findings, patients received either a follow-up or biopsy. Between 04/2006 and 12/2011 a consecutive total of 1,488 women were prospectively examined. Of 1,488 included patients, 393 patients were lost to follow-up, 1,095 patients were evaluated. 124 patients were diagnosed with malignancy by DCE-MRI (76 TP, 48 FP, 971 TN, 0 FN cases). Positive cases were confirmed by histology, negative cases by MR follow-ups or patient questionnaires over the next 5 years in 1,737 cases (sensitivity 100 %; specificity 95.2 %; PPV 61.3 %; NPV 100 %; accuracy 95.5 %). For invasive cancers only (DCIS excluded), the results were 63 TP; 27 FP; 971 TP and 0 FN (sensitivity 100 %; specificity 97.2 %; PPV 70 %; NPV 100 %; accuracy 97.5 %). The DCE-MRI indications tested imply that negative results in DCE-MRI reliably exclude cancer. The results were achieved in a stand-alone setting (single modality diagnosis). However, these results are strongly dependent on reader experience and adequate technical standards as prerequisites for optimal diagnoses. (orig.)

Set-Up and Punchline as Figure and Ground

DEFF Research Database (Denmark)

Keisalo, Marianna Päivikki

the two that cannot be resolved by appeal to either set-up or punchline, but traps thought between them in an ‘epistemological problem’ as comedian Louis CK put it. For comedians, set-ups and punchlines are basic tools, practical and concrete ways to create and organize material. They are also familiar...

Oxytocin increases bias, but not accuracy, in face recognition line-ups.

Science.gov (United States)

Bate, Sarah; Bennetts, Rachel; Parris, Benjamin A; Bindemann, Markus; Udale, Robert; Bussunt, Amanda

2015-07-01

Previous work indicates that intranasal inhalation of oxytocin improves face recognition skills, raising the possibility that it may be used in security settings. However, it is unclear whether oxytocin directly acts upon the core face-processing system itself or indirectly improves face recognition via affective or social salience mechanisms. In a double-blind procedure, 60 participants received either an oxytocin or placebo nasal spray before completing the One-in-Ten task-a standardized test of unfamiliar face recognition containing target-present and target-absent line-ups. Participants in the oxytocin condition outperformed those in the placebo condition on target-present trials, yet were more likely to make false-positive errors on target-absent trials. Signal detection analyses indicated that oxytocin induced a more liberal response bias, rather than increasing accuracy per se. These findings support a social salience account of the effects of oxytocin on face recognition and indicate that oxytocin may impede face recognition in certain scenarios. © The Author (2014). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

Improved precision and accuracy for microarrays using updated probe set definitions

Directory of Open Access Journals (Sweden)

Larsson Ola

2007-02-01

Full Text Available Abstract Background Microarrays enable high throughput detection of transcript expression levels. Different investigators have recently introduced updated probe set definitions to more accurately map probes to our current knowledge of genes and transcripts. Results We demonstrate that updated probe set definitions provide both better precision and accuracy in probe set estimates compared to the original Affymetrix definitions. We show that the improved precision mainly depends on the increased number of probes that are integrated into each probe set, but we also demonstrate an improvement when the same number of probes is used. Conclusion Updated probe set definitions does not only offer expression levels that are more accurately associated to genes and transcripts but also improvements in the estimated transcript expression levels. These results give support for the use of updated probe set definitions for analysis and meta-analysis of microarray data.

Digital versus conventional implant impressions for edentulous patients: accuracy outcomes.

Science.gov (United States)

Papaspyridakos, Panos; Gallucci, German O; Chen, Chun-Jung; Hanssen, Stijn; Naert, Ignace; Vandenberghe, Bart

2016-04-01

To compare the accuracy of digital and conventional impression techniques for completely edentulous patients and to determine the effect of different variables on the accuracy outcomes. A stone cast of an edentulous mandible with five implants was fabricated to serve as master cast (control) for both implant- and abutment-level impressions. Digital impressions (n = 10) were taken with an intraoral optical scanner (TRIOS, 3shape, Denmark) after connecting polymer scan bodies. For the conventional polyether impressions of the master cast, a splinted and a non-splinted technique were used for implant-level and abutment-level impressions (4 cast groups, n = 10 each). Master casts and conventional impression casts were digitized with an extraoral high-resolution scanner (IScan D103i, Imetric, Courgenay, Switzerland) to obtain digital volumes. Standard tessellation language (STL) datasets from the five groups of digital and conventional impressions were superimposed with the STL dataset from the master cast to assess the 3D (global) deviations. To compare the master cast with digital and conventional impressions at the implant level, analysis of variance (ANOVA) and Scheffe's post hoc test was used, while Wilcoxon's rank-sum test was used for testing the difference between abutment-level conventional impressions. Significant 3D deviations (P impressions (P > 0.001). Digital implant impressions are as accurate as conventional implant impressions. The splinted, implant-level impression technique is more accurate than the non-splinted one for completely edentulous patients, whereas there was no difference in the accuracy at the abutment level. The implant angulation up to 15° did not affect the accuracy of implant impressions. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Accuracy of diagnostic ultrasound in patients with suspected subacromial disorders: a systematic review and meta-analysis.

NARCIS (Netherlands)

Ottenheijm, R.P.; Jansen, M.J.; Staal, J.B.; Bruel, A. van den; Weijers, R.E.; Bie, R.A. de; Dinant, G.J.

2010-01-01

OBJECTIVE: To determine the diagnostic accuracy of ultrasound for detecting subacromial disorders in patients presenting in primary and secondary care settings. DATA SOURCES: Medline and Embase were searched on June 9, 2010. In addition, the reference list of 1 systematic review and all included

Accuracy, reproducibility, and uncertainty analysis of thyroid-probe-based activity measurements for determination of dose calibrator settings.

Science.gov (United States)

Esquinas, Pedro L; Tanguay, Jesse; Gonzalez, Marjorie; Vuckovic, Milan; Rodríguez-Rodríguez, Cristina; Häfeli, Urs O; Celler, Anna

2016-12-01

In the nuclear medicine department, the activity of radiopharmaceuticals is measured using dose calibrators (DCs) prior to patient injection. The DC consists of an ionization chamber that measures current generated by ionizing radiation (emitted from the radiotracer). In order to obtain an activity reading, the current is converted into units of activity by applying an appropriate calibration factor (also referred to as DC dial setting). Accurate determination of DC dial settings is crucial to ensure that patients receive the appropriate dose in diagnostic scans or radionuclide therapies. The goals of this study were (1) to describe a practical method to experimentally determine dose calibrator settings using a thyroid-probe (TP) and (2) to investigate the accuracy, reproducibility, and uncertainties of the method. As an illustration, the TP method was applied to determine 188 Re dial settings for two dose calibrator models: Atomlab 100plus and Capintec CRC-55tR. Using the TP to determine dose calibrator settings involved three measurements. First, the energy-dependent efficiency of the TP was determined from energy spectra measurements of two calibration sources ( 152 Eu and 22 Na). Second, the gamma emissions from the investigated isotope ( 188 Re) were measured using the TP and its activity was determined using γ-ray spectroscopy methods. Ambient background, scatter, and source-geometry corrections were applied during the efficiency and activity determination steps. Third, the TP-based 188 Re activity was used to determine the dose calibrator settings following the calibration curve method [B. E. Zimmerman et al., J. Nucl. Med. 40, 1508-1516 (1999)]. The interobserver reproducibility of TP measurements was determined by the coefficient of variation (COV) and uncertainties associated to each step of the measuring process were estimated. The accuracy of activity measurements using the proposed method was evaluated by comparing the TP activity estimates of 99m Tc

Setting up of a cerebral visual impairment clinic for children: Challenges and future developments.

Science.gov (United States)

Philip, Swetha Sara

2017-01-01

The aim of this study is to describe the setting up of a cerebral visual impairment (CVI) clinic in a tertiary care hospital in South India and to describe the spectrum of cases seen. The CVI clinic, set up in February 2011, receives interdisciplinary input from a core team involving a pediatrician, neurologist, psychiatrist, occupational therapist, pediatric ophthalmologist, and an optometrist. All children, children (45%) had moderate CP. Forty percent of CVI was due to birth asphyxia, but about 20% did not have any known cause for CVI. Seventy percent of patients, who came back for follow-up, were carrying out the habilitation strategies suggested. Average attendance of over 300 new patients a year suggests a definite need for CVI clinics in the country. These children need specialized care to handle their complex needs. Although difficult to coordinate, an interdisciplinary team including the support groups and voluntary organizations is needed to facilitate the successful implementation of such specialized service.

Evaluating the relationship between evolutionary divergence and phylogenetic accuracy in AFLP data sets.

Science.gov (United States)

García-Pereira, María Jesús; Caballero, Armando; Quesada, Humberto

2010-05-01

Using in silico amplified fragment length polymorphism (AFLP) fingerprints, we explore the relationship between sequence similarity and phylogeny accuracy to test when, in terms of genetic divergence, the quality of AFLP data becomes too low to be informative for a reliable phylogenetic reconstruction. We generated DNA sequences with known phylogenies using balanced and unbalanced trees with recent, uniform and ancient radiations, and average branch lengths (from the most internal node to the tip) ranging from 0.02 to 0.4 substitutions per site. The resulting sequences were used to emulate the AFLP procedure. Trees were estimated by maximum parsimony (MP), neighbor-joining (NJ), and minimum evolution (ME) methods from both DNA sequences and virtual AFLP fingerprints. The estimated trees were compared with the reference trees using a score that measures overall differences in both topology and relative branch length. As expected, the accuracy of AFLP-based phylogenies decreased dramatically in the more divergent data sets. Above a divergence of approximately 0.05, AFLP-based phylogenies were largely inaccurate irrespective of the distinct topology, radiation model, or phylogenetic method used. This value represents an upper bound of expected tree accuracy for data sets with a simple divergence history; AFLP data sets with a similar divergence but with unbalanced topologies and short ancestral branches produced much less accurate trees. The lack of homology of AFLP bands quickly increases with divergence and reaches its maximum value (100%) at a divergence of only 0.4. Low guanine-cytosine (GC) contents increase the number of nonhomologous bands in AFLP data sets and lead to less reliable trees. However, the effect of the lack of band homology on tree accuracy is surprisingly small relative to the negative impact due to the low information content of AFLP characters. Tree-building methods based on genetic distance displayed similar trends and outperformed parsimony

Priority Settings in patients with Chronic Diseases and Cancer

DEFF Research Database (Denmark)

Arreskov, Anne Beiter; Graungaard, Anette Hauskov; Søndergaard, Jens

Priority setting in patients with cancer and comorbidities Background and aim As both the cancer incidence and the number of patients diagnosed with chronic diseases are increasing, a growing population of cancer survivors will also deal with comorbid chronic diseases. The period after completed...... to comorbidities. Some studies show that participation in regular follow-up consultations concerning comorbid chronic diseases and lifestyle are lower among cancer survivors than non-cancer patients. This could be explained by changes in the patient’s priority setting or in the doctor’s priority and attempt...... to spare the patient for further treatment burden, perhaps resulting in comorbidities falling down the agenda. The overall purpose is to explore patients’ and doctors’ priority settings of comorbidities in patients who have been diagnosed with non-metastatic cancer. Method: The study will consist of three...

View of the WA10 set-up

CERN Multimedia

CERN PhotoLab

1977-01-01

The WA10 experiment by the Geneva-Lausanne Collaboration was set-up in the H5 beam (unseparated, up to 50 GeV/c) to study K+-p --> K0pi+-p and other reactions of similar topology, and the energy dependence of resonance production.

A function accounting for training set size and marker density to model the average accuracy of genomic prediction.

Science.gov (United States)

Erbe, Malena; Gredler, Birgit; Seefried, Franz Reinhold; Bapst, Beat; Simianer, Henner

2013-01-01

Prediction of genomic breeding values is of major practical relevance in dairy cattle breeding. Deterministic equations have been suggested to predict the accuracy of genomic breeding values in a given design which are based on training set size, reliability of phenotypes, and the number of independent chromosome segments ([Formula: see text]). The aim of our study was to find a general deterministic equation for the average accuracy of genomic breeding values that also accounts for marker density and can be fitted empirically. Two data sets of 5'698 Holstein Friesian bulls genotyped with 50 K SNPs and 1'332 Brown Swiss bulls genotyped with 50 K SNPs and imputed to ∼600 K SNPs were available. Different k-fold (k = 2-10, 15, 20) cross-validation scenarios (50 replicates, random assignment) were performed using a genomic BLUP approach. A maximum likelihood approach was used to estimate the parameters of different prediction equations. The highest likelihood was obtained when using a modified form of the deterministic equation of Daetwyler et al. (2010), augmented by a weighting factor (w) based on the assumption that the maximum achievable accuracy is [Formula: see text]. The proportion of genetic variance captured by the complete SNP sets ([Formula: see text]) was 0.76 to 0.82 for Holstein Friesian and 0.72 to 0.75 for Brown Swiss. When modifying the number of SNPs, w was found to be proportional to the log of the marker density up to a limit which is population and trait specific and was found to be reached with ∼20'000 SNPs in the Brown Swiss population studied.

A function accounting for training set size and marker density to model the average accuracy of genomic prediction.

Directory of Open Access Journals (Sweden)

Malena Erbe

Full Text Available Prediction of genomic breeding values is of major practical relevance in dairy cattle breeding. Deterministic equations have been suggested to predict the accuracy of genomic breeding values in a given design which are based on training set size, reliability of phenotypes, and the number of independent chromosome segments ([Formula: see text]. The aim of our study was to find a general deterministic equation for the average accuracy of genomic breeding values that also accounts for marker density and can be fitted empirically. Two data sets of 5'698 Holstein Friesian bulls genotyped with 50 K SNPs and 1'332 Brown Swiss bulls genotyped with 50 K SNPs and imputed to ∼600 K SNPs were available. Different k-fold (k = 2-10, 15, 20 cross-validation scenarios (50 replicates, random assignment were performed using a genomic BLUP approach. A maximum likelihood approach was used to estimate the parameters of different prediction equations. The highest likelihood was obtained when using a modified form of the deterministic equation of Daetwyler et al. (2010, augmented by a weighting factor (w based on the assumption that the maximum achievable accuracy is [Formula: see text]. The proportion of genetic variance captured by the complete SNP sets ([Formula: see text] was 0.76 to 0.82 for Holstein Friesian and 0.72 to 0.75 for Brown Swiss. When modifying the number of SNPs, w was found to be proportional to the log of the marker density up to a limit which is population and trait specific and was found to be reached with ∼20'000 SNPs in the Brown Swiss population studied.

Set-up errors in patients undergoing image guided radiation treatment. Relationship to body mass index and weight loss

DEFF Research Database (Denmark)

Johansen, Jørgen; Bertelsen, Anders; Hansen, Christian Rønn

2008-01-01

by the relative weight change over time. Results: The SD of the translational and rotational random set-up errors during the first three sessions for H&N were 0.9 mm (Left-Right), 1.1mm (Anterior-Posterior), 0.7 mm (Cranio-Caudal) and 0.7 degrees (LR-axis), 0.5 degrees (AP-axis), and 0.7 degrees (CC......-axis). The equivalent data for lung cancer patients were 1.1 mm (LR), 1.1mm (AP), 1.5 mm (CC) and 0.5 degrees (LR-axis), 0.6 degrees (AP-axis), and 0.4 degrees (CC-axis). The median BMI for H&N and lung was 25.8 (17.6-39.7) and 23.7 (17.4-38.8), respectively. The median weekly weight change for H&N was -0.3% (-2.0 to 1...... (H&N) and 20 lung cancer patients were investigated. Patients were positioned using customized immobilization devices consisting of vacuum cushions and thermoplastic shells. Treatment was given on an Elekta Synergy accelerator. Cone-beam acquisitions were obtained according to a standardized Action...

Developing and setting up of a nuclear medicine information management system

International Nuclear Information System (INIS)

Baghel, N.S.; Asopa, R.; Nayak, U.N.; Rajan, M.G.R.; Subhalakshmi, P.V.; Shailaja, A.; Rajashekharrao, B.; Karunanidhi, Y.R.

2010-01-01

Full text: With the advent and progress of information technology in the present decade, high-performance networks are being installed in hospitals to implement an effective and reliable Hospital Information Management Systems (HIMS). The Radiation Medicine Centre (RMC), is one of the earliest and largest nuclear medicine centres in India and several thousand patients undergo diagnostic as well as therapeutic procedures with different radiopharmaceuticals. The evolution towards a fully digital department of nuclear medicine is driven by expectations of not only improved patient management but also a well-defined workflow along with prompt and quality patient services. The aim was to develop and set up a practical and utility based Nuclear Medicine Information Management System (NMIMS) for various functional procedures at RMC. A customised NMIMS is developed with M/s ECIL using ASP.NET and SQL server technology facilitated by an IBM x3650 M3 Server, 18 thin-clients/desktop PCs and Windows 2008 server operating system and MS-SQL 2005 server software. The various modules have been developed to meet the requirements of different activities pertaining to patient appointment and scheduling, clinical assessment, radiopharmacy procedures, imaging and non-imaging studies and protocols, in-vitro laboratory tests, in-patient and out-patient treatment procedures, radiation protection and regulatory aspects and other routine operational procedures associated with patient management at RMC. The menus are developed as per scheduled workflow (SWF) in the department. The various aspects of SWF have been designed to ensure smooth, easy and trouble free patient management. Presently, the NMIMS has been developed excluding imaging data and we are in the process of setting up Picture Archiving Communication System (PACS) integrated to the existing database system, which will archive and facilitate imaging data in DICOM format in order to make a paperless department. The developed NMIMS

18F-Fluorocholine PET/CT as a complementary tool in the follow-up of low-grade glioma: diagnostic accuracy and clinical utility

International Nuclear Information System (INIS)

Gomez-Rio, Manuel; Rodriguez-Fernandez, Antonio; Llamas-Elvira, Jose M.; Testart Dardel, Nathalie; Santiago Chinchilla, Alicia; Olivares Granados, Gonzalo; Luque Caro, Raquel; Zurita Herrera, Mercedes; Chamorro Santos, Clara E.; Lardelli-Claret, Pablo

2015-01-01

The follow-up of treated low-grade glioma (LGG) requires the evaluation of subtle clinical changes and MRI results. When the result is inconclusive, additional procedures are required to assist decision-making, such as the use of advanced MRI (aMRI) sequences and nuclear medicine scans (SPECT and PET). The aim of this study was to determine whether incorporating 18 F-fluorocholine PET/CT in the follow-up protocol for treated LGG improves diagnostic accuracy and clinical utility. This was a prospective case-series study in patients with treated LGG during standard follow-up with indeterminate clinical and/or radiological findings of tumour activity. All patients underwent clinical evaluation, aMRI, 201 Tl-SPECT and 18 F-fluorocholine PET/CT. Images were interpreted by visual evaluation complemented with semiquantitative analysis. Between January 2012 and December 2013, 18 patients were included in this study. The final diagnosis was established by histology (five surgical specimens, one biopsy specimen) or by consensus of the Neuro-Oncology Group (11 patients) after a follow-up of >6 months (mean 14.9 ± 2.72 months). The global diagnostic accuracies were 90.9 % for aMRI (38.8 % inconclusive), 69.2 % for 201 Tl-SPECT (11.1 % inconclusive), and 100 % for 18 F-fluorocholine PET/CT. 201 Tl-SPECT led correctly to a change in the initial approach in 38.9 % of patients but might have led to error in 27.8 %. The use of 18 F-fluorocholine PET/CT alone rather than 201 Tl-SPECT led correctly to a change in the approach suggested by routine follow-up in 72.2 % of patients and endorsed the approach in the remaining 27.8 %. Our results support the need to complement structural MRI with aMRI and nuclear medicine procedures in selected patients. 18 F-Fluorocholine PET/CT can be useful in the individualized management of patients with treated LGG with uncertain clinical and/or radiological evidence of tumour activity. (orig.)

Set-up errors in radiotherapy for oesophageal cancers - Is electronic portal imaging or conebeam more accurate?

International Nuclear Information System (INIS)

Hawkins, Maria A.; Aitken, Alexandra; Hansen, Vibeke N.; McNair, Helen A.; Tait, Diana M.

2011-01-01

Purpose: To compare kV computed tomography (CBCT) with electronic portal imaging (EPI) and evaluate set-up variations in the anterior-posterior (AP), right-left (LR) and cranio-caudal (CC) directions and rotational variations: pitch, roll, and yaw, for oesophageal cancer patients treated with radical radiotherapy. Methods and materials: Twenty patients with locally advanced oesophageal cancer treated with chemoradiation were consented for this prospective ethics approved protocol. Patients were positioned using skin marks/tattoos, kV-CBCT scans (XVI) and EPI's were performed prior to treatment and registered to the planning CT scans and digitally reconstructed radiographs, respectively. XVI data was used to adjust patient setups before treatment delivery. A total of 122 EPI pairs and 207 CBCT scans were analysed. The systematic and random errors were calculated. Results: The systematic and random errors (mm) for XVI were 1.3, 1.7, 1.4 and 2.6, 3.9, 2.0 in RL, CC and AP direction, respectively, with EPI of similar magnitude. There was no correlation between the 2 modalities of imaging as 31.7% of all image pairs were discordant >3 mm and 12.5% >5 mm. XVI identified rotations >3 o in 44 images. Conclusions: EPI results in different position correction for verification of radiotherapy in oesophageal malignancies when compared with CBCT. CBCT verification offers adequate 3D volumetric image quality to improve the accuracy of treatment delivery for oesophageal malignancies in radiotherapy and should be used for image guidance.

Residual rotational set-up errors after daily cone-beam CT image guided radiotherapy of locally advanced cervical cancer

International Nuclear Information System (INIS)

Laursen, Louise Vagner; Elstrøm, Ulrik Vindelev; Vestergaard, Anne; Muren, Ludvig P.; Petersen, Jørgen Baltzer; Lindegaard, Jacob Christian; Grau, Cai; Tanderup, Kari

2012-01-01

Purpose: Due to the often quite extended treatment fields in cervical cancer radiotherapy, uncorrected rotational set-up errors result in a potential risk of target miss. This study reports on the residual rotational set-up error after using daily cone beam computed tomography (CBCT) to position cervical cancer patients for radiotherapy treatment. Methods and materials: Twenty-five patients with locally advanced cervical cancer had daily CBCT scans (650 CBCTs in total) prior to treatment delivery. We retrospectively analyzed the translational shifts made in the clinic prior to each treatment fraction as well as the residual rotational errors remaining after translational correction. Results: The CBCT-guided couch movement resulted in a mean translational 3D vector correction of 7.4 mm. Residual rotational error resulted in a target shift exceeding 5 mm in 57 of the 650 treatment fractions. Three patients alone accounted for 30 of these fractions. Nine patients had no shifts exceeding 5 mm and 13 patients had 5 or less treatment fractions with such shifts. Conclusion: Twenty-two of the 25 patients have none or few treatment fractions with target shifts larger than 5 mm due to residual rotational error. However, three patients display a significant number of shifts suggesting a more systematic set-up error.

Setting up crowd science projects.

Science.gov (United States)

Scheliga, Kaja; Friesike, Sascha; Puschmann, Cornelius; Fecher, Benedikt

2016-11-29

Crowd science is scientific research that is conducted with the participation of volunteers who are not professional scientists. Thanks to the Internet and online platforms, project initiators can draw on a potentially large number of volunteers. This crowd can be involved to support data-rich or labour-intensive projects that would otherwise be unfeasible. So far, research on crowd science has mainly focused on analysing individual crowd science projects. In our research, we focus on the perspective of project initiators and explore how crowd science projects are set up. Based on multiple case study research, we discuss the objectives of crowd science projects and the strategies of their initiators for accessing volunteers. We also categorise the tasks allocated to volunteers and reflect on the issue of quality assurance as well as feedback mechanisms. With this article, we contribute to a better understanding of how crowd science projects are set up and how volunteers can contribute to science. We suggest that our findings are of practical relevance for initiators of crowd science projects, for science communication as well as for informed science policy making. © The Author(s) 2016.

An adaptive control algorithm for optimization of intensity modulated radiotherapy considering uncertainties in beam profiles, patient set-up and internal organ motion

International Nuclear Information System (INIS)

Loef, Johan; Lind, Bengt K.; Brahme, Anders

1998-01-01

A new general beam optimization algorithm for inverse treatment planning is presented. It utilizes a new formulation of the probability to achieve complication-free tumour control. The new formulation explicitly describes the dependence of the treatment outcome on the incident fluence distribution, the patient geometry, the radiobiological properties of the patient and the fractionation schedule. In order to account for both measured and non-measured positioning uncertainties, the algorithm is based on a combination of dynamic and stochastic optimization techniques. Because of the difficulty in measuring all aspects of the intra- and interfractional variations in the patient geometry, such as internal organ displacements and deformations, these uncertainties are primarily accounted for in the treatment planning process by intensity modulation using stochastic optimization. The information about the deviations from the nominal fluence profiles and the nominal position of the patient relative to the beam that is obtained by portal imaging during treatment delivery, is used in a feedback loop to automatically adjust the profiles and the location of the patient for all subsequent treatments. Based on the treatment delivered in previous fractions, the algorithm furnishes optimal corrections for the remaining dose delivery both with regard to the fluence profile and its position relative to the patient. By dynamically refining the beam configuration from fraction to fraction, the algorithm generates an optimal sequence of treatments that very effectively reduces the influence of systematic and random set-up uncertainties to minimize and almost eliminate their overall effect on the treatment. Computer simulations have shown that the present algorithm leads to a significant increase in the probability of uncomplicated tumour control compared with the simple classical approach of adding fixed set-up margins to the internal target volume. (author)

Implementation of the European multicentre database of healthy controls for [123I]FP-CIT SPECT increases diagnostic accuracy in patients with clinically uncertain parkinsonian syndromes

International Nuclear Information System (INIS)

Albert, Nathalie L.; Unterrainer, Marcus; Xiong, Guoming; Bartenstein, Peter; Koch, Walter; Diemling, Markus; Varrone, Andrea; Dickson, John C.; Tossici-Bolt, Livia; Sera, Terez; Asenbaum, Susanne; Booij, Jan; Kapucu, L. Oezlem A.; Kluge, Andreas; Ziebell, Morten; Darcourt, Jacques; Nobili, Flavio; Pagani, Marco; Sabri, Osama; Hesse, Swen; Borght, Thierry vander; Laere, Koen van; Tatsch, Klaus; La Fougere, Christian

2016-01-01

Even though [ 123 I]FP-CIT SPECT provides high accuracy in detecting nigrostriatal cell loss in neurodegenerative parkinsonian syndromes (PS), some patients with an inconclusive diagnosis remain. We investigated whether the diagnostic accuracy in patients with clinically uncertain PS with previously inconclusive findings can be improved by the use of iterative reconstruction algorithms and an improved semiquantitative evaluation which additionally implemented a correction algorithm for patient age and gamma camera dependency (EARL-BRASS; Hermes Medical Solutions, Sweden). We identified 101 patients with inconclusive findings who underwent an [ 123 I]FP-CIT SPECT between 2003 and 2010 as part of the diagnostic process of suspected PS at the University of Munich, and re-evaluated these scans using iterative reconstruction algorithms and the new corrected EARL-BRASS. Clinical follow-up was obtained in 62 out of the 101 patients and constituted the gold standard for the re-evaluation to assess the possible improvement in diagnostic accuracy. Clinical follow-up confirmed the diagnosis of PS in 11 of the 62 patients. In patients in whom both visual and semiquantitative analysis showed concordant findings (48 patients), a high negative predictive value (93 %), positive predictive value (100 %) and accuracy (94 %) were found, and thus a correct diagnosis was obtained in 45 of the 48 patients. Among the 14 patients with discordant findings, the additional semiquantitative analysis correctly identified all five of nine patients patients without PS by nonpathological semiquantitative findings in visually pathological or inconclusive scans. In contrast, four of the remaining five patients with decreased semiquantitative values but visually normal scans did not show a PS during follow-up. The age-corrected and camera-corrected mode of evaluation using EARL-BRASS provided a notable improvement in the diagnostic accuracy of [ 123 I]FP-CIT SPECT in PS patients with previously

{sup 18}F-Fluorocholine PET/CT as a complementary tool in the follow-up of low-grade glioma: diagnostic accuracy and clinical utility

Energy Technology Data Exchange (ETDEWEB)

Gomez-Rio, Manuel; Rodriguez-Fernandez, Antonio; Llamas-Elvira, Jose M. [Instituto de Investigacion Biosanitaria de Granada, Granada (Spain); University Hospital ' ' Virgen de las Nieves' ' , Department of Nuclear Medicine, Granada (Spain); Testart Dardel, Nathalie [University Hospital ' ' Virgen de las Nieves' ' , Department of Nuclear Medicine, Granada (Spain); Santiago Chinchilla, Alicia [University Hospital ' ' Virgen de las Nieves' ' , Department of Radiology, Granada (Spain); Olivares Granados, Gonzalo [University Hospital ' ' Virgen de las Nieves' ' , Department of Neurosurgery, Granada (Spain); Luque Caro, Raquel [University Hospital ' ' Virgen de las Nieves' ' , Department of Medical Oncology, Granada (Spain); Zurita Herrera, Mercedes [University Hospital ' ' Virgen de las Nieves' ' , Department of Radiotherapy Oncology, Granada (Spain); Chamorro Santos, Clara E. [University Hospital ' ' Virgen de las Nieves' ' , Department of Pathology, Granada (Spain); Lardelli-Claret, Pablo [Instituto de Investigacion Biosanitaria de Granada, Granada (Spain); Centros de Investigacion Biomedica en Red de Epidemiologia y Salud Publica (CIBERESP), Granada (Spain); University of Granada, Department of Preventive Medicine and Public Health, School of Medicine, Granada (Spain)

2015-05-01

The follow-up of treated low-grade glioma (LGG) requires the evaluation of subtle clinical changes and MRI results. When the result is inconclusive, additional procedures are required to assist decision-making, such as the use of advanced MRI (aMRI) sequences and nuclear medicine scans (SPECT and PET). The aim of this study was to determine whether incorporating {sup 18}F-fluorocholine PET/CT in the follow-up protocol for treated LGG improves diagnostic accuracy and clinical utility. This was a prospective case-series study in patients with treated LGG during standard follow-up with indeterminate clinical and/or radiological findings of tumour activity. All patients underwent clinical evaluation, aMRI, {sup 201}Tl-SPECT and {sup 18}F-fluorocholine PET/CT. Images were interpreted by visual evaluation complemented with semiquantitative analysis. Between January 2012 and December 2013, 18 patients were included in this study. The final diagnosis was established by histology (five surgical specimens, one biopsy specimen) or by consensus of the Neuro-Oncology Group (11 patients) after a follow-up of >6 months (mean 14.9 ± 2.72 months). The global diagnostic accuracies were 90.9 % for aMRI (38.8 % inconclusive), 69.2 % for {sup 201}Tl-SPECT (11.1 % inconclusive), and 100 % for {sup 18}F-fluorocholine PET/CT. {sup 201}Tl-SPECT led correctly to a change in the initial approach in 38.9 % of patients but might have led to error in 27.8 %. The use of {sup 18}F-fluorocholine PET/CT alone rather than {sup 201}Tl-SPECT led correctly to a change in the approach suggested by routine follow-up in 72.2 % of patients and endorsed the approach in the remaining 27.8 %. Our results support the need to complement structural MRI with aMRI and nuclear medicine procedures in selected patients. {sup 18}F-Fluorocholine PET/CT can be useful in the individualized management of patients with treated LGG with uncertain clinical and/or radiological evidence of tumour activity. (orig.)

Accuracy and outcome of rapid ultrasound in shock and hypotension (RUSH) in Egyptian polytrauma patients.

Science.gov (United States)

Elbaih, Adel Hamed; Housseini, Ahmed Mohamed; Khalifa, Mohamed E M

2018-03-26

"Polytrauma" patients are of a higher risk of complications and death than the summation of expected mortality and morbidity of their individual injuries. The ideal goal in trauma resuscitation care is to identify and treat all injuries. With clinical and technological advanced imaging available for diagnosis and treatment of traumatic patients, point of care-rapid ultrasound in shock and hypotension (RUSH) significantly affects modern trauma services and patient outcomes. This study aims to evaluate the accuracy of RUSH and patient outcomes by early detection of the causes of unstable polytrauma. This cross-sectional, prospective study included 100 unstable polytrauma patients admitted in Suez Canal University Hospital. Clinical exam, RUSH and pan-computed tomography (pan-CT) were conducted. The result of CT was taken as the standard. Patients were managed according to the advanced trauma life support (ATLS) guidelines and treated of life threatening conditions if present. Patients were followed up for 28 days for a short outcome. The most diagnostic causes of unstability in polytrauma patients by RUSH are hypovolemic shock (64%), followed by obstructive shock (14%), distributive shock (12%) and cardiogenic shock (10%) respectively. RUSH had 94.2% sensitivity in the diagnosis of unstable polytrauma patients; the accuracy of RUSH in shock patients was 95.2%. RUSH is accurate in the diagnosis of unstable polytrauma patients; and 4% of patients were diagnosed during follow-up after admission by RUSH and pan-CT. Copyright © 2018 Daping Hospital and the Research Institute of Surgery of the Third Military Medical University. Production and hosting by Elsevier B.V. All rights reserved.

A comparative study of set up variations and bowel volumes in supine versus prone positions of patients treated with external beam radiation for carcinoma rectum.

Science.gov (United States)

Rajeev, K R; Menon, Smrithy S; Beena, K; Holla, Raghavendra; Kumar, R Rajaneesh; Dinesh, M

2014-01-01

A prospective study was undertaken to evaluate the influence of patient positioning on the set up variations to determine the planning target volume (PTV) margins and to evaluate the clinical relevance volume assessment of the small bowel (SB) within the irradiated volume. During the period of months from December 2011 to April 2012, a computed tomography (CT) scan was done either in supine position or in prone position using a belly board (BB) for 20 consecutive patients. All the patients had histologically proven rectal cancer and received either post- or pre-operative pelvic irradiation. Using a three-dimensional planning system, the dose-volume histogram for SB was defined in each axial CT slice. Total dose was 46-50 Gy (2 Gy/fraction), delivered using the 4-field box technique. The set up variation of the study group was assessed from the data received from the electronic portal imaging device in the linear accelerator. The shift along X, Y, and Z directions were noted. Both systematic and random errors were calculated and using both these values the PTV margin was calculated. The systematic errors of patients treated in the supine position were 0.87 (X-mm), 0.66 (Y-mm), 1.6 (Z-mm) and in the prone position were 1.3 (X-mm), 0.59 (Y-mm), 1.17 (Z-mm). The random errors of patients treated in the supine positions were 1.81 (X-mm), 1.73 (Y-mm), 1.83 (Z-mm) and in prone position were 2.02 (X-mm), 1.21 (Y-mm), 3.05 (Z-mm). The calculated PTV margins in the supine position were 3.45 (X-mm), 2.87 (Y-mm), 5.31 (Z-mm) and in the prone position were 4.91 (X-mm), 2.32 (Y-mm), 5.08 (Z-mm). The mean volume of the peritoneal cavity was 648.65 cm 3 in the prone position and 1197.37 cm 3 in the supine position. The prone position using BB device was more effective in reducing irradiated SB volume in rectal cancer patients. There were no significant variations in the daily set up for patients treated in both supine and prone positions.

Electronic Detection of Delayed Test Result Follow-Up in Patients with Hypothyroidism.

Science.gov (United States)

Meyer, Ashley N D; Murphy, Daniel R; Al-Mutairi, Aymer; Sittig, Dean F; Wei, Li; Russo, Elise; Singh, Hardeep

2017-07-01

Delays in following up abnormal test results are a common problem in outpatient settings. Surveillance systems that use trigger tools to identify delayed follow-up can help reduce missed opportunities in care. To develop and test an electronic health record (EHR)-based trigger algorithm to identify instances of delayed follow-up of abnormal thyroid-stimulating hormone (TSH) results in patients being treated for hypothyroidism. We developed an algorithm using structured EHR data to identify patients with hypothyroidism who had delayed follow-up (>60 days) after an abnormal TSH. We then retrospectively applied the algorithm to a large EHR data warehouse within the Department of Veterans Affairs (VA), on patient records from two large VA networks for the period from January 1, 2011, to December 31, 2011. Identified records were reviewed to confirm the presence of delays in follow-up. During the study period, 645,555 patients were seen in the outpatient setting within the two networks. Of 293,554 patients with at least one TSH test result, the trigger identified 1250 patients on treatment for hypothyroidism with elevated TSH. Of these patients, 271 were flagged as potentially having delayed follow-up of their test result. Chart reviews confirmed delays in 163 of the 271 flagged patients (PPV = 60.1%). An automated trigger algorithm applied to records in a large EHR data warehouse identified patients with hypothyroidism with potential delays in thyroid function test results follow-up. Future prospective application of the TSH trigger algorithm can be used by clinical teams as a surveillance and quality improvement technique to monitor and improve follow-up.

French scientists offered time to set up companies

CERN Document Server

Butler, D

1999-01-01

The French minister of national education, research and technology announced that French researchers working for public research institutes and universities are to be offered up to six years sabbatical leave to set up their own companies (11 para)

Standard guidelines for setting up a dermatosurgery theatre

Directory of Open Access Journals (Sweden)

Rajendran S

2009-08-01

Full Text Available Introduction, definition, rationale and scope: Dermatologists in India are now increasingly performing surgical and cosmetic procedures in their practice. This calls for minimum standards at the national level with the main focus of patient safety and hence the guidelines for setting up a dermatosurgical theatre. Facility: The dermatosurgery theatre can be created in either physician′s clinic, or a hospital depending on the procedure to be performed. The dermatosurgery theatre requires careful planning with regards to - location, dimension, shell design, lighting, electrical requirements, operation table, chair, trolley, surgical instruments, sterilization of devices, asepsis and advanced life support. Apart from physical considerations, other considerations including theatre etiquettes, consent for surgery, safety of dermatosurgeon, theatre staff and lastly biomedical waste management should be looked into. These issues are discussed in detail in the recommendations.

Accuracy of three Android-based pedometer applications in laboratory and free-living settings.

Science.gov (United States)

Leong, Jia Yan; Wong, Jyh Eiin

2017-01-01

This study examines the accuracy of three popular, free Android-based pedometer applications (apps), namely, Runtastic (RT), Pacer Works (PW), and Tayutau (TY) in laboratory and free-living settings. Forty-eight adults (22.5 ± 1.4 years) completed 3-min bouts of treadmill walking at five incremental speeds while carrying a test smartphone installed with the three apps. Experiment was repeated thrice, with the smartphone placed either in the pants pockets, at waist level, or secured to the left arm by an armband. The actual step count was manually counted by a tally counter. In the free-living setting, each of the 44 participants (21.9 ± 1.6 years) carried a smartphone with installed apps and a reference pedometer (Yamax Digi-Walker CW700) for 7 consecutive days. Results showed that TY produced the lowest mean absolute percent error (APE 6.7%) and was the only app with acceptable accuracy in counting steps in a laboratory setting. RT consistently underestimated steps with APE of 16.8% in the laboratory. PW significantly underestimated steps when the smartphone was secured to the arm, but overestimated under other conditions (APE 19.7%). TY was the most accurate app in counting steps in a laboratory setting with the lowest APE of 6.7%. In the free-living setting, the APE relative to the reference pedometer was 16.6%, 18.0%, and 16.8% for RT, PW, and TY, respectively. None of the three apps counted steps accurately in the free-living setting.

Implementation of the European multicentre database of healthy controls for [{sup 123}I]FP-CIT SPECT increases diagnostic accuracy in patients with clinically uncertain parkinsonian syndromes

Energy Technology Data Exchange (ETDEWEB)

Albert, Nathalie L.; Unterrainer, Marcus; Xiong, Guoming; Bartenstein, Peter; Koch, Walter [University of Munich, Department of Nuclear Medicine, Munich (Germany); Diemling, Markus [Hermes Medical Solutions, Stockholm (Sweden); Varrone, Andrea [Karolinska University Hospital, Karolinska Institutet, Department of Clinical Neuroscience, Centre for Psychiatry Research, Stockholm (Sweden); Dickson, John C. [UCLH NHS Foundation Trust and University College, Institute of Nuclear Medicine, London (United Kingdom); Tossici-Bolt, Livia [University Hospitals Southampton NHS Trust, Department of Medical Physics, Southampton (United Kingdom); Sera, Terez [University of Szeged, Department of Nuclear Medicine and Euromedic Szeged, Szeged (Hungary); Asenbaum, Susanne [Medical University of Vienna, Department of Neurology, Vienna (Austria); Booij, Jan [University of Amsterdam, Department of Nuclear Medicine, Academic Medical Centre, Amsterdam (Netherlands); Kapucu, L. Oezlem A. [Gazi University, Department of Nuclear Medicine, Faculty of Medicine, Ankara (Turkey); Kluge, Andreas [ABX-CRO, Dresden (Germany); Ziebell, Morten [Rigshospitalet and University of Copenhagen, Neurobiology Research Unit, Copenhagen (Denmark); Darcourt, Jacques [University of Nice-Sophia Antipolis, Nuclear Medicine Department, Centre Antoine Lacassagne, Nice (France); Nobili, Flavio [University of Genoa, Clinical Neurology Unit, Department of Neuroscience (DINOGMI), Genoa (Italy); Pagani, Marco [Institute of Cognitive Sciences and Technologies, CNR, Rome (Italy); Karolinska Hospital, Department of Nuclear medicine, Stockholm (Sweden); Sabri, Osama [University of Leipzig, Department of Nuclear Medicine, Leipzig (Germany); Hesse, Swen [University of Leipzig, Department of Nuclear Medicine, Leipzig (Germany); Leipzig University Medical Centre, Molecular Neuroimaging IFB Adiposity Diseases, Leipzig (Germany); Borght, Thierry vander [Universite Catholique de Louvain, Nuclear Medicine Division, Mont-Godinne Medical Center, Yvoir (Belgium); Laere, Koen van [University Hospital and K.U. Leuven, Nuclear Medicine, Leuven (Belgium); Tatsch, Klaus [Staedtisches Klinikum Karlsruhe, Department of Nuclear Medicine, Karlsruhe (Germany); La Fougere, Christian [University of Tuebingen, Division of Nuclear Medicine, Department of Radiology, Tuebingen (Germany)

2016-07-15

Even though [{sup 123}I]FP-CIT SPECT provides high accuracy in detecting nigrostriatal cell loss in neurodegenerative parkinsonian syndromes (PS), some patients with an inconclusive diagnosis remain. We investigated whether the diagnostic accuracy in patients with clinically uncertain PS with previously inconclusive findings can be improved by the use of iterative reconstruction algorithms and an improved semiquantitative evaluation which additionally implemented a correction algorithm for patient age and gamma camera dependency (EARL-BRASS; Hermes Medical Solutions, Sweden). We identified 101 patients with inconclusive findings who underwent an [{sup 123}I]FP-CIT SPECT between 2003 and 2010 as part of the diagnostic process of suspected PS at the University of Munich, and re-evaluated these scans using iterative reconstruction algorithms and the new corrected EARL-BRASS. Clinical follow-up was obtained in 62 out of the 101 patients and constituted the gold standard for the re-evaluation to assess the possible improvement in diagnostic accuracy. Clinical follow-up confirmed the diagnosis of PS in 11 of the 62 patients. In patients in whom both visual and semiquantitative analysis showed concordant findings (48 patients), a high negative predictive value (93 %), positive predictive value (100 %) and accuracy (94 %) were found, and thus a correct diagnosis was obtained in 45 of the 48 patients. Among the 14 patients with discordant findings, the additional semiquantitative analysis correctly identified all five of nine patients patients without PS by nonpathological semiquantitative findings in visually pathological or inconclusive scans. In contrast, four of the remaining five patients with decreased semiquantitative values but visually normal scans did not show a PS during follow-up. The age-corrected and camera-corrected mode of evaluation using EARL-BRASS provided a notable improvement in the diagnostic accuracy of [{sup 123}I]FP-CIT SPECT in PS patients with

Installing and Setting Up Git Software Tool on Windows | High-Performance

Science.gov (United States)

Computing | NREL Git Software Tool on Windows Installing and Setting Up Git Software Tool on Windows Learn how to set up the Git software tool on Windows for use with the Peregrine system. Git is this doc, we'll show you how to get git installed on Windows 7, and how to get things set up on NREL's

Influence of different process settings conditions on the accuracy of micro injection molding simulations: an experimental validation

DEFF Research Database (Denmark)

Tosello, Guido; Gava, Alberto; Hansen, Hans Nørgaard

2009-01-01

Currently available software packages exhibit poor results accuracy when performing micro injection molding (µIM) simulations. However, with an appropriate set-up of the processing conditions, the quality of results can be improved. The effects on the simulation results of different and alternative...... process conditions are investigated, namely the nominal injection speed, as well as the cavity filling time and the evolution of the cavity injection pressure as experimental data. In addition, the sensitivity of the results to the quality of the rheological data is analyzed. Simulated results...... are compared with experiments in terms of flow front position at part and micro features levels, as well as cavity injection filling time measurements....

Evaluation of different set-up error corrections on dose-volume metrics in prostate IMRT using CBCT images

International Nuclear Information System (INIS)

Hirose, Yoshinori; Tomita, Tsuneyuki; Kitsuda, Kenji; Notogawa, Takuya; Miki, Katsuhito; Nakamura, Mitsuhiro; Nakamura, Kiyonao; Ishigaki, Takashi

2014-01-01

We investigated the effect of different set-up error corrections on dose-volume metrics in intensity-modulated radiotherapy (IMRT) for prostate cancer under different planning target volume (PTV) margin settings using cone-beam computed tomography (CBCT) images. A total of 30 consecutive patients who underwent IMRT for prostate cancer were retrospectively analysed, and 7-14 CBCT datasets were acquired per patient. Interfractional variations in dose-volume metrics were evaluated under six different set-up error corrections, including tattoo, bony anatomy, and four different target matching groups. Set-up errors were incorporated into planning the isocenter position, and dose distributions were recalculated on CBCT images. These processes were repeated under two different PTV margin settings. In the on-line bony anatomy matching groups, systematic error (Σ) was 0.3 mm, 1.4 mm, and 0.3 mm in the left-right, anterior-posterior (AP), and superior-inferior directions, respectively. Σ in three successive off-line target matchings was finally comparable with that in the on-line bony anatomy matching in the AP direction. Although doses to the rectum and bladder wall were reduced for a small PTV margin, averaged reductions in the volume receiving 100% of the prescription dose from planning were within 2.5% under all PTV margin settings for all correction groups, with the exception of the tattoo set-up error correction only (≥ 5.0%). Analysis of variance showed no significant difference between on-line bony anatomy matching and target matching. While variations between the planned and delivered doses were smallest when target matching was applied, the use of bony anatomy matching still ensured the planned doses. (author)

Characterization of n-heptane as a single component Diesel surrogate fuel. EHPC test set-up implementation

Energy Technology Data Exchange (ETDEWEB)

Meijer, M.

2010-06-15

The availability of accurately measured fuel properties, during an injection event under engine relevant conditions is critical within the surrogate fuel approach. There is a need to perform in-house measurements in order to validate developed and new models. A well defined and accurately measured data-set will facilitate on-going work for sophisticated engine related in-cylinder combustion modeling. In this work pure n-heptane fuel is used as a single component surrogate fuel and is studied in a high-pressure constant volume optical test set-up. N-heptane is often used as a single component surrogate diesel fuel since it has a comparable Cetane number as European diesel. Detailed chemical-kinetic mechanisms for low-, intermediate-, and high-temperature n-heptane oxidation are available and several models exist that have sufficiently reduced dimensionality (number of species and reactions) to enable their use in CFD (Computational Fluid Mechanics) simulations. This report discusses the route and implementation to perform such an accurate and relevant n-heptane measurement series. The aim is to combine the efforts of earlier presented EHPC (Eindhoven High Pressure Cell) related work and new approaches, into the proposed surrogate fuel measurement series. The following aspects, related to the applied constant volume combustion chamber set-up, are studied and implemented: Extending the operating ranges towards relevant engine conditions; Study the accuracy and sensitivities of the different measurement steps; Implementing different optical diagnostic principles; and Implement a standardized and robust post processing routine. The different optical diagnostic principles used in this work are: high-speed Schlieren, Mie scattering and beginnings are made to implement a simultaneous LII LIF (Laser Induced Incandescence - Laser Induced Fluorescence) set-up using a new ICCD (Intensified Charge Coupled Device) camera with dual imaging feature. Combining the different

A fuzzy set approach to assess the predictive accuracy of land use simulations

NARCIS (Netherlands)

van Vliet, J.; Hagen-Zanker, A.; Hurkens, J.; van van Delden, H.

2013-01-01

The predictive accuracy of land use models is frequently assessed by comparing two data sets: the simulated land use map and the observed land use map at the end of the simulation period. A common statistic for this is Kappa, which expresses the agreement between two categorical maps, corrected for

VITEX 2016 : Evaluation of learning objectives and exercise set-up

NARCIS (Netherlands)

Rijk, R. van; Stubbé-Alberts, H.E.

2016-01-01

To strengthen awareness of the need for cooperation, between public and private partners, and between countries, a new exercise set-up was developed. The VITEX exercise set-up is a table top exercise that aims to bring relevant networks together, and supports cooperation and collaboration between

Accuracy and Consistency of Respiratory Gating in Abdominal Cancer Patients

International Nuclear Information System (INIS)

Ge, Jiajia; Santanam, Lakshmi; Yang, Deshan; Parikh, Parag J.

2013-01-01

Purpose: To evaluate respiratory gating accuracy and intrafractional consistency for abdominal cancer patients treated with respiratory gated treatment on a regular linear accelerator system. Methods and Materials: Twelve abdominal patients implanted with fiducials were treated with amplitude-based respiratory-gated radiation therapy. On the basis of daily orthogonal fluoroscopy, the operator readjusted the couch position and gating window such that the fiducial was within a setup margin (fiducial-planning target volume [f-PTV]) when RPM indicated “beam-ON.” Fifty-five pre- and post-treatment fluoroscopic movie pairs with synchronized respiratory gating signal were recorded. Fiducial motion traces were extracted from the fluoroscopic movies using a template matching algorithm and correlated with f-PTV by registering the digitally reconstructed radiographs with the fluoroscopic movies. Treatment was determined to be “accurate” if 50% of the fiducial area stayed within f-PTV while beam-ON. For movie pairs that lost gating accuracy, a MATLAB program was used to assess whether the gating window was optimized, the external-internal correlation (EIC) changed, or the patient moved between movies. A series of safety margins from 0.5 mm to 3 mm was added to f-PTV for reassessing gating accuracy. Results: A decrease in gating accuracy was observed in 44% of movie pairs from daily fluoroscopic movies of 12 abdominal patients. Three main causes for inaccurate gating were identified as change of global EIC over time (∼43%), suboptimal gating setup (∼37%), and imperfect EIC within movie (∼13%). Conclusions: Inconsistent respiratory gating accuracy may occur within 1 treatment session even with a daily adjusted gating window. To improve or maintain gating accuracy during treatment, we suggest using at least a 2.5-mm safety margin to account for gating and setup uncertainties

Clinical value of FDG-PET in the follow up of post-operative patients with endometrial cancer

International Nuclear Information System (INIS)

Saga, Tsuneo; Higashi, Tatsuya; Ishimori, Takayoshi

2003-01-01

The clinical usefulness of FDG-PET in the follow up of post-operative patients with endometrial cancer was retrospectively evaluated. Twenty-one post-operative patients with endometrial cancer received 30 FDG-PET examinations to evaluate recurrence or response to treatment. The findings of FDG-PET were compared with their serum levels of tumor markers, CT and/or MRI findings, and the final outcome. Results of FDG-PET were also correlated with the clinical course of each patient. In detecting recurrent lesions and evaluating treatment responses, FDG-PET, with the help in anatomic information by CT/MRI, showed better diagnostic ability (sensitivity 100.0%, specificity 88.2%, accuracy 93.3%) compared with combined conventional imaging (sensitivity 84.6%, specificity 85.7%, accuracy 85.0%) and tumor markers (sensitivity 100.0%, specificity 70.6%, accuracy 83.3%). FDG-PET had no false-negative results, suggesting the possibility of its use as the first-line examination in a patient's follow-up. FDG-PET could detect unknown lesions in 4 cases, and, as reported for other malignancies, FDG-PET affected the patient management in one-third of the cases. Furthermore, the results of FDG-PET correlated well with the clinical outcome of the patients, with patients with negative PET results tending to show disease-free courses. These results suggest that, despite the limited number of patients studied, FDG-PET was accurate in detecting recurrence and evaluating therapeutic response, and could afford important information in the management of post-operative patients with endometrial cancer. FDG-PET also appeared to have a possibility to predict the outcome of each patient. (author)

Diagnostic Accuracy of Nonmydriatic Fundus Photography for the Detection of Glaucoma in Diabetic Patients

Directory of Open Access Journals (Sweden)

Francisco J. Muñoz-Negrete

2015-01-01

Full Text Available Purpose. To determine the diagnostic accuracy for glaucoma of a set of criteria with nonmydriatic monoscopic fundus photography (NMFP in diabetics. Methods. Diabetics recruited from a screening program for diabetic retinopathy and diabetic glaucoma patients recruited from our glaucoma unit were included. Any patient with evidence of diabetic retinopathy was excluded. Diabetic patients had to have no visual field defects to be included as controls. Glaucoma patients had to have a glaucomatous field defect in at least one eye to be included. One NMFP was taken per eye for all subjects. These photographs were evaluated by two masked glaucoma specialists for the presence of the following: bilateral cup to disc (C/D ratio ≥0.6, notching or thinning of the neuroretinal rim, disc hemorrhages, and asymmetry in the C/D ratio between both eyes ≥0.2. This evaluation led to a dichotomous classification: if any of the above criteria was present, the patient was classified as glaucoma. If none were present, the patient was classified as normal. Results. 72 control subjects and 72 glaucoma patients were included. Evaluation of NMFP had a sensitivity of 79.17% and a specificity of 80.56% for specialist 1 and a sensitivity of 72.22% and a specificity of 88.88% for specialist 2 for the detection of glaucoma. The overall accuracy was 79.83% and 80.55%, respectively. Discussion. NMFP evaluation by a glaucoma specialist may be useful for the detection of glaucoma in diabetics.

The Impact of use of Double Set-up on Infection Rates in Revision Total Knee Replacement and Limb Salvage Procedures

Directory of Open Access Journals (Sweden)

Jennifer Waterman

2015-03-01

Full Text Available A retrospective analysis was performed to determine the impact of utilizing a double set-up procedure on reducing infection rates revision total knee and limb salvage procedures in patients with known joint infection.  Eighteen cases fit selection criteria.  The recurrence rate of infection was 5.5% which is less than reported recent literature review.   This suggests the use of a double set-up in combination with other infection reducing protocols may help further reduce recurrent infection.  Keywords: double set-up, infection, revision total knee arthroplasty, limb-salvage

Radiotherapy for breast cancer: respiratory and set-up uncertainties

International Nuclear Information System (INIS)

Saliou, M.G.; Giraud, P.; Simon, L.; Fournier-Bidoz, N.; Fourquet, A.; Dendale, R.; Rosenwald, J.C.; Cosset, J.M.

2005-01-01

Adjuvant Radiotherapy has been shown to significantly reduce locoregional recurrence but this advantage is associated with increased cardiovascular and pulmonary morbidities. All uncertainties inherent to conformal radiation therapy must be identified in order to increase the precision of treatment; misestimation of these uncertainties increases the potential risk of geometrical misses with, as a consequence, under-dosage of the tumor and/or overdosage of healthy tissues. Geometric uncertainties due to respiratory movements or set-up errors are well known. Two strategies have been proposed to limit their effect: quantification of these uncertainties, which are then taken into account in the final calculation of safety margins and/or reduction of respiratory and set-up uncertainties by an efficient immobilization or gating systems. Measured on portal films with two tangential fields. CLD (central lung distance), defined as the distance between the deep field edge and the interior chest wall at the central axis, seems to be the best predictor of set-up uncertainties. Using CLD, estimated mean set-up errors from the literature are 3.8 and 3.2 mm for the systematic and random errors respectively. These depend partly on the type of immobilization device and could be reduced by the use of portal imaging systems. Furthermore, breast is mobile during respiration with motion amplitude as high as 0.8 to 10 mm in the anteroposterior direction. Respiratory gating techniques, currently on evaluation, have the potential to reduce effect of these movements. Each radiotherapy department should perform its own assessments and determine the geometric uncertainties with respect of the equipment used and its particular treatment practices. This paper is a review of the main geometric uncertainties in breast treatment, due to respiration and set-up, and solutions proposed to limit their impact. (author)

Automotive RF immunity test set-up analysis

NARCIS (Netherlands)

Coenen, M.J.; Pues, H.; Bousquet, T.; Gillon, R.; Gielen, G.; Baric, A.

2011-01-01

Though the automotive RF emission and RF immunity requirements are highly justifiable, the application of those requirements in an non-intended manner leads to false conclusions and unnecessary redesigns for the electronics involved. When the test results become too dependent upon the test set-up

The value of follow-up FDG-PET/CT in the management and prognosis of patients with HPV-positive oropharyngeal squamous cell carcinoma

International Nuclear Information System (INIS)

Taghipour, Mehdi; Marcus, Charles; Califano, Joseph; Fakhry, Carole; Subramaniam, Rathan M.

2015-01-01

To establish the accuracy of follow-up fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT and the impact of FDG PET/CT result on management decisions and patient outcome prediction (overall and progression free survival) in human papilloma virus (HPV)-positive oropharyngeal squamous cell carcinoma (SCC). We included 96 HPV-positive oropharyngeal SCC (OPSCC) patients with 254 follow-up PET/CT scans in the study. The PET/CT result accuracy was established with histopathology or 6-month clinical follow-up as reference standard. The impact on change in management was established for each follow-up PET/CT scan. Overall survival was evaluated using Kaplan–Meier plots with a Log-rank test. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the follow-up FDG-PET/CT were 97.0%, 92.5%, 67.0%, 99.5% and 93.1%, respectively. Follow-up PET/CT results were helpful in excluding tumour in 22% (9/41) of scans performed with prior clinical suspicion of disease and identified potential disease in 9.9% (21/213) scans performed without prior clinical suspicion. There was a change in management after 12.6% (32/254) scans. In 84.3% (214/254) scans, the patients were either observed or the same treatment was continued. The overall survival differed significantly between patients with a negative versus positive follow-up scan (log rank P < 0.001). The median progression free survival was 28 months, if the first follow-up scan performed within 6–12 months post-treatment completion was negative. Follow-up FDG PET/CT scans have an impact on the management plan and add value to clinical assessment in patients with HPV-positive OPSCC.

Improved diagnostic accuracy of Alzheimer's disease by combining regional cortical thickness and default mode network functional connectivity: Validated in the Alzheimer's disease neuroimaging initiative set

International Nuclear Information System (INIS)

Park, Ji Eun; Park, Bum Woo; Kim, Sang Joon; Kim, Ho Sung; Choi, Choong Gon; Jung, Seung Jung; Oh, Joo Young; Shim, Woo Hyun; Lee, Jae Hong; Roh, Jee Hoon

2017-01-01

To identify potential imaging biomarkers of Alzheimer's disease by combining brain cortical thickness (CThk) and functional connectivity and to validate this model's diagnostic accuracy in a validation set. Data from 98 subjects was retrospectively reviewed, including a study set (n = 63) and a validation set from the Alzheimer's Disease Neuroimaging Initiative (n = 35). From each subject, data for CThk and functional connectivity of the default mode network was extracted from structural T1-weighted and resting-state functional magnetic resonance imaging. Cortical regions with significant differences between patients and healthy controls in the correlation of CThk and functional connectivity were identified in the study set. The diagnostic accuracy of functional connectivity measures combined with CThk in the identified regions was evaluated against that in the medial temporal lobes using the validation set and application of a support vector machine. Group-wise differences in the correlation of CThk and default mode network functional connectivity were identified in the superior temporal (p < 0.001) and supramarginal gyrus (p = 0.007) of the left cerebral hemisphere. Default mode network functional connectivity combined with the CThk of those two regions were more accurate than that combined with the CThk of both medial temporal lobes (91.7% vs. 75%). Combining functional information with CThk of the superior temporal and supramarginal gyri in the left cerebral hemisphere improves diagnostic accuracy, making it a potential imaging biomarker for Alzheimer's disease

An evaluation system of the setting up of predictive maintenance programmes

International Nuclear Information System (INIS)

Carnero, MaCarmen

2006-01-01

Predictive Maintenance can provide an increase in safety, quality and availability in industrial plants. However, the setting up of a Predictive Maintenance Programme is a strategic decision that until now has lacked analysis of questions related to its setting up, management and control. In this paper, an evaluation system is proposed that carries out the decision making in relation to the feasibility of the setting up. The evaluation system uses a combination of tools belonging to operational research such as: Analytic Hierarchy Process, decision rules and Bayesian tools. This system is a help tool available to the managers of Predictive Maintenance Programmes which can both increase the number of Predictive Maintenance Programmes set up and avoid the failure of these programmes. The Evaluation System has been tested in a petrochemical plant and in a food industry

Anaesthesia in Congenital Facial Anomalies in a Rural Set up of a Developing Country

Directory of Open Access Journals (Sweden)

Debasish Saha

2015-01-01

Full Text Available Background: India has an estimated backlog of 1000000 cleft patients. A total of 35000 new cleft patients are born each year. With the capacity to operate on approximately 50000 patients each year only 15000 patients from the national backlog can be operated upon each year if capability is not augmented. Objectives: To reach the population at large we meticulously planned an out-reach programme and operated on patients even in rural set ups with lack of modern facilities. We operated on patients at sub divisional centres, where apparatus for providing sevoflurane was not available. Institutional Ethical clearance was taken before conduction of the study. Patients who required prolonged surgery were taken to the tertiary centre. Working ventilators were also not available at peripheral centres. Materials and Methods: This interventional study was carried in a time span of four years on nineteen hundred and nine patients, after taking approval from the Institutional Ethical Committee. Patients were screened and some were operated at rural centers and others at a tertiary care centre. Patients who could not afford to come to the tertiary care centre were operated at different rural centers. Informed consent was taken. Results: There were 1909 patients with Congenital Facial Anomalies (CFA over four years period out of which 918 patients were of either unilateral or bilateral cleft lip. They were successfully operated at rural health centers with limited facilities. This could reduce the total load of surgeries for CFA at tertiary care hospital ensuring safe surgeries for all with CFA for all age groups and both genders.No mortality was recorded and post operative complications consisted of nausea and vomiting, three had delayed recovery and one had laryngospasm. Conclusion: Outreach programmes can increase the efficacy of Smile Train Project and effective screening of patients before surgery can result in fruitful outcomes even in a rural set up

Set-up for steam generator tube bundle washing after explosion expanding the tubes

International Nuclear Information System (INIS)

Osipov, S.I.; Kal'nin, A.Ya.; Mazanenko, M.F.

1985-01-01

Set-up for steam generator tube bundle washing after the explosion expanding of tubes is described. Washing is accomplished by distillate. Steam is added to distillate for heating, and compersed air for preventing hydraulic shock. The set-up is equiped by control equipment. Set-up performances are presented. Time for one steam generator washing constitutes 8-12 h. High economic efficiency is realized due to the set-up introduction

Practical performance for CT simulator set up and commissioning for 3d radiotherapy

International Nuclear Information System (INIS)

Wang, Y.; Rinks, A.; Zealey, W.

2004-01-01

Full text: We present a summary of the protocol used to commission two GE LightSpeed and One Siemens CT-Sim for 3D radiotherapy in early 2004. The protocol defined was based on AAPM TG-66 and ACPSEM 1997 position paper. Scanning Med-TEC Iso-align Laser Alignment Device for three-D isocentre alignment 1. Couch Movement Accuracy for both manual and scanning movement checked before isocentre alignment, as the reference distance is required for the external isocentre setup. 2. Gantry scan rotation circle vertical and tilted angle alignment checked by overlaying the vertical and horizontal image coordinate lines using the aligned ball-bearings in the phantom to determine the gantry cross plane image vertical accuracy and tilt angle accuracy. 3. Zero scan position determined by scanning the horizontally set Med-Align phantom, and adjusting the phantom position forward and backward to match the image scanning centre. 4. Internal lasers position determined by the position of aligned Med-Align phantom after the scanning centre determined. 5. Couch top to Gantry Perpendicular checked by matching the couch axis in the longitudinal and lateral direction to the position of the laser lines determined according to the CT scanning orientation. 6. Couch Central Axis aligned to ensure the couch travels though the internal isocentre for the full range of longitudinal of movement. 7. External isocentre and laser focus can be determined by moving the couch back a set distance (50cm or 60cm normally) from the internal isocentre. Planning image transfer and DRR image alignment 1. Scanning Centre indicated on the planning image depends on the functionality of the planning system. Some planning systems load the image with the scanning centre at zero position, others load up the image with the absolute distance. 2. Zero Slice position aligned to the centre of the phantom using the external laser. 3. Orientation and Distance were checked by scanning the Iso-align in both vertical and

Follow-up for osteoporosis in older patients three years after a fracture

NARCIS (Netherlands)

Schurink, M.; Hegeman, J. H.; Kreeftenberg, H. G.; ten Duis, H. J.

Background: Recently a Fracture and Osteoporosis outpatient clinic (FO clinic) was set up at the University Medical Centre Groningen (UMCG) with the aim to optimise case-finding of osteoporosis in older patients with a low-energy fracture. To provide a diagnostic setting before the start of our FO

Cone beam CT with zonal filters for simultaneous dose reduction, improved target contrast and automated set-up in radiotherapy

International Nuclear Information System (INIS)

Moore, C J; Marchant, T E; Amer, A M

2006-01-01

Cone beam CT (CBCT) using a zonal filter is introduced. The aims are reduced concomitant imaging dose to the patient, simultaneous control of body scatter for improved image quality in the tumour target zone and preserved set-up detail for radiotherapy. Aluminium transmission diaphragms added to the CBCT x-ray tube of the Elekta Synergy TM linear accelerator produced an unattenuated beam for a central 'target zone' and a partially attenuated beam for an outer 'set-up zone'. Imaging doses and contrast noise ratios (CNR) were measured in a test phantom for transmission diaphragms 12 and 24 mm thick, for 5 and 10 cm long target zones. The effect on automatic registration of zonal CBCT to conventional CT was assessed relative to full-field and lead-collimated images of an anthropomorphic phantom. Doses along the axis of rotation were reduced by up to 50% in both target and set-up zones, and weighted dose (two thirds surface dose plus one third central dose) was reduced by 10-20% for a 10 cm long target zone. CNR increased by up to 15% in zonally filtered CBCT images compared to full-field images. Automatic image registration remained as robust as that with full-field images and was superior to CBCT coned down using lead-collimation. Zonal CBCT significantly reduces imaging dose and is expected to benefit radiotherapy through improved target contrast, required to assess target coverage, and wide-field edge detail, needed for robust automatic measurement of patient set-up error

Accuracy Assessment of Geometrical Elements for Setting-Out in Horizontal Plane of Conveying Chambers at the Bauxite Mine "KOSTURI" Srebrenica

Science.gov (United States)

Milutinović, Aleksandar; Ganić, Aleksandar; Tokalić, Rade

2014-03-01

Setting-out of objects on the exploitation field of the mine, both in surface mining and in the underground mines, is determined by the specified setting-out accuracy of reference points, which are best to define spatial position of the object projected. For the purpose of achieving of the specified accuracy, it is necessary to perform a priori accuracy assessment of parameters, which are to be used when performing setting-out. Based on the a priori accuracy assessment, verification of the quality of geometrical setting- -out elements specified in the layout; definition of the accuracy for setting-out of geometrical elements; selection of setting-out method; selection at the type and class of instruments and tools that need to be applied in order to achieve predefined accuracy. The paper displays the accuracy assessment of geometrical elements for setting-out of the main haul gallery, haul downcast and helical conveying downcasts in shape of an inclined helix in horizontal plane, using the example of the underground bauxite mine »Kosturi«, Srebrenica. Wytyczanie obiektów na polu wydobywczym w kopalniach, zarówno podziemnych jak i odkrywkowych, zależy w dużej mierze od określonej dokładności wytyczania punktów referencyjnych, przy pomocy których określane jest następnie położenie przestrzenne pozostałych obiektów. W celu uzyskania założonej dokładności, należy przeprowadzić wstępną analizę dokładności oszacowania parametrów które następnie wykorzystane będą w procesie wytyczania. W oparciu o wyniki wstępnej analizy dokładności dokonuje się weryfikacji jakości geometrycznego wytyczenia elementów zaznaczonych na szkicu, uwzględniając te wyniki dobrać należy odpowiednią metodę wytyczania i rodzaj oraz klasę wykorzystywanych narzędzi i instrumentów, tak by osiągnąć założony poziom dokładności. W pracy przedstawiono oszacowanie dokładności wytyczania elementów geometrycznych dla głównego chodnika transportowego

68Ga-PSMA PET/CT in Patients with Rising Prostatic-Specific Antigen After Definitive Treatment of Prostate Cancer: Detection Efficacy and Diagnostic accuracy.

Science.gov (United States)

Hamed, Maged Abdel Galil; Basha, Mohammad Abd Alkhalik; Ahmed, Hussien; Obaya, Ahmed Ali; Afifi, Amira Hamed Mohamed; Abdelbary, Eman H

2018-06-20

68 Ga-prostate-specific membrane antigen-11 ( 68 Ga-PSMA-11) is a recently developed positron emission tomography (PET) tracer that can detect prostate cancer (PC) relapses and metastases with high contrast resolution. The aim of this study was to assess the detection efficacy and diagnostic accuracy of 68 Ga-PSMA PET/CT image in patients with rising prostatic-specific antigen (PSA) after treatment of PC. The present prospective study included 188 patients who exhibited rising of PSA level on a routine follow-up examination after definitive treatment of PC. All patients underwent a 68 Ga-PSMA PET/CT examination. For each patient, we determined the disease stage, the Gleason score, and the maximum standardized uptake value of the local recurrence and extraprostatic metastases. The detection efficacy and diagnostic accuracy of 68 Ga-PSMA PET/CT were established by histopathology and clinical and imaging follow-up as the reference standards. 68 Ga-PSMA PET/CT detected tumour relapse in 165 patients (35 patients had local recurrence, 106 patients had extraprostatic metastases, and 24 patients had combined lesions). The sensitivity, specificity, and accuracy values of 68 Ga-PSMA PET/CT examination in the detection of PC recurrence were 98.8%, 100%, and 98.8%, respectively. 68 Ga-PSMA PET/CT revealed an overall detection rate of 87.8% (165/188) in patients with rising PSA (median of 2.2 ng/mL, and range of 0.01-70 ng/mL). 68 Ga-PSMA PET/CT is a valuable tool for the detection of PC local recurrence or extraprostatic metastases following rising PSA levels after primary definitive therapy and should be incorporated during routine work-up. Copyright © 2018. Published by Elsevier Inc.

Omental deposits surveillance in gynecological malignancies at first setting follow up: 18F-FDG PET/CT compared to CT

OpenAIRE

Tamer W. Kassem

2017-01-01

Objective: The aim of this study was to compare the diagnostic performance of positron emission tomography/computed tomography (PET/CT) scan and CT scan in follow up of proven gynecological malignancies omental deposits in first setting follow up after treatment. Patients and methods: 60 female patients having proven omental deposits from gynecological malignancies underwent PET/CT examination following a preset protocol as baseline study. 34 cases of them had a second PET/CT examination f...

An experimental set-up to measure Light Yield of Scintillating Fibres

CERN Document Server

Alfieri, C; Joram, C; Kenzie, M W

2015-01-01

In the context of the LHCb SciFi Tracker project, an experimental set up was designed and built to provide reliable and reproducible measurements of the light yield of scintillating fibres. This document describes the principle and technical realisation of the set-up. A few examples illustrate the operation and data analysis. In the first implementation of the set-up a photomultiplier tube with bialkali photocathode was used for the reading of the light from the fibres under test. In order to measure also green emitting fibres, the photomultiplier was replaced in January 2016 by a SiPM with higher sensitivity and larger spectral coverage1.

Dosimetric accuracy at low monitor unit setting in electron beams at different dose rates

International Nuclear Information System (INIS)

Ravikumar, M.; Ravichandran, R.; Supe, Sanjay S.; Sharma, Anil K.

1999-01-01

As electron beam with low monitor unit (LMU) settings are used in some dosimetric studies, better understanding of accuracy in dose delivery at LMU setting is necessary. The dose measurements were carried out with 0.6 cm 3 farmer type ion chamber at d max in a polystyrene phantom. Measurements at different MUs show that the dose linearity ratio (DLR) increases as the MU setting decreases below 20 MU and DLRs are found to increase when the incident electron beams have higher energies. The increase in DLR is minimum for low dose rate setting for all five electron beam energies (6, 9, 12, 16 and 20 MeV). As the variation in dose delivery is machine-specific, a detailed study should be conducted before the low MU setting is implemented. Since errors in dose delivery are high at higher dose rates, low dose rate may be better at low MU unit setting. (author)

SU-E-CAMPUS-T-01: Analysis of the Precision of Patient Set-Up, and Fidelity of the Delivered Dose Distribution in Proton Therapy of Ocular Tumors

International Nuclear Information System (INIS)

Trofimov, A; Carpenter, K; Shih, HA

2014-01-01

Purpose: To quantify daily set-up variations in fractionated proton therapy of ocular melanomas, and to assess the effect on the fidelity of delivered distribution to the plan. Methods: In a typical five-fraction course, daily set-up is achieved by matching the position of fiducial markers in orthogonal radiographs to the images generated by treatment planning program. A patient maintains the required gaze direction voluntarily, without the aid of fixation devices. Confirmation radiographs are acquired to assess intrafractional changes. For this study, daily radiographs were analyzed to determine the daily iso-center position and apparent gaze direction, which were then transferred to the planning system to calculate the dose delivered in individual fractions, and accumulated dose for the entire course. Dose-volume metrics were compared between the planned and accumulated distributions for the tumor and organs at risk, for representative cases that varied by location within the ocular globe. Results: The analysis of the first set of cases (3 posterior, 3 transequatorial and 4 anterior tumors) revealed varying dose deviation patterns, depending on the tumor location. For anterior and posterior tumors, the largest dose increases were observed in the lens and ciliary body, while for the equatorial tumors, macula, optic nerve and disk, were most often affected. The iso-center position error was below 1.3 mm (95%-confidence interval), and the standard deviation of daily polar and azimuthal gaze set-up were 1.5 and 3 degrees, respectively. Conclusion: We quantified interfractional and intrafractional set-up variation, and estimated their effect on the delivered dose for representative cases. Current safety margins are sufficient to maintain the target coverage, however, the dose delivered to critical structures often deviates from the plan. The ongoing analysis will further explore the patterns of dose deviation, and may help to identify particular treatment scenarios

SU-E-CAMPUS-T-01: Analysis of the Precision of Patient Set-Up, and Fidelity of the Delivered Dose Distribution in Proton Therapy of Ocular Tumors

Energy Technology Data Exchange (ETDEWEB)

Trofimov, A; Carpenter, K; Shih, HA [Massachusetts General Hospital, Boston, MA (United States)

2014-06-15

Purpose: To quantify daily set-up variations in fractionated proton therapy of ocular melanomas, and to assess the effect on the fidelity of delivered distribution to the plan. Methods: In a typical five-fraction course, daily set-up is achieved by matching the position of fiducial markers in orthogonal radiographs to the images generated by treatment planning program. A patient maintains the required gaze direction voluntarily, without the aid of fixation devices. Confirmation radiographs are acquired to assess intrafractional changes. For this study, daily radiographs were analyzed to determine the daily iso-center position and apparent gaze direction, which were then transferred to the planning system to calculate the dose delivered in individual fractions, and accumulated dose for the entire course. Dose-volume metrics were compared between the planned and accumulated distributions for the tumor and organs at risk, for representative cases that varied by location within the ocular globe. Results: The analysis of the first set of cases (3 posterior, 3 transequatorial and 4 anterior tumors) revealed varying dose deviation patterns, depending on the tumor location. For anterior and posterior tumors, the largest dose increases were observed in the lens and ciliary body, while for the equatorial tumors, macula, optic nerve and disk, were most often affected. The iso-center position error was below 1.3 mm (95%-confidence interval), and the standard deviation of daily polar and azimuthal gaze set-up were 1.5 and 3 degrees, respectively. Conclusion: We quantified interfractional and intrafractional set-up variation, and estimated their effect on the delivered dose for representative cases. Current safety margins are sufficient to maintain the target coverage, however, the dose delivered to critical structures often deviates from the plan. The ongoing analysis will further explore the patterns of dose deviation, and may help to identify particular treatment scenarios

An optimised set-up for total reflection particle induced X-ray emission

International Nuclear Information System (INIS)

Kan, J.A. van; Vis, R.D.

1997-01-01

MeV proton beams at small angles of incidence (0-35 mrad) are used to analyse trace elements on flat surfaces such as Si wafers or quartz substrates. In these experiments, the particle induced X-ray emission (PIXE) signal is used in a new optimized set-up. This set-up is constructed in such a way that the X-ray detector can reach very large solid angles, larger than 1 sr. Use of these large detector solid angles, combined with the reduction of bremsstrahlung background, affords limits of detection (LOD) of the order of 10 10 at cm -2 using total reflection particle induced X-ray emission (TPIXE). The LODs from earlier TPIXE measurements in a non-optimized set-up are used to estimate LODs in the new TPIXE set-up. Si wafers with low surface concentrations of V, Ni, Cu and Ag are used as standards to calibrate the LODs found with this set-up. The metal concentrations are determined by total reflection X-ray fluorescence (TXRF). The TPIXE measurements are compared with TXRF measurements on the same wafers. (Author)

upSET, the Drosophila homologue of SET3, Is Required for Viability and the Proper Balance of Active and Repressive Chromatin Marks

Directory of Open Access Journals (Sweden)

Kyle A. McElroy

2017-02-01

Full Text Available Chromatin plays a critical role in faithful implementation of gene expression programs. Different post-translational modifications (PTMs of histone proteins reflect the underlying state of gene activity, and many chromatin proteins write, erase, bind, or are repelled by, these histone marks. One such protein is UpSET, the Drosophila homolog of yeast Set3 and mammalian KMT2E (MLL5. Here, we show that UpSET is necessary for the proper balance between active and repressed states. Using CRISPR/Cas-9 editing, we generated S2 cells that are mutant for upSET. We found that loss of UpSET is tolerated in S2 cells, but that heterochromatin is misregulated, as evidenced by a strong decrease in H3K9me2 levels assessed by bulk histone PTM quantification. To test whether this finding was consistent in the whole organism, we deleted the upSET coding sequence using CRISPR/Cas-9, which we found to be lethal in both sexes in flies. We were able to rescue this lethality using a tagged upSET transgene, and found that UpSET protein localizes to transcriptional start sites (TSS of active genes throughout the genome. Misregulated heterochromatin is apparent by suppressed position effect variegation of the wm4 allele in heterozygous upSET-deleted flies. Using nascent-RNA sequencing in the upSET-mutant S2 lines, we show that this result applies to heterochromatin genes generally. Our findings support a critical role for UpSET in maintaining heterochromatin, perhaps by delimiting the active chromatin environment.

Points in the set-up of tests for fMRI. Toward the delineation of language-competent areas in clinical practice

International Nuclear Information System (INIS)

Takashima, Hisaharu; Ejima, Mitsuhiro; Takeyama, Mamoru; Yamaguchi, Masami; Sato, Yoshino

2001-01-01

This hospital has performed fMRI of language-competent areas of the brain to identify the language-dominant hemisphere and obtain the configuration of the focus in the language-dominant side of the brain. Until now, signals have been detected in only two of fifteen patients who were diagnosed by language tests of a last-syllable word chain. In the present experiment, we tried to have subjects select the type of test. The result was that changes in signals were detected in eight of ten patients. Although the set-up of tests for fMRI is said to hold significant value, clear-cut studies to back this up have rarely been seen. Because clinical medicine treats patients who have difficulty in communication or suffer from aphasia, it is important to take into consideration individual variations and to set up a test suitable for, or achievable by, these individuals. The present method enabled us to avoid failure in examination caused by unsuccessful tests. (author)

Points in the set-up of tests for fMRI. Toward the delineation of language-competent areas in clinical practice

Energy Technology Data Exchange (ETDEWEB)

Takashima, Hisaharu; Ejima, Mitsuhiro; Takeyama, Mamoru; Yamaguchi, Masami; Sato, Yoshino [Tokyo Women' s Medical Coll. (Japan). Hospital

2001-06-01

This hospital has performed fMRI of language-competent areas of the brain to identify the language-dominant hemisphere and obtain the configuration of the focus in the language-dominant side of the brain. Until now, signals have been detected in only two of fifteen patients who were diagnosed by language tests of a last-syllable word chain. In the present experiment, we tried to have subjects select the type of test. The result was that changes in signals were detected in eight of ten patients. Although the set-up of tests for fMRI is said to hold significant value, clear-cut studies to back this up have rarely been seen. Because clinical medicine treats patients who have difficulty in communication or suffer from aphasia, it is important to take into consideration individual variations and to set up a test suitable for, or achievable by, these individuals. The present method enabled us to avoid failure in examination caused by unsuccessful tests. (author)

SETTING UP OF A HOMECARE SYSTEM FOR HIGH COST NEBULISERS IN A PAEDIATRIC CYSTIC FIBROSIS CENTRE.

Science.gov (United States)

Chorro-Mari, Veronica; Christiansen, Nanna

2016-09-01

Due to national changes to the commissioning process of high cost nebulisers (HCN) for Cystic Fibrosis (CF) patients, CF centres have to repatriate the prescribing of the HCN to the tertiary care centres.1 The following nebulisers will no longer be prescribed by primary care: Cayston® (Aztreonam); Colomycin®, Pomixin®, Clobreathe® (Colistimethate); Pulmozyme® (Dornase alfa); Tobi®, Tobi Podhaler ®, Bramitob® (Tobramycin).This abstract explains how the Royal London Hospital (RLH) Paediatric Pharmacy recruited over 100 paediatric (CF) patients smoothly within a period of 4 months and set up a homecare system to avoid patients and families having to travel large distances to obtain their medication. A number of homecare companies were evaluated initially. Parameters looked at were reports of customer satisfaction, delivery cost, turn-around time once the prescription was received and availability of same day delivery service.In order to capture existing patients we met with CF Specialist Nurses to establish the total number of patients on HCN, what nebulised treatment they were on and their respective doses. We prioritised patients that had known problems with GP prescribing and anybody newly starting on HCN.To communicate the change to parents, a letter was sent to all parents explaining the changeover to homecare delivery and tertiary prescribing. In addition a section in the parent bulletin was dedicated to the topic as well. Following this we contacted parents via phone and in clinic to request consent and explain the process.Up to 10 patients were contacted weekly (average of 7); the consent form and registration form were then faxed to the Homecare company for patient registration. In parallel to this prescriptions were requested for the patients that had been set up in the previous week, ensuring that prescribing was spread out over time to avoid having peak times for repeat prescriptions.In addition to the letter to parents GP surgeries were also

Diagnostic accuracy of high-definition CT coronary angiography in high-risk patients

International Nuclear Information System (INIS)

Iyengar, S.S.; Morgan-Hughes, G.; Ukoumunne, O.; Clayton, B.; Davies, E.J.; Nikolaou, V.; Hyde, C.J.; Shore, A.C.; Roobottom, C.A.

2016-01-01

Aim: To assess the diagnostic accuracy of computed tomography coronary angiography (CTCA) using a combination of high-definition CT (HD-CTCA) and high level of reader experience, with invasive coronary angiography (ICA) as the reference standard, in high-risk patients for the investigation of coronary artery disease (CAD). Materials and methods: Three hundred high-risk patients underwent HD-CTCA and ICA. Independent experts evaluated the images for the presence of significant CAD, defined primarily as the presence of moderate (≥50%) stenosis and secondarily as the presence of severe (≥70%) stenosis in at least one coronary segment, in a blinded fashion. HD-CTCA was compared to ICA as the reference standard. Results: No patients were excluded. Two hundred and six patients (69%) had moderate and 178 (59%) had severe stenosis in at least one vessel at ICA. The sensitivity, specificity, positive predictive value, and negative predictive value were 97.1%, 97.9%, 99% and 93.9% for moderate stenosis, and 98.9%, 93.4%, 95.7% and 98.3%, for severe stenosis, on a per-patient basis. Conclusion: The combination of HD-CTCA and experienced readers applied to a high-risk population, results in high diagnostic accuracy comparable to ICA. Modern generation CT systems in experienced hands might be considered for an expanded role. - Highlights: • Diagnostic accuracy of High-Definition CT Angiography (HD-CTCA) has been assessed. • Invasive Coronary angiography (ICA) is the reference standard. • Diagnostic accuracy of HD-CTCA is comparable to ICA. • Diagnostic accuracy is not affected by coronary calcium or stents. • HD-CTCA provides a non-invasive alternative in high-risk patients.

Splendidly blended: a machine learning set up for CDU control

Science.gov (United States)

Utzny, Clemens

2017-06-01

As the concepts of machine learning and artificial intelligence continue to grow in importance in the context of internet related applications it is still in its infancy when it comes to process control within the semiconductor industry. Especially the branch of mask manufacturing presents a challenge to the concepts of machine learning since the business process intrinsically induces pronounced product variability on the background of small plate numbers. In this paper we present the architectural set up of a machine learning algorithm which successfully deals with the demands and pitfalls of mask manufacturing. A detailed motivation of this basic set up followed by an analysis of its statistical properties is given. The machine learning set up for mask manufacturing involves two learning steps: an initial step which identifies and classifies the basic global CD patterns of a process. These results form the basis for the extraction of an optimized training set via balanced sampling. A second learning step uses this training set to obtain the local as well as global CD relationships induced by the manufacturing process. Using two production motivated examples we show how this approach is flexible and powerful enough to deal with the exacting demands of mask manufacturing. In one example we show how dedicated covariates can be used in conjunction with increased spatial resolution of the CD map model in order to deal with pathological CD effects at the mask boundary. The other example shows how the model set up enables strategies for dealing tool specific CD signature differences. In this case the balanced sampling enables a process control scheme which allows usage of the full tool park within the specified tight tolerance budget. Overall, this paper shows that the current rapid developments off the machine learning algorithms can be successfully used within the context of semiconductor manufacturing.

Precision assessment of model-based RSA for a total knee prosthesis in a biplanar set-up.

Science.gov (United States)

Trozzi, C; Kaptein, B L; Garling, E H; Shelyakova, T; Russo, A; Bragonzoni, L; Martelli, S

2008-10-01

Model-based Roentgen Stereophotogrammetric Analysis (RSA) was recently developed for the measurement of prosthesis micromotion. Its main advantage is that markers do not need to be attached to the implants as traditional marker-based RSA requires. Model-based RSA has only been tested in uniplanar radiographic set-ups. A biplanar set-up would theoretically facilitate the pose estimation algorithm, since radiographic projections would show more different shape features of the implants than in uniplanar images. We tested the precision of model-based RSA and compared it with that of the traditional marker-based method in a biplanar set-up. Micromotions of both tibial and femoral components were measured with both the techniques from double examinations of patients participating in a clinical study. The results showed that in the biplanar set-up model-based RSA presents a homogeneous distribution of precision for all the translation directions, but an inhomogeneous error for rotations, especially internal-external rotation presented higher errors than rotations about the transverse and sagittal axes. Model-based RSA was less precise than the marker-based method, although the differences were not significant for the translations and rotations of the tibial component, with the exception of the internal-external rotations. For both prosthesis components the precisions of model-based RSA were below 0.2 mm for all the translations, and below 0.3 degrees for rotations about transverse and sagittal axes. These values are still acceptable for clinical studies aimed at evaluating total knee prosthesis micromotion. In a biplanar set-up model-based RSA is a valid alternative to traditional marker-based RSA where marking of the prosthesis is an enormous disadvantage.

Improvement of Head-Up Display Standards. Volume 5. Head Up Display ILS (Instrument Landing System) Accuracy Flight Tests.

Science.gov (United States)

1987-09-01

amber system. The front canopy of the NT-33A is cov- ered with an amber plastic sheet; when the front seat pilot low- ers his blue visor, the...tigation of the effect of head-up display symbol dynamic response caracteristics on flying qualities; Task B was an investigation of symbol accuracy...An amber vinyl plastic sheet covered the in- side front half of the NT-33 canopy. Blue snap-on visors were pi ovided to the evaluation pilots. The

Accuracy of a reformulated fast-set vinyl polysiloxane impression material using dual-arch trays.

Science.gov (United States)

Kang, Alex H; Johnson, Glen H; Lepe, Xavier; Wataha, John C

2009-05-01

A common technique used for making crown impressions involves use of a vinyl polysiloxane impression material in combination with a dual-arch tray. A leading dental manufacturer has reformulated its vinyl polysiloxane (VPS) impression line, but the accuracy of the new material has not been verified. The purpose of this study was to assess the accuracy of reformulated VPS impression materials using the single-step dual-arch impression technique. Dual-arch impressions were made on a typodont containing a master stainless steel standard crown preparation die, from which gypsum working dies were formed, recovered, and measured. The impression materials evaluated were Imprint 3 Penta Putty with Quick Step Regular Body (IP-0); Imprint 3 Penta Quick Step Heavy Body with Quick Step Light Body (IP-1); Aquasil Ultra Rigid Fast Set with LV Fast Set (AQ-1); and Aquasil Ultra Heavy Fast Set with XLV Fast Set (AQ-2) (n=10). All impressions were disinfected with CaviCide spray for 10 minutes prior to pouring with type IV gypsum. Buccolingual (BL), mesiodistal (MD), and occlusogingival (OG) dimensions were measured and compared to the master die using an optical measuring microscope. Linear dimensional change was also assessed for IP-0 and AQ-1 at 1 and 24 hours based on ANSI/ADA Specification No. 19. Single-factor ANOVA with Dunnett's T3 multiple comparisons was used to compare BL, MD, and OG changes, with hypothesis testing at alpha=.05. A repeated-measures ANOVA was used to compare linear dimensional changes. There were statistical differences among the 4 impression systems for 3 of 4 dimensions of the master die. IP-0 working dies were significantly larger in MD and OG-L dimensions but significantly smaller in the BL dimension. IP-1 working dies were significantly smaller in the BL dimension compared to the master die. With the exception of IP-0, differences detected were small and clinically insignificant. No significant differences were observed for linear dimensional change

Setting up Schizosaccharomyces pombe crosses/matings

DEFF Research Database (Denmark)

Ekwall, Karl; Thon, Genevieve

2017-01-01

Here we provide methods for setting up standard crosses with Schizosaccharomyces pombe strains. All strain genotypes and pedigrees should be recorded in a laboratory strain book. Matings between two haploid strains of interest are induced on solid medium poor in nitrogen. Usually, sporulation agar...

Extended heart failure clinic follow-up in low-risk patients

DEFF Research Database (Denmark)

Schou, Morten; Gustafsson, Finn; Videbaek, Lars

2013-01-01

BackgroundOutpatient follow-up in specialized heart failure clinics (HFCs) is recommended by current guidelines and implemented in most European countries, but the optimal duration of HFC programmes has not been established. Nor is it known whether all or only high-risk patients, e.g. identified...... by NT-proBNP, might benefit from an extended HFC follow-up.Methods and resultsIn a multi-centre setting, we randomly assigned 921 clinically stable systolic heart failure (HF) outpatients on optimal medical therapy to undergo either an extended follow-up in the HFC (n = 461) or referral back...

Effects of sample size on robustness and prediction accuracy of a prognostic gene signature

Directory of Open Access Journals (Sweden)

Kim Seon-Young

2009-05-01

Full Text Available Abstract Background Few overlap between independently developed gene signatures and poor inter-study applicability of gene signatures are two of major concerns raised in the development of microarray-based prognostic gene signatures. One recent study suggested that thousands of samples are needed to generate a robust prognostic gene signature. Results A data set of 1,372 samples was generated by combining eight breast cancer gene expression data sets produced using the same microarray platform and, using the data set, effects of varying samples sizes on a few performances of a prognostic gene signature were investigated. The overlap between independently developed gene signatures was increased linearly with more samples, attaining an average overlap of 16.56% with 600 samples. The concordance between predicted outcomes by different gene signatures also was increased with more samples up to 94.61% with 300 samples. The accuracy of outcome prediction also increased with more samples. Finally, analysis using only Estrogen Receptor-positive (ER+ patients attained higher prediction accuracy than using both patients, suggesting that sub-type specific analysis can lead to the development of better prognostic gene signatures Conclusion Increasing sample sizes generated a gene signature with better stability, better concordance in outcome prediction, and better prediction accuracy. However, the degree of performance improvement by the increased sample size was different between the degree of overlap and the degree of concordance in outcome prediction, suggesting that the sample size required for a study should be determined according to the specific aims of the study.

Can the diagnostic accuracy of radionuclide ventriculography during exercise be improved by means of a step-up loading procedure?

International Nuclear Information System (INIS)

Ruegenberg, T.

1985-01-01

34 patients (31 of whom were coronary heart disease sufferers as proven by angiography) and further 3 patients failing to show symptoms of this disorder were subjected to radionuclide ventriculography carried out with the aid of 99m Tc-labelled erythrocytes in such a way that examinations at rest were directly followed by maximum loading tests. In a second series of examinations a step-up procedure was adopted where initial recordings at rest were followed by preliminary exercise tests using only 25% of the maximum load. The parameters chosen to evaluate the results were heart rate, ejection fraction, maximum velocity of changes in volume, endsystolic and enddiastolic volumes (ESV and EDV) as well as cardiac output. In 23 patients the preliminary exercise test revealed an insufficient increase or even decrease of the ejection fraction that was associated with delayed volume changes, increases in ESV and EDV as well as reductions in cardiac output and in 21 patients it became evident during those examinations that the onset of stenocardiac complaints was preceded by markedly pronounced function disorders in the left ventricle. It was concluded from these findings that the step-up procedure followed here may in some patients provide additional information on the level of myocardial performance. It can thus be assumed to contribute considerably to higher diagnostic accuracy, although it requires no more time than conventional exercise tests and is not associated with additional radiation exposure. (TRV) [de

Clustering and training set selection methods for improving the accuracy of quantitative laser induced breakdown spectroscopy

International Nuclear Information System (INIS)

Anderson, Ryan B.; Bell, James F.; Wiens, Roger C.; Morris, Richard V.; Clegg, Samuel M.

2012-01-01

We investigated five clustering and training set selection methods to improve the accuracy of quantitative chemical analysis of geologic samples by laser induced breakdown spectroscopy (LIBS) using partial least squares (PLS) regression. The LIBS spectra were previously acquired for 195 rock slabs and 31 pressed powder geostandards under 7 Torr CO 2 at a stand-off distance of 7 m at 17 mJ per pulse to simulate the operational conditions of the ChemCam LIBS instrument on the Mars Science Laboratory Curiosity rover. The clustering and training set selection methods, which do not require prior knowledge of the chemical composition of the test-set samples, are based on grouping similar spectra and selecting appropriate training spectra for the partial least squares (PLS2) model. These methods were: (1) hierarchical clustering of the full set of training spectra and selection of a subset for use in training; (2) k-means clustering of all spectra and generation of PLS2 models based on the training samples within each cluster; (3) iterative use of PLS2 to predict sample composition and k-means clustering of the predicted compositions to subdivide the groups of spectra; (4) soft independent modeling of class analogy (SIMCA) classification of spectra, and generation of PLS2 models based on the training samples within each class; (5) use of Bayesian information criteria (BIC) to determine an optimal number of clusters and generation of PLS2 models based on the training samples within each cluster. The iterative method and the k-means method using 5 clusters showed the best performance, improving the absolute quadrature root mean squared error (RMSE) by ∼ 3 wt.%. The statistical significance of these improvements was ∼ 85%. Our results show that although clustering methods can modestly improve results, a large and diverse training set is the most reliable way to improve the accuracy of quantitative LIBS. In particular, additional sulfate standards and specifically

Feasibility study of patient motion monitoring using tactile array sensor

International Nuclear Information System (INIS)

Kim, Tae Ho; Kang, Seong Hee; Kim, Dong Su; Cho, Min Seok; Kim, Kyeong Hyeon; Suh, Tae Suk; Kim, Si Yong

2014-01-01

The aim of this study is to evaluate patient pretreatment set-up error and intra-fraction motion using the tactile array sensors (Pressure Profile Systems Inc, Los Angeles, CA) which could measure distributed pressure profiles along the contacting surface and to check a feasibility of the sensor (tactile array sensor) in the patient motion monitoring. Laser alignment and optical camera based monitoring system are very useful for reduce patient set-up error but these systems could not monitor the blind area like patient's back position. Actually after patient alignment using laser or optical monitoring system, it was assumed that there is no error in the patient's back position (pressure profile distribution). But if an error occurs in the patient's back position, it will affect the radiation therapy accuracy. In spite of optical motion monitoring or using the immobilization tool, distributed pressure profiles of patient's back position was changed during inter and intra-fraction. For more accurate patient set-up, blind area (patient's back) monitoring was necessary. We expect that the proposed method will be very useful for make up for the weakness of optical monitoring method

Feasibility study of patient motion monitoring using tactile array sensor

Energy Technology Data Exchange (ETDEWEB)

Kim, Tae Ho; Kang, Seong Hee; Kim, Dong Su; Cho, Min Seok; Kim, Kyeong Hyeon; Suh, Tae Suk [Dept. of Biomedical Engineering, Research Institute of Biomedical Engineering, the Catholic University of Korea, Seoul (Korea, Republic of); Kim, Si Yong [Dept. of Radiation Oncology, Virginia Commonwealth University, Richmond (United States)

2014-11-15

The aim of this study is to evaluate patient pretreatment set-up error and intra-fraction motion using the tactile array sensors (Pressure Profile Systems Inc, Los Angeles, CA) which could measure distributed pressure profiles along the contacting surface and to check a feasibility of the sensor (tactile array sensor) in the patient motion monitoring. Laser alignment and optical camera based monitoring system are very useful for reduce patient set-up error but these systems could not monitor the blind area like patient's back position. Actually after patient alignment using laser or optical monitoring system, it was assumed that there is no error in the patient's back position (pressure profile distribution). But if an error occurs in the patient's back position, it will affect the radiation therapy accuracy. In spite of optical motion monitoring or using the immobilization tool, distributed pressure profiles of patient's back position was changed during inter and intra-fraction. For more accurate patient set-up, blind area (patient's back) monitoring was necessary. We expect that the proposed method will be very useful for make up for the weakness of optical monitoring method.

Follow-up of recurrences of limb soft tissue sarcomas in patients with localized disease: performance of ultrasound

International Nuclear Information System (INIS)

Tagliafico, Alberto; Truini, Mauro; Spina, Bruno; Cambiaso, Paolo; Zaottini, Federico; Bignotti, Bianca; Derchi, Lorenzo E.; Martinoli, Carlo; Calabrese, Massimo

2015-01-01

To evaluate diagnostic performance of ultrasound in the detection of local recurrences in patients with localized soft tissue sarcomas of the limb. An analysis of patients treated for soft tissue sarcomas between 2005 and April 2014 was performed. Sixty-eight patients (men/women, 36:32; age range, 18-84 years) were evaluated. Sensitivity, specificity with 95 % confidence intervals (CIs), positive predictive value (PPV), pre-test probability (the prevalence), negative predictive value (NPV), likelihood ratio for positive results (LH+), accuracy and post-test probability (post-P) of ultrasound were reported on a per patient basis using surgical findings and clinical follow-up as reference standard. Effects of independent variables (US equipment, age and sex, body mass index, radiologist) were considered. Comparison with MR was also performed. The overall sensitivity and specificity were 0.88 (0.60-0.94) and 0.94 (0.86-0.98). PPV, pre-test probability, NPV, LH+, accuracy and post-P: 0.83/0.25/0.96/14.9/0.92/0.83. There were two false negative cases both graded as G3 and deeply located and three false positive US cases. Diagnostic accuracy was not dependent by US machine (p = 0.08), age and sex (p = 0.16), body mass index (p = 0.07) and radiologists (p = 0.07). Diagnostic accuracy of ultrasound was relatively high. Negative US results excluded the presence of a local recurrence with acceptable accuracy. (orig.)

Accuracy of abdominal auscultation for bowel obstruction.

Science.gov (United States)

Breum, Birger Michael; Rud, Bo; Kirkegaard, Thomas; Nordentoft, Tyge

2015-09-14

To investigate the accuracy and inter-observer variation of bowel sound assessment in patients with clinically suspected bowel obstruction. Bowel sounds were recorded in patients with suspected bowel obstruction using a Littmann(®) Electronic Stethoscope. The recordings were processed to yield 25-s sound sequences in random order on PCs. Observers, recruited from doctors within the department, classified the sound sequences as either normal or pathological. The reference tests for bowel obstruction were intraoperative and endoscopic findings and clinical follow up. Sensitivity and specificity were calculated for each observer and compared between junior and senior doctors. Interobserver variation was measured using the Kappa statistic. Bowel sound sequences from 98 patients were assessed by 53 (33 junior and 20 senior) doctors. Laparotomy was performed in 47 patients, 35 of whom had bowel obstruction. Two patients underwent colorectal stenting due to large bowel obstruction. The median sensitivity and specificity was 0.42 (range: 0.19-0.64) and 0.78 (range: 0.35-0.98), respectively. There was no significant difference in accuracy between junior and senior doctors. The median frequency with which doctors classified bowel sounds as abnormal did not differ significantly between patients with and without bowel obstruction (26% vs 23%, P = 0.08). The 53 doctors made up 1378 unique pairs and the median Kappa value was 0.29 (range: -0.15-0.66). Accuracy and inter-observer agreement was generally low. Clinical decisions in patients with possible bowel obstruction should not be based on auscultatory assessment of bowel sounds.

'When measurements mean action' decision models for portal image review to eliminate systematic set-up errors

International Nuclear Information System (INIS)

Wratten, C.R.; Denham, J.W.; O; Brien, P.; Hamilton, C.S.; Kron, T.; London Regional Cancer Centre, London, Ontario

2004-01-01

The aim of the present paper is to evaluate how the use of decision models in the review of portal images can eliminate systematic set-up errors during conformal therapy. Sixteen patients undergoing four-field irradiation of prostate cancer have had daily portal images obtained during the first two treatment weeks and weekly thereafter. The magnitude of random and systematic variations has been calculated by comparison of the portal image with the reference simulator images using the two-dimensional decision model embodied in the Hotelling's evaluation process (HEP). Random day-to-day set-up variation was small in this group of patients. Systematic errors were, however, common. In 15 of 16 patients, one or more errors of >2 mm were diagnosed at some stage during treatment. Sixteen of the 23 errors were between 2 and 4 mm. Although there were examples of oversensitivity of the HEP in three cases, and one instance of undersensitivity, the HEP proved highly sensitive to the small (2-4 mm) systematic errors that must be eliminated during high precision radiotherapy. The HEP has proven valuable in diagnosing very small ( 4 mm) systematic errors using one-dimensional decision models, HEP can eliminate the majority of systematic errors during the first 2 treatment weeks. Copyright (2004) Blackwell Science Pty Ltd

Setting up home-based palliative care in countries with limited resources: a model from Sarawak, Malaysia.

Science.gov (United States)

Devi, B C R; Tang, T S; Corbex, M

2008-12-01

The provision of palliative care (PC) and opioids is difficult to ensure in remote areas in low- and middle-income countries. We describe here the set up of a home-care program in Sarawak (the Malaysian part of the Borneo Island), where half the population lives in villages that are difficult to access. The establishment of this program, initiated in 1994 by the Department of Radiotherapy of Sarawak General Hospital, consisted of training, empowering nurses, simplifying referral, facilitating access to medication, and increasing awareness among public and health professionals about PC. The program has been sustainable and cost efficient, serving 936 patients in 2006. The total morphine usage in the program increased from 1400 g in 2006. The results show that pain medication can be provided even in remote areas with effective organization and empowerment of nurses, who were the most important determinants for the set up of this program. Education of family was also a key aspect. The authors believe that the experience gained in Sarawak may help other regions with low or middle resources in the set up of their PC program especially for their remote rural population.

Seminar on setting up your own business

CERN Multimedia

DSU Department

2008-01-01

Organised by the French-Swiss Foundation for Research and Technology (FFRST), in partnership with CERN, and open to all CERN personnel: Friday 7 March 2008, from 9.00 a.m. to 4.00 p.m. in the Globe of Science and Innovation Are you interested in setting up your own business? Have you already taken any steps in that direction? Do you wish to develop a business plan based on your own professional expertise? If so, you are cordially invited to take part in this seminar, at which you will have the opportunity to: hear first-hand accounts from former members of the CERN personnel who have become entrepreneurs and talk about their experience and needs in terms of financial support, find out about the possibilities for obtaining support at the national level (in Switzerland and France) through presentations of the CTI Start-up and OSEO programmes, have discussions with the relevant Swiss and French regional authorities responsible for supporting start-ups in innovative technolog...

Seminar on setting up your own business

CERN Multimedia

DSU Department

2008-01-01

Organised by the French-Swiss Foundation for Research and Technology (FFRST), in partnership with CERN, and open to all CERN personnel: Friday 7 March 2008, from 9.00 a.m. to 4.00 p.m. in the Globe of Science and Innovation Are you interested in setting up your own business? Have you already taken any steps in that direction? Do you wish to develop a business plan based on your own professional expertise? If so, then you are cordially invited to take part in this seminar at which you will have the opportunity to: hear first-hand accounts from former members of the CERN personnel who have become entrepreneurs and talk about their experience and needs in terms of financial support, find out about the possibilities of obtaining support at national level (in Switzerland and France) through presentations of the CTI Start-up and OSEO programmes, have discussions with the relevant Swiss and French regional authorities responsible for supporting start-ups in innovative technologies...

Surface imaging, portal imaging, and skin marker set-up vs. CBCT for radiotherapy of the thorax and pelvis

Energy Technology Data Exchange (ETDEWEB)

Pallotta, Stefania; Bucciolini, Marta [Universita degli Studi di Firenze, Dipartimento di Scienze Biomediche Sperimentali e Cliniche, Florence (Italy); AOU Careggi, Sezione di Fisica Medica, Florence (Italy); Vanzi, Eleonora; Marrazzo, Livia [AOU Careggi, Sezione di Fisica Medica, Florence (Italy); Simontacchi, Gabriele; Paiar, Fabiola [AOU Careggi, Sezione di Radioterapia, Florence (Italy); Ceroti, Marco [ISPO, U.O. Epidemiologia Molecolare e Nutrizionale, Florence (Italy); Livi, Lorenzo [Universita degli Studi di Firenze, Dipartimento di Scienze Biomediche Sperimentali e Cliniche, Florence (Italy); AOU Careggi, Sezione di Radioterapia, Florence (Italy)

2015-09-15

The aim of this study was to compare surface imaging, portal imaging, and skin marker set-up in radiotherapy of thoracic and pelvic regions, using cone beam computed tomography (CBCT) data as the gold standard. Twenty patients were included in this study. CBCT, surface acquisition (SA), and two orthogonal portal images (PI) were acquired during the first four treatment sessions. Patient set-up corrections, obtained by registering the planning CT with CBCT, were used as the gold standard. Registration results of the PI and SA were evaluated and compared with those obtained with CBCT. The advantage derived from using SA or PI verification systems over a skin marker set-up was also quantified. A statistically significant difference between PI and SA (in favour of PI) was observed in seven patients undergoing treatment of the pelvic region and in two patients undergoing treatment of the thoracic region. The use of SA or PI, compared with a skin marker set-up, improved patient positioning in 50% and 57 % of the thoracic fractions, respectively. For pelvic fractions, the use of PI was beneficial in 73 % of the cases, while the use of SA was beneficial in only 45 %. Patient positioning worsened with SA, particularly along longitudinal and vertical directions. PI yielded more accurate registration results than SA for both pelvic and thoracic fractions. Compared with the skin marker set-up, PI performances were superior to SA for pelvic fractions while comparable results were obtained for thoracic fractions. (orig.) [German] Ziel dieser Studie ist der Vergleich der Patientenpositionierung mittels der 3-D/4-D-Erfassung der Patientenoberflaeche durch ein Abtastsystem, kV/MV-Verifikationsaufnahmen mit Hochenergiebildsystemen und Markierungen auf der Haut bei Bestrahlungen im Thorax- bzw. Beckenbereich. Als Goldstandard zum Vergleich dienten CBCT(''cone beam computed tomography'')-Aufnahmen. Die Studie basiert auf Untersuchungen an 20 Patienten. Es wurden

Individual differences in eyewitness identification accuracy between sequential and simultaneous line-ups: consequences for police practice and jury decisions

Directory of Open Access Journals (Sweden)

Dominic Willmott

2016-10-01

Full Text Available Background Although previous research has indicated that sequential line-up procedures result in fewer mistaken identifications, this was found to be at the expense of accurate identifications more typical within simultaneous procedures. Hence, there remains a lack of agreement about which procedure is superior, and the interaction such procedures have with eyewitness confidence. The interaction between witness demographics and identification accuracy also remains unclear. Participants and procedure The opportunistic sample, consisting of 60 people from the general population, was divided randomly into two experimental conditions: simultaneous (SIM and sequential (SEQ. Participants in the sequential procedure observed 12 photographs, one at a time, deciding if they believed the suspect to be the person shown in the current photograph and unable to return to a given picture once they decided the individual shown was not the suspect described. Participants in the simultaneous condition were shown all 12 photographs concurrently and asked to determine which, if any, of the photographs was the suspect described. Results No significant differences were found in identification accuracy between line-up procedures, but significant differences in confidence levels between the two line-up procedures were found. Additionally, analysis of demographic features showed previous line-up experience to be significantly associated with identification accuracy. Conclusions The present research provides new insight into the interaction of eyewitness confidence between line-up techniques, offering an alternative explanation of witness confidence as well as procedural fairness. Evidence of practice effects increasing the accuracy of identification provides beneficial future implications for police line-up procedures and safer jury decisions, often reliant on identification evidence.

Evaluation of Pictorial Dietary Assessment Tool for Hospitalized Patients with Diabetes: Cost, Accuracy, and User Satisfaction Analysis

Directory of Open Access Journals (Sweden)

Dwi Budiningsari

2017-12-01

Full Text Available Although nutritional screening and dietary monitoring in clinical settings are important, studies on related user satisfaction and cost benefit are still lacking. This study aimed to: (1 elucidate the cost of implementing a newly developed dietary monitoring tool, the Pictorial Dietary Assessment Tool (PDAT; and (2 investigate the accuracy of estimation and satisfaction of healthcare staff after the use of the PDAT. A cross-over intervention study was conducted among 132 hospitalized patients with diabetes. Cost and time for the implementation of PDAT in comparison to modified Comstock was estimated using the activity-based costing approach. Accuracy was expressed as the percentages of energy and protein obtained by both methods, which were within 15% and 30%, respectively, of those obtained by the food weighing. Satisfaction of healthcare staff was measured using a standardized questionnaire. Time to complete the food intake recording of patients using PDAT (2.31 ± 0.70 min was shorter than when modified Comstock (3.53 ± 1.27 min was used (p < 0.001. Overall cost per patient was slightly higher for PDAT (United States Dollar 0.27 ± 0.02 than for modified Comstock (USD 0.26 ± 0.04 (p < 0.05. The accuracy of energy intake estimated by modified Comstock was 10% lower than that of PDAT. There was poorer accuracy of protein intake estimated by modified Comstock (<40% compared to that estimated by the PDAT (>71% (p < 0.05. Mean user satisfaction of healthcare staff was significantly higher for PDAT than that for modified Comstock (p < 0.05. PDAT requires a shorter time to be completed and was rated better than modified Comstock.

A Kolmogorov-Smirnov Based Test for Comparing the Predictive Accuracy of Two Sets of Forecasts

Directory of Open Access Journals (Sweden)

Hossein Hassani

2015-08-01

Full Text Available This paper introduces a complement statistical test for distinguishing between the predictive accuracy of two sets of forecasts. We propose a non-parametric test founded upon the principles of the Kolmogorov-Smirnov (KS test, referred to as the KS Predictive Accuracy (KSPA test. The KSPA test is able to serve two distinct purposes. Initially, the test seeks to determine whether there exists a statistically significant difference between the distribution of forecast errors, and secondly it exploits the principles of stochastic dominance to determine whether the forecasts with the lower error also reports a stochastically smaller error than forecasts from a competing model, and thereby enables distinguishing between the predictive accuracy of forecasts. We perform a simulation study for the size and power of the proposed test and report the results for different noise distributions, sample sizes and forecasting horizons. The simulation results indicate that the KSPA test is correctly sized, and robust in the face of varying forecasting horizons and sample sizes along with significant accuracy gains reported especially in the case of small sample sizes. Real world applications are also considered to illustrate the applicability of the proposed KSPA test in practice.

Set-up of a pre-test mock-up experiment in preparation for the HCPB Breeder Unit mock-up experimental campaign

Energy Technology Data Exchange (ETDEWEB)

Hernández, F., E-mail: francisco.hernandez@kit.edu [Karlsruhe Institute of Technology (KIT), Institute for Neutron Physics and Reactor Technology (INR) (Germany); Kolb, M. [Karlsruhe Institute of Technology (KIT), Institute for Applied Materials (IAM-WPT) (Germany); Ilić, M.; Kunze, A. [Karlsruhe Institute of Technology (KIT), Institute for Neutron Physics and Reactor Technology (INR) (Germany); Németh, J. [KFKI Research Institute for Particle and Nuclear Physics (Hungary); Weth, A. von der [Karlsruhe Institute of Technology (KIT), Institute for Neutron Physics and Reactor Technology (INR) (Germany)

2013-10-15

Highlights: ► As preparation for the HCPB-TBM Breeder Unit out-of-pile testing campaign, a pre-test experiment (PREMUX) has been prepared and described. ► A new heater system based on a wire heater matrix has been developed for imitating the neutronic volumetric heating and it is compared with the conventional plate heaters. ► The test section is described and preliminary thermal results with the available models are presented and are to be benchmarked with PREMUX. ► The PREMUX integration in the air cooling loop L-STAR/LL in the Karlsruhe Institute for Technology is shown and future steps are discussed. -- Abstract: The complexity of the experimental set-up for testing a full-scaled Breeder Unit (BU) mock-up for the European Helium Cooled Pebble Bed Test Blanket Module (HCPB-TBM) has motivated to build a pre-test mock-up experiment (PREMUX) consisting of a slice of the BU in the Li{sub 4}SiO{sub 4} region. This pre-test aims at verifying the feasibility of the methods to be used for the subsequent testing of the full-scaled BU mock-up. Key parameters needed for the modeling of the breeder material is also to be determined by the Hot Wire Method (HWM). The modeling tools for the thermo-mechanics of the pebble beds and for the mock-up structure are to be calibrated and validated as well. This paper presents the setting-up of PREMUX in the L-STAR/LL facility at the Karlsruhe Institute of Technology. A key requirement of the experiments is to mimic the neutronic volumetric heating. A new heater concept is discussed and compared to several conventional heater configurations with respect to the estimated temperature distribution in the pebble beds. The design and integration of the thermocouple system in the heater matrix and pebble beds is also described, as well as other key aspects of the mock-up (dimensions, layout, cooling system, purge gas line, boundary conditions and integration in the test facility). The adequacy of these methods for the full-scaled BU

Computational fluid dynamics simulation of indoor climate in low energy buildings: Computational set up

Directory of Open Access Journals (Sweden)

Risberg Daniel

2017-01-01

Full Text Available In this paper CFD was used for simulation of the indoor climate in a part of a low energy building. The focus of the work was on investigating the computational set up, such as grid size and boundary conditions in order to solve the indoor climate problems in an accurate way. Future work is to model a complete building, with reasonable calculation time and accuracy. A limited number of grid elements and knowledge of boundary settings are therefore essential. An accurate grid edge size of around 0.1 m was enough to predict the climate according to a grid independency study. Different turbulence models were compared with only small differences in the indoor air velocities and temperatures. The models show that radiation between building surfaces has a large impact on the temperature field inside the building, with the largest differences at the floor level. Simplifying the simulations by modelling the radiator as a surface in the outer wall of the room is appropriate for the calculations. The overall indoor climate is finally compared between three different cases for the outdoor air temperature. The results show a good indoor climate for a low energy building all around the year.

Accuracy of robotic patient positioners used in ion beam therapy

International Nuclear Information System (INIS)

Nairz, Olaf; Winter, Marcus; Heeg, Peter; Jäkel, Oliver

2013-01-01

In this study we investigate the accuracy of industrial six axes robots employed for patient positioning at the Heidelberg Ion Beam Therapy Center. In total 1018 patient setups were monitored with a laser tracker and subsequently analyzed. The measurements were performed in the two rooms with a fixed horizontal beam line. Both, the 3d translational errors and the rotational errors around the three table axes were determined. For the first room the 3d error was smaller than 0.72 mm in 95 percent of all setups. The standard deviation of the rotational errors was at most 0.026° for all axes. For the second room Siemens implemented an improved approach strategy to the final couch positions. The 95 percent quantile of the 3d error could in this room be reduced to 0.53 mm; the standard deviation of the rotational errors was also at most 0.026°. Robots are very flexible tools for patient positioning in six degrees of freedom. This study proved that the robots are able to achieve clinically acceptable accuracy in real patient setups, too

Clustering and training set selection methods for improving the accuracy of quantitative laser induced breakdown spectroscopy

Energy Technology Data Exchange (ETDEWEB)

Anderson, Ryan B., E-mail: randerson@astro.cornell.edu [Cornell University Department of Astronomy, 406 Space Sciences Building, Ithaca, NY 14853 (United States); Bell, James F., E-mail: Jim.Bell@asu.edu [Arizona State University School of Earth and Space Exploration, Bldg.: INTDS-A, Room: 115B, Box 871404, Tempe, AZ 85287 (United States); Wiens, Roger C., E-mail: rwiens@lanl.gov [Los Alamos National Laboratory, P.O. Box 1663 MS J565, Los Alamos, NM 87545 (United States); Morris, Richard V., E-mail: richard.v.morris@nasa.gov [NASA Johnson Space Center, 2101 NASA Parkway, Houston, TX 77058 (United States); Clegg, Samuel M., E-mail: sclegg@lanl.gov [Los Alamos National Laboratory, P.O. Box 1663 MS J565, Los Alamos, NM 87545 (United States)

2012-04-15

We investigated five clustering and training set selection methods to improve the accuracy of quantitative chemical analysis of geologic samples by laser induced breakdown spectroscopy (LIBS) using partial least squares (PLS) regression. The LIBS spectra were previously acquired for 195 rock slabs and 31 pressed powder geostandards under 7 Torr CO{sub 2} at a stand-off distance of 7 m at 17 mJ per pulse to simulate the operational conditions of the ChemCam LIBS instrument on the Mars Science Laboratory Curiosity rover. The clustering and training set selection methods, which do not require prior knowledge of the chemical composition of the test-set samples, are based on grouping similar spectra and selecting appropriate training spectra for the partial least squares (PLS2) model. These methods were: (1) hierarchical clustering of the full set of training spectra and selection of a subset for use in training; (2) k-means clustering of all spectra and generation of PLS2 models based on the training samples within each cluster; (3) iterative use of PLS2 to predict sample composition and k-means clustering of the predicted compositions to subdivide the groups of spectra; (4) soft independent modeling of class analogy (SIMCA) classification of spectra, and generation of PLS2 models based on the training samples within each class; (5) use of Bayesian information criteria (BIC) to determine an optimal number of clusters and generation of PLS2 models based on the training samples within each cluster. The iterative method and the k-means method using 5 clusters showed the best performance, improving the absolute quadrature root mean squared error (RMSE) by {approx} 3 wt.%. The statistical significance of these improvements was {approx} 85%. Our results show that although clustering methods can modestly improve results, a large and diverse training set is the most reliable way to improve the accuracy of quantitative LIBS. In particular, additional sulfate standards and

Over-relaxation phenomena during the set-up of RFP plasmas

International Nuclear Information System (INIS)

Nordlund, P.; Mazur, S.

1995-03-01

Experiments on the Extrap T1 reversed field pinch have shown that the formation of the RFP configuration is quite sensitive to the relative programming of the toroidal field and ohmic heating circuits. In this paper, new measurements of the evolution of the current density profile and of the spectral structure of the fluctuations during the set-up phase of RFP plasmas in the T1 experiment are presented. These measurements improve the understanding of the role of different spectral components in the dynamics of RFP formation. Under unfavourable (slow) set-up conditions, comparatively high energy is accumulated in m = 1 internal kinks prior to reversal of the edge toroidal fields. At reversal, nonlinearly driven m = 0 modes trigger a rapid broadening of the m = 1 spectrum. This behaviour is associated with a violent suppression of the current density in the core leading to an over-relaxation of the discharge involving a hollowing of the parallel current density profile. The over-relaxation phenomenon increases the volt-second consumption and plasma/wall interaction during RFP set-up, and degrades the flat-top discharge performance. 15 refs, 5 figs, 1 tab

Over-relaxation phenomena during the set-up of RFP plasmas

Energy Technology Data Exchange (ETDEWEB)

Nordlund, P.; Mazur, S.

1995-03-01

Experiments on the Extrap T1 reversed field pinch have shown that the formation of the RFP configuration is quite sensitive to the relative programming of the toroidal field and ohmic heating circuits. In this paper, new measurements of the evolution of the current density profile and of the spectral structure of the fluctuations during the set-up phase of RFP plasmas in the T1 experiment are presented. These measurements improve the understanding of the role of different spectral components in the dynamics of RFP formation. Under unfavourable (slow) set-up conditions, comparatively high energy is accumulated in m = 1 internal kinks prior to reversal of the edge toroidal fields. At reversal, nonlinearly driven m = 0 modes trigger a rapid broadening of the m = 1 spectrum. This behaviour is associated with a violent suppression of the current density in the core leading to an over-relaxation of the discharge involving a hollowing of the parallel current density profile. The over-relaxation phenomenon increases the volt-second consumption and plasma/wall interaction during RFP set-up, and degrades the flat-top discharge performance. 15 refs, 5 figs, 1 tab.

Technologies for the Fast Set-Up of Automated Assembly Processes

DEFF Research Database (Denmark)

Krüger, Norbert; Ude, Ales; Petersen, Henrik Gordon

2014-01-01

of so called few-of-a-kind production. Therefore, most production of this kind is done manually and thus often performed in low-wage countries. In the IntellAct project, we have developed a set of methods which facilitate the set-up of a complex automatic assembly process, and here we present our work...

Improved diagnostic accuracy of Alzheimer's disease by combining regional cortical thickness and default mode network functional connectivity: Validated in the Alzheimer's disease neuroimaging initiative set

Energy Technology Data Exchange (ETDEWEB)

Park, Ji Eun; Park, Bum Woo; Kim, Sang Joon; Kim, Ho Sung; Choi, Choong Gon; Jung, Seung Jung; Oh, Joo Young; Shim, Woo Hyun [Dept. of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of); Lee, Jae Hong; Roh, Jee Hoon [University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of)

2017-11-15

To identify potential imaging biomarkers of Alzheimer's disease by combining brain cortical thickness (CThk) and functional connectivity and to validate this model's diagnostic accuracy in a validation set. Data from 98 subjects was retrospectively reviewed, including a study set (n = 63) and a validation set from the Alzheimer's Disease Neuroimaging Initiative (n = 35). From each subject, data for CThk and functional connectivity of the default mode network was extracted from structural T1-weighted and resting-state functional magnetic resonance imaging. Cortical regions with significant differences between patients and healthy controls in the correlation of CThk and functional connectivity were identified in the study set. The diagnostic accuracy of functional connectivity measures combined with CThk in the identified regions was evaluated against that in the medial temporal lobes using the validation set and application of a support vector machine. Group-wise differences in the correlation of CThk and default mode network functional connectivity were identified in the superior temporal (p < 0.001) and supramarginal gyrus (p = 0.007) of the left cerebral hemisphere. Default mode network functional connectivity combined with the CThk of those two regions were more accurate than that combined with the CThk of both medial temporal lobes (91.7% vs. 75%). Combining functional information with CThk of the superior temporal and supramarginal gyri in the left cerebral hemisphere improves diagnostic accuracy, making it a potential imaging biomarker for Alzheimer's disease.

Special problems of setting up nuclear medicine in a developing country

Energy Technology Data Exchange (ETDEWEB)

Ganatra, R D

1993-12-31

There are some special problems in setting up nuclear medicine in a developing country. They can be briefly described in the form of the following general rules. 1) Impossible triangle. For the practice of nuclear medicine, three things are needed: Instrument, Radiopharmaceutical and a Patient. In a developing country, these three become three sides of an impossible triangle. When the radiopharmaceutical is available, the instrument may not be working; when the instrument is functioning, the radiopharmaceutical may not have been obtained from the foreign supplier; and when both are there, the patient might no longer be in the hospital. Three sides of this triangle never join to become a congruent whole. 2) Reverse square law. Further away one is from the source of supply of instruments and radiopharmaceuticals, the problems multiply by the square of this distance. 3) Future of nuclear medicine is tied to the electrical supply available in a developing country. These problems related to power supply are described in the Chapter on maintenance of instruments

Special problems of setting up nuclear medicine in a developing country

International Nuclear Information System (INIS)

Ganatra, R.D.

1992-01-01

There are some special problems in setting up nuclear medicine in a developing country. They can be briefly described in the form of the following general rules. 1) Impossible triangle. For the practice of nuclear medicine, three things are needed: Instrument, Radiopharmaceutical and a Patient. In a developing country, these three become three sides of an impossible triangle. When the radiopharmaceutical is available, the instrument may not be working; when the instrument is functioning, the radiopharmaceutical may not have been obtained from the foreign supplier; and when both are there, the patient might no longer be in the hospital. Three sides of this triangle never join to become a congruent whole. 2) Reverse square law. Further away one is from the source of supply of instruments and radiopharmaceuticals, the problems multiply by the square of this distance. 3) Future of nuclear medicine is tied to the electrical supply available in a developing country. These problems related to power supply are described in the Chapter on maintenance of instruments

Computed tomographic simulation of craniospinal fields in pediatric patients: improved treatment accuracy and patient comfort.

Science.gov (United States)

Mah, K; Danjoux, C E; Manship, S; Makhani, N; Cardoso, M; Sixel, K E

1998-07-15

To reduce the time required for planning and simulating craniospinal fields through the use of a computed tomography (CT) simulator and virtual simulation, and to improve the accuracy of field and shielding placement. A CT simulation planning technique was developed. Localization of critical anatomic features such as the eyes, cribriform plate region, and caudal extent of the thecal sac are enhanced by this technique. Over a 2-month period, nine consecutive pediatric patients were simulated and planned for craniospinal irradiation. Four patients underwent both conventional simulation and CT simulation. Five were planned using CT simulation only. The accuracy of CT simulation was assessed by comparing digitally reconstructed radiographs (DRRs) to portal films for all patients and to conventional simulation films as well in the first four patients. Time spent by patients in the CT simulation suite was 20 min on average and 40 min maximally for those who were noncompliant. Image acquisition time was absence of the patient, virtual simulation of all fields took 20 min. The DRRs were in agreement with portal and/or simulation films to within 5 mm in five of the eight cases. Discrepancies of > or =5 mm in the positioning of the inferior border of the cranial fields in the first three patients were due to a systematic error in CT scan acquisition and marker contouring which was corrected by modifying the technique after the fourth patient. In one patient, the facial shield had to be moved 0.75 cm inferiorly owing to an error in shield construction. Our analysis showed that CT simulation of craniospinal fields was accurate. It resulted in a significant reduction in the time the patient must be immobilized during the planning process. This technique can improve accuracy in field placement and shielding by using three-dimensional CT-aided localization of critical and target structures. Overall, it has improved staff efficiency and resource utilization.

Computed tomographic simulation of craniospinal fields in pediatric patients: improved treatment accuracy and patient comfort

International Nuclear Information System (INIS)

Mah, Katherine; Danjoux, Cyril E.; Manship, Sharan; Makhani, Nadiya; Cardoso, Marlene; Sixel, Katharina E.

1998-01-01

Purpose: To reduce the time required for planning and simulating craniospinal fields through the use of a computed tomography (CT) simulator and virtual simulation, and to improve the accuracy of field and shielding placement. Methods and Materials: A CT simulation planning technique was developed. Localization of critical anatomic features such as the eyes, cribriform plate region, and caudal extent of the thecal sac are enhanced by this technique. Over a 2-month period, nine consecutive pediatric patients were simulated and planned for craniospinal irradiation. Four patients underwent both conventional simulation and CT simulation. Five were planned using CT simulation only. The accuracy of CT simulation was assessed by comparing digitally reconstructed radiographs (DRRs) to portal films for all patients and to conventional simulation films as well in the first four patients. Results: Time spent by patients in the CT simulation suite was 20 min on average and 40 min maximally for those who were noncompliant. Image acquisition time was <10 min in all cases. In the absence of the patient, virtual simulation of all fields took 20 min. The DRRs were in agreement with portal and/or simulation films to within 5 mm in five of the eight cases. Discrepancies of ≥5 mm in the positioning of the inferior border of the cranial fields in the first three patients were due to a systematic error in CT scan acquisition and marker contouring which was corrected by modifying the technique after the fourth patient. In one patient, the facial shield had to be moved 0.75 cm inferiorly owing to an error in shield construction. Conclusions: Our analysis showed that CT simulation of craniospinal fields was accurate. It resulted in a significant reduction in the time the patient must be immobilized during the planning process. This technique can improve accuracy in field placement and shielding by using three-dimensional CT-aided localization of critical and target structures. Overall

LS1 Report: A brand new set-up for ASACUSA-CUSP

CERN Multimedia

Antonella Del Rosso

2014-01-01

ASACUSA is running for the first time with a totally new set-up. Three new vital instruments have been designed, produced and installed during LS1 in addition to several other major modifications. The collaboration is now ready to perform the first high-precision measurement of the hyperfine structure of antihydrogen – a study that aims at comparing the inner properties of matter and antimatter.   The ASACUSA set-up. The ASACUSA-CUSP collaboration comprises about 30 scientists from various institutes in Europe and Japan. Because of the Japanese contribution, the experiment is often known by its Japanese pronunciation, the experiment’s logo is in Japanese, and the logbook uses Japanese time! This year, for the first time, the experiment is running with a completely new set-up, which now includes a new superconducting double cusp magnet, a new tracking detector and a new final antihydrogen detector. “The magnet is the heart of the ASACUSA experiment,” expl...

Intensity modulated radiation therapy for oropharyngeal cancer: the sensitivity of plan objectives and constraints to set-up uncertainty

International Nuclear Information System (INIS)

Ploquin, Nicolas; Song, William; Lau, Harold; Dunscombe, Peter

2005-01-01

The goal of this study was to assess the impact of set-up uncertainty on compliance with the objectives and constraints of an intensity modulated radiation therapy protocol for early stage cancer of the oropharynx. As the convolution approach to the quantitative study of set-up uncertainties cannot accommodate either surface contours or internal inhomogeneities, both of which are highly relevant to sites in the head and neck, we have employed the more resource intensive direct simulation method. The impact of both systematic (variable from 0 to 6 mm) and random (fixed at 2 mm) set-up uncertainties on compliance with the criteria of the RTOG H-0022 protocol has been examined for eight geometrically complex structures: CTV66 (gross tumour volume and palpable lymph nodes suspicious for metastases), CTV54 (lymph node groups or surgical neck levels at risk of subclinical metastases), glottic larynx, spinal cord, brainstem, mandible and left and right parotids. In a probability-based approach, both dose-volume histograms and equivalent uniform doses were used to describe the dose distributions achieved by plans for two patients, in the presence of set-up uncertainty. The equivalent uniform dose is defined to be that dose which, when delivered uniformly to the organ of interest, will lead to the same response as the non-uniform dose under consideration. For systematic set-up uncertainties greater than 2 mm and 5 mm respectively, coverage of the CTV66 and CTV54 could be significantly compromised. Directional sensitivity was observed in both cases. Most organs at risk (except the glottic larynx which did not comply under static conditions) continued to meet the dose constraints up to 4 mm systematic uncertainty for both plans. The exception was the contra lateral parotid gland, which this protocol is specifically designed to protect. Sensitivity to systematic set-up uncertainty of 2 mm was observed for this organ at risk in both clinical plans

An ontology-based approach to patient follow-up assessment for continuous and personalized chronic disease management.

Science.gov (United States)

Zhang, Yi-Fan; Gou, Ling; Zhou, Tian-Shu; Lin, De-Nan; Zheng, Jing; Li, Ye; Li, Jing-Song

2017-08-01

Chronic diseases are complex and persistent clinical conditions that require close collaboration among patients and health care providers in the implementation of long-term and integrated care programs. However, current solutions focus partially on intensive interventions at hospitals rather than on continuous and personalized chronic disease management. This study aims to fill this gap by providing computerized clinical decision support during follow-up assessments of chronically ill patients at home. We proposed an ontology-based framework to integrate patient data, medical domain knowledge, and patient assessment criteria for chronic disease patient follow-up assessments. A clinical decision support system was developed to implement this framework for automatic selection and adaptation of standard assessment protocols to suit patient personal conditions. We evaluated our method in the case study of type 2 diabetic patient follow-up assessments. The proposed framework was instantiated using real data from 115,477 follow-up assessment records of 36,162 type 2 diabetic patients. Standard evaluation criteria were automatically selected and adapted to the particularities of each patient. Assessment results were generated as a general typing of patient overall condition and detailed scoring for each criterion, providing important indicators to the case manager about possible inappropriate judgments, in addition to raising patient awareness of their disease control outcomes. Using historical data as the gold standard, our system achieved a rate of accuracy of 99.93% and completeness of 95.00%. This study contributes to improving the accessibility, efficiency and quality of current patient follow-up services. It also provides a generic approach to knowledge sharing and reuse for patient-centered chronic disease management. Copyright © 2017 Elsevier Inc. All rights reserved.

Development of a grinding-specific performance test set-up

DEFF Research Database (Denmark)

Olesen, C. G.; Larsen, B. H.; Andresen, E. L.

2015-01-01

The aim of this study was to develop a performance test set-up for America's Cup grinders. The test set-up had to mimic the on-boat grinding activity and be capable of collecting data for analysis and evaluation of grinding performance. This study included a literature-based analysis of grinding...... demands and a test protocol developed to accommodate the necessary physiological loads. This study resulted in a test protocol consisting of 10 intervals of 20 revolutions each interspersed with active resting periods of 50 s. The 20 revolutions are a combination of both forward and backward grinding...... and an exponentially rising resistance. A custom-made grinding ergometer was developed with computer-controlled resistance and capable of collecting data during the test. The data collected can be used to find measures of grinding performance such as peak power, time to complete and the decline in repeated grinding...

Development of a grinding-specific performance test set-up.

Science.gov (United States)

Olesen, C G; Larsen, B H; Andresen, E L; de Zee, M

2015-01-01

The aim of this study was to develop a performance test set-up for America's Cup grinders. The test set-up had to mimic the on-boat grinding activity and be capable of collecting data for analysis and evaluation of grinding performance. This study included a literature-based analysis of grinding demands and a test protocol developed to accommodate the necessary physiological loads. This study resulted in a test protocol consisting of 10 intervals of 20 revolutions each interspersed with active resting periods of 50 s. The 20 revolutions are a combination of both forward and backward grinding and an exponentially rising resistance. A custom-made grinding ergometer was developed with computer-controlled resistance and capable of collecting data during the test. The data collected can be used to find measures of grinding performance such as peak power, time to complete and the decline in repeated grinding performance.

Follow-up care for breast cancer survivors: improving patient outcomes

Directory of Open Access Journals (Sweden)

Chopra I

2014-08-01

Full Text Available Ishveen Chopra,1 Avijeet Chopra2 1Department of Pharmacy Administration, Duquesne University, Pittsburgh, PA, USA; 2Department of Molecular and Cell Biology, University of Connecticut, Storrs, CT, USA Background: Appropriate follow-up care is important for improving health outcomes in breast cancer survivors (BCSs and requires determination of the optimum intensity of clinical examination and surveillance, assessment of models of follow-up care such as primary care-based follow-up, an understanding of the goals of follow-up care, and unique psychosocial aspects of care for these patients. The objective of this systematic review was to identify studies focusing on follow-up care in BCSs from the patient's and physician's perspective or from patterns of care and to integrate primary empirical evidence on the different aspects of follow-up care from these studies. Methods: A comprehensive literature review and evaluation was conducted for all relevant publications in English from January 1, 1990 to December 31, 2013 using electronic databases. Studies were included in the final review if they focused on BCS’s preferences and perceptions, physician's perceptions, patterns of care, and effectiveness of follow-up care. Results: A total of 47 studies assessing the different aspects of follow-up care were included in the review, with a majority of studies (n=13 evaluating the pattern of follow-up care in BCSs, followed by studies focusing on BCS's perceptions (n=9 and preferences (n=9. Most of the studies reported variations in recommended frequency, duration, and intensity of follow-up care as well as frequency of mammogram screening. In addition, variations were noted in patient preferences for type of health care provider (specialist versus non-specialist. Further, BCSs perceived a lack of psychosocial support and information for management of side effects. Conclusion: The studies reviewed, conducted in a range of settings, reflect variations in

Accuracy of the initial diagnosis among patients with an acutely altered mental status

OpenAIRE

Sporer, KA; Solares, M; Edward, JD; Wang, W; Alan, HBW; Robert, MR

2013-01-01

Objectives: The objectives of this prospective observational study were to: (1) determine the accuracy of physician diagnosis in patients with an acutely altered mental status (AMS) within the first 20 min of emergency department (ED) presentation; and (2) access if physician confidence in early diagnosis correlates with accuracy of diagnosis. Methods: A prospective observational convenience study was conducted of 112 adult patients who presented to an urban county ED with AMS (Glasgow Coma S...

Optimizing imaging in suspected appendicitis (OPTIMAP-study: A multicenter diagnostic accuracy study of MRI in patients with suspected acute appendicitis. Study Protocol

Directory of Open Access Journals (Sweden)

Bossuyt Patrick MM

2010-10-01

Full Text Available Abstract Background In patients with clinically suspected appendicitis, imaging is needed to substantiate the clinical diagnosis. Imaging accuracy of ultrasonography (US is suboptimal, while the most accurate technique (CT is associated with cancer related deaths through exposure to ionizing radiation. MRI is a potential replacement, without associated ionizing radiation and no need for contrast medium administration. If MRI is proven to be sufficiently accurate, it could be introduced in the diagnostic pathway of patients with suspected appendicitis, increasing diagnostic accuracy and improving clinical outcomes, without the risk of radiation induced cancer or iodinated contrast medium-related drawbacks. The multicenter OPTIMAP study was designed to estimate the diagnostic accuracy of MRI in patients with suspected acute appendicitis in the general population. Methods/Design Eligible for this study are consecutive patients presenting with clinically suspected appendicitis at the emergency department in six centers. All patients will undergo imaging according to the Dutch guideline for acute appendicitis: initial ultrasonography in all and subsequent CT whenever US does not confirm acute appendicitis. Then MRI is performed in all patients, but the results are not used for patient management. A final diagnosis assigned by an expert panel, based on all available information including 3-months follow-up, except MRI findings, is used as the reference standard in estimating accuracy. We will calculate the sensitivity, specificity, predictive values and inter-observer agreement of MRI, and aim to include 230 patients. Patient acceptance and total imaging costs will also be evaluated. Discussion If MRI is found to be sufficiently accurate, it could replace CT in some or all patients. This will limit or obviate the ionizing radiation exposure associated risk of cancer induction and contrast medium induced nephropathy with CT, preventing the burden and

Quantitative modeling of the accuracy in registering preoperative patient-specific anatomic models into left atrial cardiac ablation procedures

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Rettmann, Maryam E., E-mail: rettmann.maryam@mayo.edu; Holmes, David R.; Camp, Jon J.; Cameron, Bruce M.; Robb, Richard A. [Biomedical Imaging Resource, Mayo Clinic College of Medicine, Rochester, Minnesota 55905 (United States); Kwartowitz, David M. [Department of Bioengineering, Clemson University, Clemson, South Carolina 29634 (United States); Gunawan, Mia [Department of Biochemistry and Molecular and Cellular Biology, Georgetown University, Washington D.C. 20057 (United States); Johnson, Susan B.; Packer, Douglas L. [Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905 (United States); Dalegrave, Charles [Clinical Cardiac Electrophysiology, Cardiology Division Hospital Sao Paulo, Federal University of Sao Paulo, 04024-002 Brazil (Brazil); Kolasa, Mark W. [David Grant Medical Center, Fairfield, California 94535 (United States)

2014-02-15

Purpose: In cardiac ablation therapy, accurate anatomic guidance is necessary to create effective tissue lesions for elimination of left atrial fibrillation. While fluoroscopy, ultrasound, and electroanatomic maps are important guidance tools, they lack information regarding detailed patient anatomy which can be obtained from high resolution imaging techniques. For this reason, there has been significant effort in incorporating detailed, patient-specific models generated from preoperative imaging datasets into the procedure. Both clinical and animal studies have investigated registration and targeting accuracy when using preoperative models; however, the effect of various error sources on registration accuracy has not been quantitatively evaluated. Methods: Data from phantom, canine, and patient studies are used to model and evaluate registration accuracy. In the phantom studies, data are collected using a magnetically tracked catheter on a static phantom model. Monte Carlo simulation studies were run to evaluate both baseline errors as well as the effect of different sources of error that would be present in a dynamicin vivo setting. Error is simulated by varying the variance parameters on the landmark fiducial, physical target, and surface point locations in the phantom simulation studies. In vivo validation studies were undertaken in six canines in which metal clips were placed in the left atrium to serve as ground truth points. A small clinical evaluation was completed in three patients. Landmark-based and combined landmark and surface-based registration algorithms were evaluated in all studies. In the phantom and canine studies, both target registration error and point-to-surface error are used to assess accuracy. In the patient studies, no ground truth is available and registration accuracy is quantified using point-to-surface error only. Results: The phantom simulation studies demonstrated that combined landmark and surface-based registration improved

How to address patients' defences: a pilot study of the accuracy of defence interpretations and alliance.

Science.gov (United States)

Junod, Olivier; de Roten, Yves; Martinez, Elena; Drapeau, Martin; Despland, Jean-Nicolas

2005-12-01

This pilot study examined the accuracy of therapist defence interpretations (TAD) in high-alliance patients (N = 7) and low-alliance patients (N = 8). TAD accuracy was assessed in the two subgroups by comparing for each case the patient's most frequent defensive level with the most frequent defensive level addressed by the therapist when making defence interpretations. Results show that in high-alliance patient-therapist dyads, the therapists tend to address accurate or higher (more mature) defensive level than patients most frequent level. On the other hand, the therapists address lower (more immature) defensive level in low-alliance dyads. These results are discussed along with possible ways to better assess TAD accuracy.

Robotic-based carbon ion therapy and patient positioning in 6 degrees of freedom: setup accuracy of two standard immobilization devices used in carbon ion therapy and IMRT.

Science.gov (United States)

Jensen, Alexandra D; Winter, Marcus; Kuhn, Sabine P; Debus, Jürgen; Nairz, Olaf; Münter, Marc W

2012-03-29

To investigate repositioning accuracy in particle radiotherapy in 6 degrees of freedom (DOF) and intensity-modulated radiotherapy (IMRT, 3 DOF) for two immobilization devices (Scotchcast masks vs thermoplastic head masks) currently in use at our institution for fractionated radiation therapy in head and neck cancer patients. Position verifications in patients treated with carbon ion therapy and IMRT for head and neck malignancies were evaluated. Most patients received combined treatment regimen (IMRT plus carbon ion boost), immobilization was achieved with either Scotchcast or thermoplastic head masks. Position corrections in robotic-based carbon ion therapy allowing 6 DOF were compared to IMRT allowing corrections in 3 DOF for two standard immobilization devices. In total, 838 set-up controls of 38 patients were analyzed. Robotic-based position correction including correction of rotations was well tolerated and without discomfort. Standard deviations of translational components were between 0.5 and 0.8 mm for Scotchcast and 0.7 and 1.3 mm for thermoplastic masks in 6 DOF and 1.2-1.4 mm and 1.0-1.1 mm in 3 DOF respectively. Mean overall displacement vectors were between 2.1 mm (Scotchcast) and 2.9 mm (thermoplastic masks) in 6 DOF and 3.9-3.0 mm in 3 DOF respectively. Displacement vectors were lower when correction in 6 DOF was allowed as opposed to 3 DOF only, which was maintained at the traditional action level of >3 mm for position correction in the pre-on-board imaging era. Setup accuracy for both systems was within the expected range. Smaller shifts were required when 6 DOF were available for correction as opposed to 3 DOF. Where highest possible positioning accuracy is required, frequent image guidance is mandatory to achieve best possible plan delivery and maintenance of sharp gradients and optimal normal tissue sparing inherent in carbon ion therapy.

Global patient safety and antiretroviral drug-drug interactions in the resource-limited setting.

Science.gov (United States)

Seden, Kay; Khoo, Saye H; Back, David; Byakika-Kibwika, Pauline; Lamorde, Mohammed; Ryan, Mairin; Merry, Concepta

2013-01-01

Scale-up of HIV treatment services may have contributed to an increase in functional health facilities available in resource-limited settings and an increase in patient use of facilities and retention in care. As more patients are reached with medicines, monitoring patient safety is increasingly important. Limited data from resource-limited settings suggest that medication error and antiretroviral drug-drug interactions may pose a significant risk to patient safety. Commonly cited causes of medication error in the developed world include the speed and complexity of the medication use cycle combined with inadequate systems and processes. In resource-limited settings, specific factors may contribute, such as inadequate human resources and high disease burden. Management of drug-drug interactions may be complicated by limited access to alternative medicines or laboratory monitoring. Improving patient safety by addressing the issue of antiretroviral drug-drug interactions has the potential not just to improve healthcare for individuals, but also to strengthen health systems and improve vital communication among healthcare providers and with regulatory agencies.

Setting up a parathyroid multidisciplinary team meeting: one year's experience, outcomes and learning points.

Science.gov (United States)

Hancox, S H; Sinnott, J D; Kirkland, P; Lipscomb, D; Owens, E; Howlett, D C

2018-03-01

A parathyroid multidisciplinary team meeting was set up at East Sussex Healthcare Trust, from November 2014 to November 2015, in order to improve and streamline services for patients with parathyroid pathology. Data were collected on all new referrals for hyperparathyroidism, and on the outcomes for each patient discussed at the meeting, including the number of operations and management outcomes. A survey was sent out to the members of the multidisciplinary team meeting to determine their perception of its effectiveness. Seventy-nine new referrals were discussed throughout the year; 43 per cent were recommended for surgery, 41 per cent had a trial of conservative or medical management before re-discussion, and 16 per cent required further imaging. Ninety-two per cent of patients underwent an ultrasound, single-photon emission computed tomography/computed tomography or nuclear medicine (sestamibi) scan prior to the meeting. All ultrasound scans were performed by a consultant radiologist. The multidisciplinary team meeting has been successful, with perceived benefits for patients, improved imaging evaluation and efficiency of referral pathways, leading to more appropriate patient management.

Diagnostic test accuracy of nutritional tools used to identify undernutrition in patients with colorectal cancer: a systematic review.

Science.gov (United States)

Håkonsen, Sasja Jul; Pedersen, Preben Ulrich; Bath-Hextall, Fiona; Kirkpatrick, Pamela

2015-05-15

Effective nutritional screening, nutritional care planning and nutritional support are essential in all settings, and there is no doubt that a health service seeking to increase safety and clinical effectiveness must take nutritional care seriously. Screening and early detection of malnutrition is crucial in identifying patients at nutritional risk. There is a high prevalence of malnutrition in hospitalized patients undergoing treatment for colorectal cancer. To synthesize the best available evidence regarding the diagnostic test accuracy of nutritional tools (sensitivity and specificity) used to identify malnutrition (specifically undernutrition) in patients with colorectal cancer (such as the Malnutrition Screening Tool and Nutritional Risk Index) compared to reference tests (such as the Subjective Global Assessment or Patient Generated Subjective Global Assessment). Patients with colorectal cancer requiring either (or all) surgery, chemotherapy and/or radiotherapy in secondary care. Focus of the review: The diagnostic test accuracy of validated assessment tools/instruments (such as the Malnutrition Screening Tool and Nutritional Risk Index) in the diagnosis of malnutrition (specifically under-nutrition) in patients with colorectal cancer, relative to reference tests (Subjective Global Assessment or Patient Generated Subjective Global Assessment). Types of studies: Diagnostic test accuracy studies regardless of study design. Studies published in English, German, Danish, Swedish and Norwegian were considered for inclusion in this review. Databases were searched from their inception to April 2014. Methodological quality was determined using the Quality Assessment of Diagnostic Accuracy Studies checklist. Data was collected using the data extraction form: the Standards for Reporting Studies of Diagnostic Accuracy checklist for the reporting of studies of diagnostic accuracy. The accuracy of diagnostic tests is presented in terms of sensitivity, specificity, positive

SU-C-204-06: Surface Imaging for the Set-Up of Proton Post-Mastectomy Chestwall Irradiation: Gated Images Vs Non Gated Images

Energy Technology Data Exchange (ETDEWEB)

Batin, E; Depauw, N; MacDonald, S; Lu, H [Massachusetts General Hospital, Boston, MA (United States)

2015-06-15

Purpose: Historically, the set-up for proton post-mastectomy chestwall irradiation at our institution started with positioning the patient using tattoos and lasers. One or more rounds of orthogonal X-rays at gantry 0° and beamline X-ray at treatment gantry angle were then taken to finalize the set-up position. As chestwall targets are shallow and superficial, surface imaging is a promising tool for set-up and needs to be investigated Methods: The orthogonal imaging was entirely replaced by AlignRT™ (ART) images. The beamline X-Ray image is kept as a confirmation, based primarily on three opaque markers placed on skin surface instead of bony anatomy. In the first phase of the process, ART gated images were used to set-up the patient and the same specific point of the breathing curve was used every day. The moves (translations and rotations) computed for each point of the breathing curve during the first five fractions were analyzed for ten patients. During a second phase of the study, ART gated images were replaced by ART non-gated images combined with real-time monitoring. In both cases, ART images were acquired just before treatment to access the patient position compare to the non-gated CT. Results: The average difference between the maximum move and the minimum move depending on the chosen breathing curve point was less than 1.7 mm for all translations and less than 0.7° for all rotations. The average position discrepancy over the course of treatment obtained by ART non gated images combined to real-time monitoring taken before treatment to the planning CT were smaller than the average position discrepancy obtained using ART gated images. The X-Ray validation images show similar results with both ART imaging process. Conclusion: The use of ART non gated images combined with real time imaging allows positioning post-mastectomy chestwall patients in less than 3 mm / 1°.

SU-C-204-06: Surface Imaging for the Set-Up of Proton Post-Mastectomy Chestwall Irradiation: Gated Images Vs Non Gated Images

International Nuclear Information System (INIS)

Batin, E; Depauw, N; MacDonald, S; Lu, H

2015-01-01

Purpose: Historically, the set-up for proton post-mastectomy chestwall irradiation at our institution started with positioning the patient using tattoos and lasers. One or more rounds of orthogonal X-rays at gantry 0° and beamline X-ray at treatment gantry angle were then taken to finalize the set-up position. As chestwall targets are shallow and superficial, surface imaging is a promising tool for set-up and needs to be investigated Methods: The orthogonal imaging was entirely replaced by AlignRT™ (ART) images. The beamline X-Ray image is kept as a confirmation, based primarily on three opaque markers placed on skin surface instead of bony anatomy. In the first phase of the process, ART gated images were used to set-up the patient and the same specific point of the breathing curve was used every day. The moves (translations and rotations) computed for each point of the breathing curve during the first five fractions were analyzed for ten patients. During a second phase of the study, ART gated images were replaced by ART non-gated images combined with real-time monitoring. In both cases, ART images were acquired just before treatment to access the patient position compare to the non-gated CT. Results: The average difference between the maximum move and the minimum move depending on the chosen breathing curve point was less than 1.7 mm for all translations and less than 0.7° for all rotations. The average position discrepancy over the course of treatment obtained by ART non gated images combined to real-time monitoring taken before treatment to the planning CT were smaller than the average position discrepancy obtained using ART gated images. The X-Ray validation images show similar results with both ART imaging process. Conclusion: The use of ART non gated images combined with real time imaging allows positioning post-mastectomy chestwall patients in less than 3 mm / 1°

Improving beam set-up using an online beam optics tool

International Nuclear Information System (INIS)

Richter, S.; Barth, W.; Franczak, B.; Scheeler, U.; Wilms, D.

2004-01-01

The GSI accelerator facility [1] consists of the Universal Linear Accelerator (Unilac), the heavy ion synchrotron SIS, and the Experimental Storage Ring (ESR). Two Unilac injectors with three ion source terminals provide ion species from the lightest such as hydrogen up to uranium. The High Current Injector (HSI) for low charge state ion beams provides mostly high intense but short pulses, whereas the High Charge State Injector (HLI) supplies long pulses with a high duty factor of up to 27%. Before entering the Alvarez section of the Unilac the ion beam from the HSI is stripped in a supersonic gas jet. Up to three different ion species can be accelerated for up to five experiments in a time-sharing mode. Frequent changes of beam energy and intensity during a single beam time period may result in time consuming set-up and tuning especially of the beam transport lines. To shorten these changeover times an online optics tool (MIRKO EXPERT) had been developed. Based on online emittance measurements at well-defined locations the beam envelopes are calculated using the actual magnet settings. With this input improved calculated magnet settings can be directly sent to the magnet power supplies. The program reads profile grid measurements, such that an atomized beam alignment is established and that steering times are minimized. Experiences on this tool will be reported. At the Unilac a special focus is put on high current operation with short but intense beam pulses. Limitations like missing non-destructive beam diagnostics, insufficient longitudinal beam diagnostics, insufficient longitudinal beam matching, and influence of the hard edged model for magnetic fields will be discussed. Special attention will be put on the limits due to high current effects with bunched beams. (author)

Impact of the diagnostic process on the accuracy of source identification and time to antibiotics in septic emergency department patients.

Science.gov (United States)

Uittenbogaard, Annemieke J M; de Deckere, Ernie R J T; Sandel, Maro H; Vis, Alice; Houser, Christine M; de Groot, Bas

2014-06-01

Timely administration of effective antibiotics is important in sepsis management. Source-targeted antibiotics are believed to be most effective, but source identification could cause time delays. First, to describe the accuracy/time delays of a diagnostic work-up and the association with time to antibiotics in septic emergency department (ED) patients. Second, to assess the fraction in which source-targeted antibiotics could have been administered solely on the basis of patient history and physical examination. Secondary analysis of the prospective observational study on septic ED patients was carried out. The time to test result availability was associated with time to antibiotics. The accuracy of the suspected source of infection in the ED was assessed. For patients with pneumosepsis, urosepsis, and abdominal sepsis, combinations of signs and symptoms were assessed to achieve a maximal positive predictive value for the sepsis source, identifying a subset of patients in whom source-targeted antibiotics could be administered without waiting for diagnostic test results. The time to antibiotics increased by 18 (95% confidence interval: 12-24) min/h delay in test result availability (n=323). In 38-79% of patients, antibiotics were administered after additional tests, whereas the ED diagnosis was correct in 68-85% of patients. The maximal positive predictive value of signs and symptoms was 0.87 for patients with pneumosepsis and urosepsis and 0.75 for those with abdominal sepsis. Use of signs and symptoms would have led to correct ED diagnosis in 33% of patients. Diagnostic tests are associated with delayed administration of antibiotics to septic ED patients while increasing the diagnostic accuracy to only 68-85%. In one-third of septic ED patients, the choice of antibiotics could have been accurately determined solely on the basis of patient history and physical examination.

Accuracy of MFCC-Based Speaker Recognition in Series 60 Device

Directory of Open Access Journals (Sweden)

Pasi Fränti

2005-10-01

Full Text Available A fixed point implementation of speaker recognition based on MFCC signal processing is considered. We analyze the numerical error of the MFCC and its effect on the recognition accuracy. Techniques to reduce the information loss in a converted fixed point implementation are introduced. We increase the signal processing accuracy by adjusting the ratio of presentation accuracy of the operators and the signal. The signal processing error is found out to be more important to the speaker recognition accuracy than the error in the classification algorithm. The results are verified by applying the alternative technique to speech data. We also discuss the specific programming requirements set up by the Symbian and Series 60.

Assessment of three-dimensional set-up errors in conventional head and neck radiotherapy using electronic portal imaging device

International Nuclear Information System (INIS)

Gupta, Tejpal; Chopra, Supriya; Kadam, Avinash; Agarwal, Jai Prakash; Devi, P Reena; Ghosh-Laskar, Sarbani; Dinshaw, Ketayun Ardeshir

2007-01-01

Set-up errors are an inherent part of radiation treatment process. Coverage of target volume is a direct function of set-up margins, which should be optimized to prevent inadvertent irradiation of adjacent normal tissues. The aim of this study was to evaluate three-dimensional (3D) set-up errors and propose optimum margins for target volume coverage in head and neck radiotherapy. The dataset consisted of 93 pairs of orthogonal simulator and corresponding portal images on which 558 point positions were measured to calculate translational displacement in 25 patients undergoing conventional head and neck radiotherapy with antero-lateral wedge pair technique. Mean displacements, population systematic (Σ) and random (σ) errors and 3D vector of displacement was calculated. Set-up margins were calculated using published margin recipes. The mean displacement in antero-posterior (AP), medio-lateral (ML) and supero-inferior (SI) direction was -0.25 mm (-6.50 to +7.70 mm), -0.48 mm (-5.50 to +7.80 mm) and +0.45 mm (-7.30 to +7.40 mm) respectively. Ninety three percent of the displacements were within 5 mm in all three cardinal directions. Population systematic (Σ) and random errors (σ) were 0.96, 0.98 and 1.20 mm and 1.94, 1.97 and 2.48 mm in AP, ML and SI direction respectively. The mean 3D vector of displacement was 3.84 cm. Using van Herk's formula, the clinical target volume to planning target volume margins were 3.76, 3.83 and 4.74 mm in AP, ML and SI direction respectively. The present study report compares well with published set-up error data relevant to head and neck radiotherapy practice. The set-up margins were <5 mm in all directions. Caution is warranted against adopting generic margin recipes as different margin generating recipes lead to a different probability of target volume coverage

Whole body MRI, including diffusion-weighted imaging in follow-up of patients with testicular cancer.

Science.gov (United States)

Mosavi, Firas; Laurell, Anna; Ahlström, Håkan

2015-11-01

Whole body (WB) magnetic resonance imaging (MRI), including diffusion-weighted imaging (DWI) has become increasingly utilized in cancer imaging, yet the clinical utility of these techniques in follow-up of testicular cancer patients has not been evaluated. The purpose of this study was to evaluate the feasibility of WB MRI with continuous table movement (CTM) technique, including multistep DWI in follow-up of patients with testicular cancer. WB MRI including DWI was performed in follow-up of 71 consecutive patients (median age, 37 years; range 19-84) with histologically confirmed testicular cancer. WB MRI protocol included axial T1-Dixon and T2-BLADE sequences using CTM technique. Furthermore, multi-step DWI was performed using b-value 50 and 1000 s/mm(2). One criterion for feasibility was patient tolerance and satisfactory image quality. Another criterion was the accuracy in detection of any pathological mass, compared to standard of reference. Signal intensity in DWI was used for evaluation of residual mass activity. Clinical, laboratory and imaging follow-up were applied as standard of reference for the evaluation of WB MRI. WB MRI was tolerated in nearly all patients (69/71 patients, 97%) and the image quality was satisfactory. Metal artifacts deteriorated the image quality in six patients, but it did not influence the overall results. No case of clinical relapse was observed during the follow-up time. There was a good agreement between conventional WB MRI and standard of reference in all patients. Three patients showed residual masses and DWI signal was not restricted in these patients. Furthermore, DWI showed abnormally high signal intensity in a normal-sized retroperitoneal lymph node indicating metastasis. The subsequent (18)F-FDG PET/CT could verify the finding. WB MRI with CTM technique including multi-step DWI is feasible in follow-up of patients with testicular cancer. DWI may contribute to important added-value data to conventional MRI sequences

Accuracy of Inferior Vena Cava Ultrasound for Predicting Dehydration in Children with Acute Diarrhea in Resource-Limited Settings.

Science.gov (United States)

Modi, Payal; Glavis-Bloom, Justin; Nasrin, Sabiha; Guy, Allysia; Chowa, Erika P; Dvor, Nathan; Dworkis, Daniel A; Oh, Michael; Silvestri, David M; Strasberg, Stephen; Rege, Soham; Noble, Vicki E; Alam, Nur H; Levine, Adam C

2016-01-01

Although dehydration from diarrhea is a leading cause of morbidity and mortality in children under five, existing methods of assessing dehydration status in children have limited accuracy. To assess the accuracy of point-of-care ultrasound measurement of the aorta-to-IVC ratio as a predictor of dehydration in children. A prospective cohort study of children under five years with acute diarrhea was conducted in the rehydration unit of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Ultrasound measurements of aorta-to-IVC ratio and dehydrated weight were obtained on patient arrival. Percent weight change was monitored during rehydration to classify children as having "some dehydration" with weight change 3-9% or "severe dehydration" with weight change > 9%. Logistic regression analysis and Receiver-Operator Characteristic (ROC) curves were used to evaluate the accuracy of aorta-to-IVC ratio as a predictor of dehydration severity. 850 children were enrolled, of which 771 were included in the final analysis. Aorta to IVC ratio was a significant predictor of the percent dehydration in children with acute diarrhea, with each 1-point increase in the aorta to IVC ratio predicting a 1.1% increase in the percent dehydration of the child. However, the area under the ROC curve (0.60), sensitivity (67%), and specificity (49%), for predicting severe dehydration were all poor. Point-of-care ultrasound of the aorta-to-IVC ratio was statistically associated with volume status, but was not accurate enough to be used as an independent screening tool for dehydration in children under five years presenting with acute diarrhea in a resource-limited setting.

Accuracy of Inferior Vena Cava Ultrasound for Predicting Dehydration in Children with Acute Diarrhea in Resource-Limited Settings.

Directory of Open Access Journals (Sweden)

Payal Modi

Full Text Available Although dehydration from diarrhea is a leading cause of morbidity and mortality in children under five, existing methods of assessing dehydration status in children have limited accuracy.To assess the accuracy of point-of-care ultrasound measurement of the aorta-to-IVC ratio as a predictor of dehydration in children.A prospective cohort study of children under five years with acute diarrhea was conducted in the rehydration unit of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b. Ultrasound measurements of aorta-to-IVC ratio and dehydrated weight were obtained on patient arrival. Percent weight change was monitored during rehydration to classify children as having "some dehydration" with weight change 3-9% or "severe dehydration" with weight change > 9%. Logistic regression analysis and Receiver-Operator Characteristic (ROC curves were used to evaluate the accuracy of aorta-to-IVC ratio as a predictor of dehydration severity.850 children were enrolled, of which 771 were included in the final analysis. Aorta to IVC ratio was a significant predictor of the percent dehydration in children with acute diarrhea, with each 1-point increase in the aorta to IVC ratio predicting a 1.1% increase in the percent dehydration of the child. However, the area under the ROC curve (0.60, sensitivity (67%, and specificity (49%, for predicting severe dehydration were all poor.Point-of-care ultrasound of the aorta-to-IVC ratio was statistically associated with volume status, but was not accurate enough to be used as an independent screening tool for dehydration in children under five years presenting with acute diarrhea in a resource-limited setting.

Challenges in setting up quality control in diagnostic radiology ...

African Journals Online (AJOL)

Journal Home > Vol 24, No 4 (2015) >. Log in or ... Quality control (QC) on diagnostic radiology equipment form part of the fundamental requirements for the ... Inadequate cooperation by facilities management, lack of QC equipment and insufficient staff form the major challenges in setting up QC in the facilities under study.

Treatment accuracy of fractionated stereotactic radiotherapy

International Nuclear Information System (INIS)

Kumar, Shaleen; Burke, Kevin; Nalder, Colin; Jarrett, Paula; Mubata, Cephas; A'Hern, Roger; Humphreys, Mandy; Bidmead, Margaret; Brada, Michael

2005-01-01

Background and purpose: To assess the geometric accuracy of the delivery of fractionated stereotactic radiotherapy (FSRT) for brain tumours using the Gill-Thomas-Cosman (GTC) relocatable frame. Accuracy of treatment delivery was measured via portal images acquired with an amorphous silicon based electronic portal imager (EPI). Results were used to assess the existing verification process and to review the current margins used for the expansion of clinical target volume (CTV) to planning target volume (PTV). Patients and methods: Patients were immobilized in a GTC frame. Target volume definition was performed on localization CT and MRI scans and a CTV to PTV margin of 5 mm (based on initial experience) was introduced in 3D. A Brown-Roberts-Wells (BRW) fiducial system was used for stereotactic coordinate definition. The existing verification process consisted of an intercomparison of the coordinates of the isocentres and anatomy between the localization and verification CT scans. Treatment was delivered with 6 MV photons using four fixed non-coplanar conformal fields using a multi-leaf collimator. Portal imaging verification consisted of the acquisition of orthogonal images centred through the treatment isocentre. Digitally reconstructed radiographs (DRRs) created from the CT localization scans were used as reference images. Semi-automated matching software was used to quantify set up deviations (displacements and rotations) between reference and portal images. Results: One hundred and twenty six anterior and 123 lateral portal images were available for analysis for set up deviations. For displacements, the total errors in the cranial/caudal direction were shown to have the largest SD's of 1.2 mm, while systematic and random errors reached SD's of 1.0 and 0.7 mm, respectively, in the cranial/caudal direction. The corresponding data for rotational errors (the largest deviation was found in the sagittal plane) was 0.7 deg. SD (total error), 0.5 deg. (systematic) and 0

[Guidelines for the follow up of patients with bronchopulmonary dysplasia].

Science.gov (United States)

Pérez Tarazona, S; Rueda Esteban, S; Alfonso Diego, J; Barrio Gómez de Agüero, M I; Callejón Callejón, A; Cortell Aznar, I; de la Serna Blázquez, O; Domingo Miró, X; García García, M L; García Hernández, G; Luna Paredes, C; Mesa Medina, O; Moreno Galdó, A; Moreno Requena, L; Pérez Pérez, G; Salcedo Posadas, A; Sánchez Solís de Querol, M; Torrent Vernetta, A; Valdesoiro Navarrete, L; Vilella Sabaté, M

2016-01-01

Bronchopulmonary dysplasia (BPD) is the most common complication of preterm birth, and remains a major problem in pediatric pulmonology units. The decision of discharging from the Neonatal Unit should be based on a thorough assessment of the condition of the patient and compliance with certain requirements, including respiratory and nutritional stability, and caregiver education on disease management. For proper control of the disease, a schedule of visits and complementary tests should be established prior to discharge, and guidelines for prevention of exacerbations and appropriate treatment should be applied. In this paper, the Working Group in Perinatal Respiratory Diseases of the Spanish Society of Pediatric Pulmonology proposes a protocol to serve as a reference for the follow up of patients with BPD among different centers and health care settings. Key factors to consider when planning discharge from the Neonatal Unit and during follow up are reviewed. Recommendations on treatment and prevention of complications are then discussed. The final section of this guide aims to provide a specific schedule for follow-up and diagnostic interventions to be performed in patients with BPD. Copyright © 2015 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

Diagnostic Accuracy of Tests for Polyuria in Lithium-Treated Patients.

Science.gov (United States)

Kinahan, James Conor; NiChorcorain, Aoife; Cunningham, Sean; Freyne, Aideen; Cooney, Colm; Barry, Siobhan; Kelly, Brendan D

2015-08-01

In lithium-treated patients, polyuria increases the risk of dehydration and lithium toxicity. If detected early, it is reversible. Despite its prevalence and associated morbidity in clinical practice, it remains underrecognized and therefore undertreated. The 24-hour urine collection is limited by its convenience and practicality. This study explores the diagnostic accuracy of alternative tests such as questionnaires on subjective polyuria, polydipsia, nocturia (dichotomous and ordinal responses), early morning urine sample osmolality (EMUO), and fluid intake record (FIR). This is a cross-sectional study of 179 lithium-treated patients attending a general adult and an old age psychiatry service. Participants completed the tests after completing an accurate 24-hour urine collection. The diagnostic accuracy of the individual tests was explored using the appropriate statistical techniques. Seventy-nine participants completed all of the tests. Polydipsia severity, EMUO, and FIR significantly differentiated the participants with polyuria (area under the receiver operating characteristic curve of 0.646, 0.760, and 0.846, respectively). Of the tests investigated, the FIR made the largest significant change in the probability that a patient experiences polyuria (3500 mL/24 hours; interval likelihood ratio, 14). Symptomatic questioning, EMUO, and an FIR could be used in clinical practice to inform the prescriber of the probability that a lithium-treated patient is experiencing polyuria.

Dr Google: The readability and accuracy of patient education websites for Graves' disease treatment.

Science.gov (United States)

Purdy, Amanda C; Idriss, Almoatazbellah; Ahern, Susan; Lin, Elizabeth; Elfenbein, Dawn M

2017-11-01

National guidelines emphasize the importance of incorporating patient preferences into the recommendations for the treatment of Graves' disease. Many patients use the Internet to obtain health information, and search results can affect their treatment decisions. This study compares the readability and accuracy of patient-oriented online resources for the treatment of Graves' disease by website affiliation and treatment modality. A systematic Internet search was used to identify the top websites discussing the treatment of Graves' disease. Readability was measured using 5 standardized tests. Accuracy was assessed by a blinded, expert panel, which scored the accuracy of sites on a scale of 1 to 5. Mean readability and accuracy scores were compared among website affiliations and treatment modalities. We identified 13 unique websites, including 2 academic, 2 government, 5 nonprofit, and 4 private sites. There was a difference in both readability (mean 13.2, range 9.1-15.7, P = .003) and accuracy (mean 4.04, range 2.75-4.50, P = .019) based on website affiliation. Government sites (mean readability 11.1) were easier to read than academic (14.3, P < .01), nonprofit (13.9, P < .01), and private sites (13.5, P < .05). Academic sites (mean accuracy 4.50) were more accurate than private sites (3.56, P < .05). Online patient resources for the treatment of Graves' disease are written at an inappropriately high reading level. Academic sites contain both the most accurate and the most difficult to read information. Private sites represented the majority of our top results but contained the least accurate information. Copyright © 2017 Elsevier Inc. All rights reserved.

Accuracy and Quality of Spirometry in Primary Care Offices.

Science.gov (United States)

Hegewald, Matthew J; Gallo, Heather M; Wilson, Emily L

2016-12-01

Spirometry is necessary for the optimal management of patients with respiratory disease. The quality of spirometry performed in the primary care setting has been inconsistent. We aimed to evaluate spirometer accuracy, determine the clinical significance of inaccurate spirometers, and assess the quality of spirograms obtained in primary care offices. We tested 17 spirometers used in primary care offices with a waveform generator; accuracy and precision were assessed using American Thoracic Society criteria. The clinical significance of inaccurate instruments was determined by applying the FEV 1 /FVC error from an obstructed waveform to a clinical data set. Spirogram quality was determined by grading spirograms using acceptability and repeatability criteria. The relationship between the number of tests performed by a clinic and test quality was assessed. Only 1 of 17 spirometers met accuracy criteria, with mean errors for FVC, FEV 1 , and FEV 1 /FVC ranging from 1.7 to 3.1%. Applying the percentage error to a clinical data set resulted in 28% of tests being recategorized from obstructed to nonobstructed. Of the spirograms reviewed, 60% were considered acceptable for clinical use. There was no association between the number of tests performed by a clinic and spirometry quality. Most spirometers tested were not accurate. The magnitude of the errors resulted in significant changes in the categorization of patients with obstruction. Acceptable-quality tests were produced for only 60% of patients. Our results raise concerns regarding the utility of spirometry obtained in primary care offices without greater attention to quality assurance and training.

Ready for goal setting? Process evaluation of a patient-specific goal-setting method in physiotherapy.

Science.gov (United States)

Stevens, Anita; Köke, Albère; van der Weijden, Trudy; Beurskens, Anna

2017-08-31

Patient participation and goal setting appear to be difficult in daily physiotherapy practice, and practical methods are lacking. An existing patient-specific instrument, Patient-Specific Complaints (PSC), was therefore optimized into a new Patient Specific Goal-setting method (PSG). The aims of this study were to examine the feasibility of the PSG in daily physiotherapy practice, and to explore the potential impact of the new method. We conducted a process evaluation within a non-controlled intervention study. Community-based physiotherapists were instructed on how to work with the PSG in three group training sessions. The PSG is a six-step method embedded across the physiotherapy process, in which patients are stimulated to participate in the goal-setting process by: identifying problematic activities, prioritizing them, scoring their abilities, setting goals, planning and evaluating. Quantitative and qualitative data were collected among patients and physiotherapists by recording consultations and assessing patient files, questionnaires and written reflection reports. Data were collected from 51 physiotherapists and 218 patients, and 38 recordings and 219 patient files were analysed. The PSG steps were performed as intended, but the 'setting goals' and 'planning treatment' steps were not performed in detail. The patients and physiotherapists were positive about the method, and the physiotherapists perceived increased patient participation. They became aware of the importance of engaging patients in a dialogue, instead of focusing on gathering information. The lack of integration in the electronic patient system was a major barrier for optimal use in practice. Although the self-reported actual use of the PSG, i.e. informing and involving patients, and client-centred competences had improved, this was not completely confirmed by the objectively observed behaviour. The PSG is a feasible method and tends to have impact on increasing patient participation in the goal-setting

Diagnostic accuracy and treatment management of depression in elderly primary care patients.

NARCIS (Netherlands)

Volkers, A.C.; Nuyen, J.; Verhaak, P.F.M.; Schellevis, F.G.

2003-01-01

Background: The negative impact of major depression on the risk of somatic diseases, mortality and social functioning is prominent in elderly patients. Aim: We investigated how accurately general practitioners (GPs) diagnose depression in old age and if diagnostic accuracy is related to patient and

Diagnostic accuracy of surgeons and trainees in assessment of patients with acute abdominal pain.

Science.gov (United States)

2016-09-01

Diagnostic accuracy in the assessment of patients with acute abdominal pain in the emergency ward is not adequate. It has been argued that this is because the investigations are carried out predominantly by a trainee. Resource utilization could be lowered if surgeons had a higher initial diagnostic accuracy. Patients with acute abdominal pain were included in a prospective cohort study. A surgical trainee and a surgeon made independent assessments in the emergency department, recording the clinical diagnosis and proposed diagnostic investigations. A reference standard diagnosis was established by an expert panel, and the proportion of correct diagnoses was calculated. Diagnostic accuracy was expressed in terms of sensitivity, specificity, positive predictive value and negative predictive value. Interobserver agreement for the diagnosis and elements of history-taking and physical examination were expressed by means of Cohen's κ. Certainty of diagnosis was recorded using a visual analogue scale. A trainee and a surgeon independently assessed 126 patients. Trainees made a correct diagnosis in 44·4 per cent of patients and surgeons in 42·9 per cent (P = 0·839). Surgeons, however, recorded a higher level of diagnostic certainty. Diagnostic accuracy was comparable in distinguishing urgent from non-urgent diagnoses, and for the most common diseases. Interobserver agreement for the clinical diagnosis varied from fair to moderate (κ = 0·28-0·57). The diagnostic accuracy of the initial clinical assessment is not improved when a surgeon rather than a surgical trainee assesses a patient with abdominal pain in the emergency department. © 2016 BJS Society Ltd Published by John Wiley & Sons Ltd.

Market and Impact Study Setting Up MMX Discount Store

OpenAIRE

Sabina Irimie; Andreea Ionică; Virginia Băleanu; Cristina Osvath

2008-01-01

The paper is focused on the following elements of the impact study’s content: social and economic features of the area and the social, economic and commercial impact. Currently we witness the materialisation of the research’s results by setting up such a store MMX DISCOUNT in the town of Vulcan from the Jiu Valley

A HPMT based set-up to characterize scintillating crystals

International Nuclear Information System (INIS)

D'Ambrosio, C.; Ercoli, C.; Jaaskelainen, S.; Lecoeur, G.; Leutz, H.; Loos, R.; Piedigrossi, D.; Puertolas, D.; Rosso, E.; Schomaker, R.

1999-01-01

We have developed a fully automatic measurement set-up, capable of measuring light yields arising from scintillating crystals in a linear range of about four orders of magnitude. The photodetector is a hybrid photomultiplier tube specially developed to optimize linear range and photon detection. Crystal and photodetector are temperature controlled by a closed water circuit, as this is essential when measuring low light yield scintillating crystals with a marked temperature dependence of their light yield. Gamma sources can be placed either on top or on the side of the crystal. In this latter case, the source can be automatically moved by a computer-controlled step motor to provide a uniformity profile of the light yield along the crystal. Tagged and not-tagged operation modes are possible. The whole set-up is computer-controlled in an effort to provide fast and reliable measurements, to characterize many crystals per day. This is important for the quality control of the lead tungstate crystals that will be applied in the electromagnetic calorimeter of the CMS-detector at the LHC at CERN. (author)

A HPMT based set-up to characterize scintillating crystals

Energy Technology Data Exchange (ETDEWEB)

D' Ambrosio, C.; Ercoli, C.; Jaaskelainen, S.; Lecoeur, G.; Leutz, H.; Loos, R.; Piedigrossi, D.; Puertolas, D.; Rosso, E.; Schomaker, R

1999-09-21

We have developed a fully automatic measurement set-up, capable of measuring light yields arising from scintillating crystals in a linear range of about four orders of magnitude. The photodetector is a hybrid photomultiplier tube specially developed to optimize linear range and photon detection. Crystal and photodetector are temperature controlled by a closed water circuit, as this is essential when measuring low light yield scintillating crystals with a marked temperature dependence of their light yield. Gamma sources can be placed either on top or on the side of the crystal. In this latter case, the source can be automatically moved by a computer-controlled step motor to provide a uniformity profile of the light yield along the crystal. Tagged and not-tagged operation modes are possible. The whole set-up is computer-controlled in an effort to provide fast and reliable measurements, to characterize many crystals per day. This is important for the quality control of the lead tungstate crystals that will be applied in the electromagnetic calorimeter of the CMS-detector at the LHC at CERN. (author)

Diagnostic accuracy of 18F-FDG PET/CT for detection of suspected recurrence in patients with oesophageal carcinoma

International Nuclear Information System (INIS)

Sharma, Punit; Jain, Sachin; Karunanithi, Sellam; Malhotra, Arun; Bal, Chandrasekhar; Kumar, Rakesh; Pal, Sujoy; Julka, Pramod Kumar; Thulkar, Sanjay

2014-01-01

To evaluate the role of 18 F-FDG PET/CT in the detection of recurrence in patients with oesophageal carcinoma, suspected clinically or following conventional investigations. This was a retrospective study. Data from 180 patients (age 56.3 ± 10.4 years; 126 men, 54 women) with histopathologically proven oesophageal carcinoma (squamous cell 115, adenocarcinoma 59, neuroendocrine carcinoma 4, small cell 1, poorly differentiated 1) who had undergone 227 18 F-FDG PET/CT studies for suspected recurrence were analysed. Recurrence was suspected clinically or following conventional investigations. PET/CT images were revaluated by two nuclear medicine physicians in consensus. Findings were grouped into local, nodal and distant recurrence. Results were compared to those from contrast-enhanced (CE) CT when available (109 patients). Clinical/imaging follow-up (minimum 6 months) with histopathology (when available) was taken as the reference standard. Of the 227 18 F-FDG PET/CT studies,166 were positive and 61 were negative for recurrent disease. PET/CT showed local recurrence in 134, nodal recurrence in 115 and distant recurrence in 47, with more than one site of recurrence in 34. The PET/CT findings were true-positive in 153 studies, true-negative in 54, false-positive in 13 and false-negative in 7. The sensitivity of 18 F-FDG PET/CT was 96 %, the specificity was 81 %, the positive and negative predictive values were 92 % and 89 %, respectively, and the accuracy was 91 %. PET/CT showed similar accuracy in patients with squamous cell carcinoma and in those with adenocarcinoma (P = 0.181). 18 F-FDG PET/CT was more specific than CECT (67 % vs. 21 %; P 18 F-FDG PET/CT shows high accuracy in the detection of suspected recurrence in patients with oesophageal carcinoma. It is more specific than and is superior to CECT in the detection of nodal recurrence. (orig.)

Magnetic spectrometer of the DEUTERON-2 set-up

International Nuclear Information System (INIS)

Ajvazyan, R.V.; Alanakyan, K.V.; Amaryan, M.J.

1989-01-01

A magnetic spectrometer of the two-arm DEUTERON-2 set-up of the Erevan Physical Institute is described. It is shown that the rejection factor for electrons and pions is 10 -2 - 10 -3 . The positively charged particles in the momentum range up to 1.5 GeV/c are identified by momentum and time-of-flight measurements. The main characteristics of the spectrometer are: momentum and angular acceptance δp/p = 46%, Δθ = 4 deg, solid angle ΔΩ = 2.75 msr, momentum resolution δp/p = 1.5%, angular resolutions δθ = 0.6 deg, δφ = 2 deg. The intervals of measured momentum and the polar scattering anlge are 0.5-3 GeV/c and 10-30 deg, 68-90 deg respectively. 7 refs.; 11 figs

A review on the processing accuracy of two-photon polymerization

Directory of Open Access Journals (Sweden)

Xiaoqin Zhou

2015-03-01

Full Text Available Two-photon polymerization (TPP is a powerful and potential technology to fabricate true three-dimensional (3D micro/nanostructures of various materials with subdiffraction-limit resolution. And it has been applied to microoptics, electronics, communications, biomedicine, microfluidic devices, MEMS and metamaterials. These applications, such as microoptics and photon crystals, put forward rigorous requirements on the processing accuracy of TPP, including the dimensional accuracy, shape accuracy and surface roughness and the processing accuracy influences their performance, even invalidate them. In order to fabricate precise 3D micro/nanostructures, the factors influencing the processing accuracy need to be considered comprehensively and systematically. In this paper, we review the basis of TPP micro/nanofabrication, including mechanism of TPP, experimental set-up for TPP and scaling laws of resolution of TPP. Then, we discuss the factors influencing the processing accuracy. Finally, we summarize the methods reported lately to improve the processing accuracy from improving the resolution and changing spatial arrangement of voxels.

A review on the processing accuracy of two-photon polymerization

Energy Technology Data Exchange (ETDEWEB)

Zhou, Xiaoqin; Hou, Yihong [School of Mechanical Science and Engineering, Jilin University, Changchun, 130022 (China); Lin, Jieqiong, E-mail: linjieqiong@mail.ccut.edu.cn [School of Electromechanical Engineering, Changchun University of Technology, Changchun, 130012 (China)

2015-03-15

Two-photon polymerization (TPP) is a powerful and potential technology to fabricate true three-dimensional (3D) micro/nanostructures of various materials with subdiffraction-limit resolution. And it has been applied to microoptics, electronics, communications, biomedicine, microfluidic devices, MEMS and metamaterials. These applications, such as microoptics and photon crystals, put forward rigorous requirements on the processing accuracy of TPP, including the dimensional accuracy, shape accuracy and surface roughness and the processing accuracy influences their performance, even invalidate them. In order to fabricate precise 3D micro/nanostructures, the factors influencing the processing accuracy need to be considered comprehensively and systematically. In this paper, we review the basis of TPP micro/nanofabrication, including mechanism of TPP, experimental set-up for TPP and scaling laws of resolution of TPP. Then, we discuss the factors influencing the processing accuracy. Finally, we summarize the methods reported lately to improve the processing accuracy from improving the resolution and changing spatial arrangement of voxels.

A Magnetic Set-Up to Help Teach Newton's Laws

Science.gov (United States)

Panijpan, Bhinyo; Sujarittham, Thanida; Arayathanitkul, Kwan; Tanamatayarat, Jintawat; Nopparatjamjomras, Suchai

2009-01-01

A set-up comprising a magnetic disc, a solenoid and a mechanical balance was used to teach first-year physics students Newton's third law with the help of a free body diagram. The image of a floating magnet immobilized by the solenoid's repulsive force should help dispel a common misconception of students as regards the first law: that stationary…

An experimental set-up for carbon isotopic analysis of atmospheric ...

Indian Academy of Sciences (India)

We present here, an experimental set-up developed for the first time in India for the ... The internal reproducibility (precision) for the δ13C ... interaction of CO2 and water, and reproduce iso- ..... enhanced emission of anthropogenic CO2, varia-.

Implementation of random set-up errors in Monte Carlo calculated dynamic IMRT treatment plans

International Nuclear Information System (INIS)

Stapleton, S; Zavgorodni, S; Popescu, I A; Beckham, W A

2005-01-01

The fluence-convolution method for incorporating random set-up errors (RSE) into the Monte Carlo treatment planning dose calculations was previously proposed by Beckham et al, and it was validated for open field radiotherapy treatments. This study confirms the applicability of the fluence-convolution method for dynamic intensity modulated radiotherapy (IMRT) dose calculations and evaluates the impact of set-up uncertainties on a clinical IMRT dose distribution. BEAMnrc and DOSXYZnrc codes were used for Monte Carlo calculations. A sliding window IMRT delivery was simulated using a dynamic multi-leaf collimator (DMLC) transport model developed by Keall et al. The dose distributions were benchmarked for dynamic IMRT fields using extended dose range (EDR) film, accumulating the dose from 16 subsequent fractions shifted randomly. Agreement of calculated and measured relative dose values was well within statistical uncertainty. A clinical seven field sliding window IMRT head and neck treatment was then simulated and the effects of random set-up errors (standard deviation of 2 mm) were evaluated. The dose-volume histograms calculated in the PTV with and without corrections for RSE showed only small differences indicating a reduction of the volume of high dose region due to set-up errors. As well, it showed that adequate coverage of the PTV was maintained when RSE was incorporated. Slice-by-slice comparison of the dose distributions revealed differences of up to 5.6%. The incorporation of set-up errors altered the position of the hot spot in the plan. This work demonstrated validity of implementation of the fluence-convolution method to dynamic IMRT Monte Carlo dose calculations. It also showed that accounting for the set-up errors could be essential for correct identification of the value and position of the hot spot

Implementation of random set-up errors in Monte Carlo calculated dynamic IMRT treatment plans

Science.gov (United States)

Stapleton, S.; Zavgorodni, S.; Popescu, I. A.; Beckham, W. A.

2005-02-01

The fluence-convolution method for incorporating random set-up errors (RSE) into the Monte Carlo treatment planning dose calculations was previously proposed by Beckham et al, and it was validated for open field radiotherapy treatments. This study confirms the applicability of the fluence-convolution method for dynamic intensity modulated radiotherapy (IMRT) dose calculations and evaluates the impact of set-up uncertainties on a clinical IMRT dose distribution. BEAMnrc and DOSXYZnrc codes were used for Monte Carlo calculations. A sliding window IMRT delivery was simulated using a dynamic multi-leaf collimator (DMLC) transport model developed by Keall et al. The dose distributions were benchmarked for dynamic IMRT fields using extended dose range (EDR) film, accumulating the dose from 16 subsequent fractions shifted randomly. Agreement of calculated and measured relative dose values was well within statistical uncertainty. A clinical seven field sliding window IMRT head and neck treatment was then simulated and the effects of random set-up errors (standard deviation of 2 mm) were evaluated. The dose-volume histograms calculated in the PTV with and without corrections for RSE showed only small differences indicating a reduction of the volume of high dose region due to set-up errors. As well, it showed that adequate coverage of the PTV was maintained when RSE was incorporated. Slice-by-slice comparison of the dose distributions revealed differences of up to 5.6%. The incorporation of set-up errors altered the position of the hot spot in the plan. This work demonstrated validity of implementation of the fluence-convolution method to dynamic IMRT Monte Carlo dose calculations. It also showed that accounting for the set-up errors could be essential for correct identification of the value and position of the hot spot.

Effects of accuracy constraints on reach-to-grasp movements in cerebellar patients.

Science.gov (United States)

Rand, M K; Shimansky, Y; Stelmach, G E; Bracha, V; Bloedel, J R

2000-11-01

Reach-to-grasp movements of patients with pathology restricted to the cerebellum were compared with those of normal controls. Two types of paradigms with different accuracy constraints were used to examine whether cerebellar impairment disrupts the stereotypic relationship between arm transport and grip aperture and whether the variability of this relationship is altered when greater accuracy is required. The movements were made to either a vertical dowel or to a cross bar of a small cross. All subjects were asked to reach for either target at a fast but comfortable speed, grasp the object between the index finger and thumb, and lift it a short distance off the table. In terms of the relationship between arm transport and grip aperture, the control subjects showed a high consistency in grip aperture and wrist velocity profiles from trial to trial for movements to both the dowel and the cross. The relationship between the maximum velocity of the wrist and the time at which grip aperture was maximal during the reach was highly consistent throughout the experiment. In contrast, the time of maximum grip aperture and maximum wrist velocity of the cerebellar patients was quite variable from trial to trial, and the relationship of these measurements also varied considerably. These abnormalities were present regardless of the accuracy requirement. In addition, the cerebellar patients required a significantly longer time to grasp and lift the objects than the control subjects. Furthermore, the patients exhibited a greater grip aperture during reach than the controls. These data indicate that the cerebellum contributes substantially to the coordination of movements required to perform reach-to-grasp movements. Specifically, the cerebellum is critical for executing this behavior with a consistent, well-timed relationship between the transport and grasp components. This contribution is apparent even when accuracy demands are minimal.

Accuracy of rockall score for in hospital re bleeding among cirrhotic patients with variceal bleed

International Nuclear Information System (INIS)

Asgher, S.; Saleem, M.K.

2015-01-01

To assess the diagnostic accuracy of Roc kall scoring system for predicting in-hospital re-ble- eding in cirrhotic patients presenting with variceal bleed. Material and Methods: This descriptive case series study was conducted at Department of Medicine Combined Military Hospital Lahore from December 2013 to May 2014. We included patients with liver cirrhosis who presented with upper GI bleeding and showed varices as the cause of bleeding on endoscopy. Clinical and endoscopic features were noted to calculate Rockall score. Patients with score < 2 and > 8 were included. After treating with appropriate pharmacological and endoscopic therapy, patients were followed for re-bleeding for 10 days. Diagnostic accuracy was assessed by calculating sensitivity, specificity, positive and negative predictive values using 2 x 2 tables. Results: In the study, 175 patients were included. Mean age was 51.5 ± 1.22 years. Male to female ratio was 1.5 to 1.0 out of 175 patients, 157 patients (89.7%) were of low risk group (score = 2) while 18 patients (10.3%) were in high risk group (score > 8). In low risk group, re-bleeding occurred only in 2 patients (1.2%) while in high risk group, re-bleeding occurred in 14 patients (78%). Rockall score was found to have good diagnostic accuracy with sensitivity of 87.5%, specificity of 97.48%, positive predictive value of 77.8% and negative predictive value of 98.7%. Conclusion: In cases of variceal bleed, frequency of re-bleed is less in patients who are in low risk category with lower Rockall score and high in high risk patients with higher rockall score. The Rockall score has a good diagnostic accuracy in prediction of re-bleed in variceal bleeding. (author)

Patient satisfaction among Spanish-speaking patients in a public health setting.

Science.gov (United States)

Welty, Elisabeth; Yeager, Valerie A; Ouimet, Claude; Menachemi, Nir

2012-01-01

Despite the growing literature on health care quality, few patient satisfaction studies have focused upon the public health setting; where many Hispanic patients receive care. The purpose of this study was to examine the differences in satisfaction between English and Spanish-speaking patients in a local health department clinical setting. We conducted a paper-based satisfaction survey of patients that visited any of the seven Jefferson County Department of Health primary care centers from March 19 to April 19, 2008. Using Chi-squared analyses we found 25% of the Spanish-speaking patients reported regularly having problems getting an appointment compared to 16.8% among English-speakers (p speaking patients controlling for center location, purpose of visit, and time spent waiting. Specifically, Spanish speaking patients were more likely to report problems getting an appointment and less likely to report having their medical problems resolved when leaving their visit as compared to those who spoke English. Findings presented herein may provide insight regarding the quality of care received, specifically regarding patient satisfaction in the public health setting. © 2011 National Association for Healthcare Quality.

Mathematical model of the electronuclear set-up on the beam of the JINR synchrotron

International Nuclear Information System (INIS)

Barashenkov, V.S.; Kumawat, H.; Lobanova, V.A.; Kumar, V.

2003-01-01

On the base of the Monte Carlo code CASCADE, developed at JINR, a mathematical model of the deep-subcritical set-up with uranium blanket used in experiments underway at JINR using a 0.6-4 GeV proton beam, is created. The neutron spectra, yields and energies of generated particles are calculated and compared for several modifications of the set-up. The influence of paraffin and graphite moderators on the characteristics of particles escaping lead target is studied. The modelled set-up can be considered as a first step to experiments with the designed at JINR U-Pu ADS SAD with heat power of several tens of kW

Mathematical Model of the Electronuclear Set-Up on the Beam of the JINR Synchrotron

CERN Document Server

Barashenkov, V S; Kumawat, H; Lobanova, V A

2004-01-01

On the base of the Monte Carlo code CASCADE, developed at JINR, a mathematical model of the deep-subcritical set-up with uranium blanket used in experiments underway at JINR using a 0.6-4 GeV proton beam, is created. The neutron spectra, yields and energies of generated particles are calculated and compared for several modifications of the set-up. The influence of paraffin and graphite moderators on the characteristics of particles escaping lead target is studied. The modelled set-up can be considered as a first step to experiments with the designed at JINR U-Pu ADS SAD with heat power of several tens of kW.

Setting up and managing a remote maintenance operation for fusion

International Nuclear Information System (INIS)

Haist, Bernhard

2008-01-01

Trying to set up and manage a remote maintenance operation for a thermonuclear fusion reactor is a complex undertaking. There are many problems and challenges which need addressing. This paper tries to guide the reader through this process by composing a list of generic problems and by analysing possible solutions. The first challenge before setting up a remote maintenance operation for a fusion reactor is the systematic analysis of all the remote handling requirements. Based upon this the remote handling concept, including facility layout and equipment, can be defined. The following aspects have to be considered and incorporated into the remote handling concept: - Remote handling task development. - Remote handling task logistics and resource management. - Command, control and human-machine interface system. - Viewing and camera systems. - Virtual reality and Augmented Reality software. - Automatic path planning and collision avoidance. - Remote transfer of heavy loads. - Maintainability of RH equipment. - Reliability, redundant systems and safety. - Rationalisation and modularity in both hardware and software. - Recovery from failure modes. - Condition monitoring and fault detection/prediction. - Ability to deal with unforeseen problems. Oxford Technologies Ltd. has a proven track record in setting up and running the Remote Handling group at the JET Joint Undertaking in Culham, UK. Based on the unique experience gained at JET, Oxford Technologies Ltd. also developed the current design and remote handling concept of the ITER Hot Cell during a study in 2004. Examples of both the JET remote handling experience and the ITER Hot Cell design and layout are given throughout this paper

Setting up and managing a remote maintenance operation for fusion

International Nuclear Information System (INIS)

Haist, B.

2007-01-01

Trying to set up and manage a remote maintenance operation for a thermonuclear fusion reactor is a complex undertaking. There are many problems and challenges which need addressing. This paper tries to guide the reader through this process by composing a list of generic problems and by analysing possible solutions. The first challenge before setting up a remote maintenance operation for a fusion reactor is the systematic analysis of all the remote handling requirements. Based upon this the remote handling concept, including facility layout and equipment, can be defined. The following aspects have to be considered and incorporated into the remote handling concept: - Remote handling task development - Remote handling task logistics and resource management - Command, control and human-machine interface system - Viewing and camera systems - Virtual Reality and Augmented Reality software - Automatic path planning and collision avoidance - Remote transfer of heavy loads - Maintainability of RH Equipment - Reliability, redundant systems and safety - Rationalisation and modularity in both hardware and software - Recovery from failure modes - Condition monitoring and fault detection/prediction - Ability to deal with unforeseen problems Oxford Technologies Ltd has a proven track record in setting up and running the Remote Handling group at the JET Joint Undertaking in Culham, UK. Based on the unique experience gained at JET, Oxford Technologies Ltd also developed the current design and remote handling concept of the ITER Hot Cell during a study in 2004. Examples of both the JET Remote Handling experience and the ITER Hot Cell design and layout are given throughout this paper. (orig.)

Setting up and managing a remote maintenance operation for fusion

Energy Technology Data Exchange (ETDEWEB)

Haist, Bernhard [Oxford Technologies Ltd., 7 Nuffield Way, Abingdon, Oxon OX14 1RJ (United Kingdom)], E-mail: Bernhard.Haist@oxfordtechnologies.co.uk

2008-12-15

Trying to set up and manage a remote maintenance operation for a thermonuclear fusion reactor is a complex undertaking. There are many problems and challenges which need addressing. This paper tries to guide the reader through this process by composing a list of generic problems and by analysing possible solutions. The first challenge before setting up a remote maintenance operation for a fusion reactor is the systematic analysis of all the remote handling requirements. Based upon this the remote handling concept, including facility layout and equipment, can be defined. The following aspects have to be considered and incorporated into the remote handling concept: - Remote handling task development. - Remote handling task logistics and resource management. - Command, control and human-machine interface system. - Viewing and camera systems. - Virtual reality and Augmented Reality software. - Automatic path planning and collision avoidance. - Remote transfer of heavy loads. - Maintainability of RH equipment. - Reliability, redundant systems and safety. - Rationalisation and modularity in both hardware and software. - Recovery from failure modes. - Condition monitoring and fault detection/prediction. - Ability to deal with unforeseen problems. Oxford Technologies Ltd. has a proven track record in setting up and running the Remote Handling group at the JET Joint Undertaking in Culham, UK. Based on the unique experience gained at JET, Oxford Technologies Ltd. also developed the current design and remote handling concept of the ITER Hot Cell during a study in 2004. Examples of both the JET remote handling experience and the ITER Hot Cell design and layout are given throughout this paper.

Accuracy of Consecutive Fecal Calprotectin Measurements to Predict Relapse in Inflammatory Bowel Disease Patients Under Maintenance With Anti-TNF Therapy: A Prospective Longitudinal Cohort Study.

Science.gov (United States)

Ferreiro-Iglesias, Rocio; Barreiro-de Acosta, Manuel; Lorenzo-Gonzalez, Aurelio; Dominguez-Muñoz, Juan E

2018-03-01

Predicting relapse in inflammatory bowel disease (IBD) patients could allow early changes in therapy. We aimed at evaluating the accuracy of consecutive fecal calprotectin (FC) measurements to predict flares in IBD patients under maintenance treatment with anti-tumor necrosis factor (TNF) drugs. A prospective longitudinal cohort study with 16-month follow-up period was designed. IBD patients in clinical remission for at least 6 months under anti-TNF therapy were included. FC was quantified at 4-month intervals for 1 year, and patients were clinically evaluated for relapse at 2-month intervals. Diagnostic accuracy of FC for predicting relapse was evaluated by receiver-operating characteristic curve analysis. In total, 95 of 106 included patients finalized the study and were analyzed (median age 44 y, 50.5% female, 75% with Crohn's disease). A total of 30 patients (31.6%) had a relapse over follow-up. FC concentration was significantly higher in patients who relapsed (477 μg/g) than in patients who maintained in remission (65 μg/g) (Ppredict remission was 130 μg/g (negative predictive value of 100%), and 300 μg/g to predict relapse (positive predictive value of 78.3%). FC is a good predictor of clinical relapse and a particularly good predictor of remission over the following 4 months in patients with IBD on maintenance therapy with anti-TNF drugs. FC levels 300 μg/g allow predicting relapse with a high probability at any time over the following 4 months.

Up-titration of allopurinol in patients with gout.

Science.gov (United States)

Jennings, Claudine G; Mackenzie, Isla S; Flynn, Rob; Ford, Ian; Nuki, George; De Caterina, Raffaele; Riches, Philip L; Ralston, Stuart H; MacDonald, Thomas M

2014-08-01

European League against Rheumatism (EULAR) gout management guidelines recommend achieving a target urate level titration in achieving the EULAR target levels. The Febuxostat versus Allopurinol Streamlined Trial (FAST) is an ongoing multi-centre study comparing the cardiovascular safety of febuxostat and allopurinol (target recruitment: 5706 patients). Recruited patients were already taking allopurinol and the protocol required up-titration of daily allopurinol dose, in 100 mg increments, to achieve the EULAR urate target level prior to randomisation. We reviewed pre-randomisation data from the first 400 recruited and subsequently randomised FAST patients. Of 400 patients, 144 (36%) had urate levels ≥357 µmol/L at screening and required allopurinol up-titration. Higher urate levels were significantly associated with lower allopurinol dose, male sex, increased BMI, increased alcohol intake and diuretic use. Mean fall in urate levels after a single 100-mg dose increase was 71 µmol/L. The number of up-titrations required ranged from one to five (median = 1) with 65% of patients controlled after one 100-mg up-titration. Overall, 97% of up-titrated patients achieved target urate levels with median final allopurinol dose of 300 mg daily. Side effects and complications of up-titration were minimal. Overall, 36% of FAST patients were not at target urate levels and required up-titration. Allopurinol up-titration was effective in achieving urate target levels and was generally well tolerated by patients. Copyright © 2014 Elsevier Inc. All rights reserved.

Accuracy of CT-guided biopsies in 158 patients with thoracic spinal lesions

Energy Technology Data Exchange (ETDEWEB)

Hao, D.J.; He, B.R.; Liu, T.J.; Zhao, Q.P. (Dept. of Spinal Surgery, Xian Red Cross Hospital, Xian Shaanxi (China)), email: zqpddn1@gmail.com; Sun, H.H. (Dept. of Orthopaedic, Tangdu Hospital, Fourth Military Medical Univ., Xian Shaanxi (China)); Jiang, Y.H. (Dept. of Radiology, Xian Red Cross Hospital, Xian Shaanxi (China))

2011-11-15

Background. Inconsistent accuracies of CT-guided thoracic spinal biopsies have been reported in previous studies. Purpose. To determine the accuracy of CT-guided thoracic spinal biopsy, to compare the results with those previously reported, and to determine if there are any factors that influence the accuracy of CT-guided thoracic spinal biopsy. Material and Methods. In total, 158 consecutive CT-guided percutaneous thoracic spine procedures (performed at the Dept. of Spinal Surgery, Xian Red Cross Hospital between April 2000 and July 2010) were reviewed. The 158 lesions were categorized by location and radiographic features. Pathological and clinical follow-up were used to determine accuracy. Results. The diagnostic accuracy of CT-guided thoracic spinal biopsy was 90.5% overall. Biopsy of metastatic bone disease (98.2%) was significantly more accurate than biopsies of primary tumors (80.9%) and of hematological malignancies (47.0%) (P < 0.05 and P < 0.005, respectively). The diagnostic accuracy of CT-guided thoracic spinal biopsy was significantly higher for the lower thoracic spine (97.6%) than for the middle (90.0%) or upper thoracic spine (80.4%) (P < 0.05 and P < 0.025, respectively). The diagnostic accuracy was significantly higher for lytic lesions (96.4%) than for sclerotic lesions (81.3%) (P < 0.010). The accuracy of biopsies performed using the transpedicular approach (91.0%) was not significantly different from that of biopsies performed using posterolateral approaches (91.5%) (0.25 < P < 0.5). Conclusion. Percutaneous CT-guided thoracic spinal biopsy is a viable alternative to open surgical biopsy. The diagnostic accuracy was not affected by any of the variables except for lesion level, histology, and radiographic features

Accuracy of CT-guided biopsies in 158 patients with thoracic spinal lesions

International Nuclear Information System (INIS)

Hao, D.J.; He, B.R.; Liu, T.J.; Zhao, Q.P.; Sun, H.H.; Jiang, Y.H.

2011-01-01

Background. Inconsistent accuracies of CT-guided thoracic spinal biopsies have been reported in previous studies. Purpose. To determine the accuracy of CT-guided thoracic spinal biopsy, to compare the results with those previously reported, and to determine if there are any factors that influence the accuracy of CT-guided thoracic spinal biopsy. Material and Methods. In total, 158 consecutive CT-guided percutaneous thoracic spine procedures (performed at the Dept. of Spinal Surgery, Xian Red Cross Hospital between April 2000 and July 2010) were reviewed. The 158 lesions were categorized by location and radiographic features. Pathological and clinical follow-up were used to determine accuracy. Results. The diagnostic accuracy of CT-guided thoracic spinal biopsy was 90.5% overall. Biopsy of metastatic bone disease (98.2%) was significantly more accurate than biopsies of primary tumors (80.9%) and of hematological malignancies (47.0%) (P < 0.05 and P < 0.005, respectively). The diagnostic accuracy of CT-guided thoracic spinal biopsy was significantly higher for the lower thoracic spine (97.6%) than for the middle (90.0%) or upper thoracic spine (80.4%) (P < 0.05 and P < 0.025, respectively). The diagnostic accuracy was significantly higher for lytic lesions (96.4%) than for sclerotic lesions (81.3%) (P < 0.010). The accuracy of biopsies performed using the transpedicular approach (91.0%) was not significantly different from that of biopsies performed using posterolateral approaches (91.5%) (0.25 < P < 0.5). Conclusion. Percutaneous CT-guided thoracic spinal biopsy is a viable alternative to open surgical biopsy. The diagnostic accuracy was not affected by any of the variables except for lesion level, histology, and radiographic features

Systematic review of discharge coding accuracy

Science.gov (United States)

Burns, E.M.; Rigby, E.; Mamidanna, R.; Bottle, A.; Aylin, P.; Ziprin, P.; Faiz, O.D.

2012-01-01

Introduction Routinely collected data sets are increasingly used for research, financial reimbursement and health service planning. High quality data are necessary for reliable analysis. This study aims to assess the published accuracy of routinely collected data sets in Great Britain. Methods Systematic searches of the EMBASE, PUBMED, OVID and Cochrane databases were performed from 1989 to present using defined search terms. Included studies were those that compared routinely collected data sets with case or operative note review and those that compared routinely collected data with clinical registries. Results Thirty-two studies were included. Twenty-five studies compared routinely collected data with case or operation notes. Seven studies compared routinely collected data with clinical registries. The overall median accuracy (routinely collected data sets versus case notes) was 83.2% (IQR: 67.3–92.1%). The median diagnostic accuracy was 80.3% (IQR: 63.3–94.1%) with a median procedure accuracy of 84.2% (IQR: 68.7–88.7%). There was considerable variation in accuracy rates between studies (50.5–97.8%). Since the 2002 introduction of Payment by Results, accuracy has improved in some respects, for example primary diagnoses accuracy has improved from 73.8% (IQR: 59.3–92.1%) to 96.0% (IQR: 89.3–96.3), P= 0.020. Conclusion Accuracy rates are improving. Current levels of reported accuracy suggest that routinely collected data are sufficiently robust to support their use for research and managerial decision-making. PMID:21795302

Assessment of patient safety culture in primary care setting, Al-Mukala, Yemen.

Science.gov (United States)

Webair, Hana H; Al-Assani, Salwa S; Al-Haddad, Reema H; Al-Shaeeb, Wafa H; Bin Selm, Manal A; Alyamani, Abdulla S

2015-10-13

Patient safety culture in primary care is the first step to achieve high quality health care. This study aims to provide a baseline assessment of patient safety culture in primary care settings in Al-Mukala, Yemen as a first published study from a least developed country. A survey was conducted in primary healthcare centres and units in Al-Mukala District, Yemen. A comprehensive sample from the available 16 centres was included. An Arabic version of the Medical Office Survey on Patient Safety Culture was distributed to all health workers (110). Participants were physicians, nurses and administrative staff. The response rate from the participating centres was 71 %. (N = 78). The percent positive responses of the items is equal to the percentage of participants who answered positively. Composite scores were calculated by averaging the percent positive response on the items within a dimension. Positive safety culture was defined as 60 % or more positive responses on items or dimensions. Patient safety culture was perceived to be generally positive with the exception of the dimensions of 'Communication openness', 'Work pressure and pace' and 'Patient care tracking/follow-up', as the percent positive response of these dimensions were 58, 57, and 52 % respectively. Overall, positive rating on quality and patient safety were low (49 and 46 % respectively). Although patient safety culture in Al-Mukala primary care setting is generally positive, patient safety and quality rating were fairly low. Implementation of a safety and quality management system in Al-Mukala primary care setting are paramount. Further research is needed to confirm the applicability of the Medical Office Survey on Patient Safety Culture (MOSPSC) for Al-Mukala primary care.

Set-up for pulse radiolysis of agressive substances

International Nuclear Information System (INIS)

Kozlowska-Milner, E.; Broszkiewicz, R.; Stanikowski, J.

1975-01-01

A set-up for the pulse radiolysis of aggressive substances with a relatively low consumption of the liquid, tested for anhydrous HNO 3 , has been described. The samples have been irradiated with single pulses of 10 MeV electrons at the linear accelerator type LAE 13-9. The absorption spectra of the irradiated samples (within a range of 300-800 nm) were provided by a xenon lamp. The variations of the voltage from the photomultiplier, coupled with an oscilloscope, were registered with the aid of a Polaroid camera. (T.G.)

Single ion hit detection set-up for the Zagreb ion microprobe

Science.gov (United States)

Smith, R. W.; Karlušić, M.; Jakšić, M.

2012-04-01

Irradiation of materials by heavy ions accelerated in MV tandem accelerators may lead to the production of latent ion tracks in many insulators and semiconductors. If irradiation is performed in a high resolution microprobe facility, ion tracks can be ordered by submicrometer positioning precision. However, full control of the ion track positioning can only be achieved by a reliable ion hit detection system that should provide a trigger signal irrespectively of the type and thickness of the material being irradiated. The most useful process that can be utilised for this purpose is emission of secondary electrons from the sample surface that follows the ion impact. The status report of the set-up presented here is based on the use of a channel electron multiplier (CEM) detector mounted on an interchangable sample holder that is inserted into the chamber in a close geometry along with the sample to be irradiated. The set-up has been tested at the Zagreb ion microprobe for different ions and energies, as well as different geometrical arrangements. For energies of heavy ions below 1 MeV/amu, results show that efficient (100%) control of ion impact can be achieved only for ions heavier than silicon. The successful use of the set-up is demonstrated by production of ordered single ion tracks in a polycarbonate film and by monitoring fluence during ion microbeam patterning of Foturan glass.

Controlling Mechatronic Set-up Using Real-time Linux and CTC ++

NARCIS (Netherlands)

Broenink, Johannes F.; Jovanovic, D.S.; Hilderink, G.H.; van Amerongen, J.; Jonker, B.; Regtien, P.; Stramigioli, S.

2002-01-01

The development of control software for mechatronic systems is presented by means of a case study: a 2 DOF mechanical rotational set-up usable as a camera-positioning device. The control software is generated using the code generation facility of 20-SIM, thus guaranteeing the generated code being

Trace element analysis in an optimized set-up for total reflection PIXE (TPIXE)

International Nuclear Information System (INIS)

Van Kan, J.A.; Vis, R.D.

1996-01-01

A newly constructed chamber for measuring with MeV proton beams at small incidence angles (0 to 35 mrad) is used to analyse trace elements on flat surfaces such as Si wafers, quartz substrates and perspex. This set-up is constructed in such a way that the X-ray detector can reach very large solid angles, larger than 1 sr. Using these large solid angles in combination with the reduction of bremsstrahlungs background, lower limits of detection (LOD) using TPIXE can be obtained as compared with PIXE in the conventional geometry. Standard solutions are used to determine the LODs obtainable with TPIXE in the optimized set-up. These solutions contain traces of As and Sr with concentrations down to 20 ppb in an insulin solution. The limits of detection found are compared with earlier ones obtained with TPIXE in a non optimized set-up and with TXRF results. (author)

Follow-up of colorectal cancer patients: quality of life and attitudes towards follow-up

NARCIS (Netherlands)

Stiggelbout, A. M.; de Haes, J. C.; Vree, R.; van de Velde, C. J.; Bruijninckx, C. M.; van Groningen, K.; Kievit, J.

1997-01-01

The aims of our study were to assess the effect of follow-up on the quality of life of colorectal cancer patients and to assess the attitudes of patients towards follow-up as a function of patient characteristics. Patients who had been treated with curative intent were selected from four types of

Analysis on Dynamic Transmission Accuracy for RV Reducer

Directory of Open Access Journals (Sweden)

Zhang Fengshou

2017-01-01

Full Text Available By taking rotate vector (RV reducer as the research object, the factors affecting the transmission accuracy are studied, including the machining errors of the main parts, assembly errors, clearance, micro-displacement, gear mesh stiffness and damping, bearing stiffness. Based on Newton second law, the transmission error mathematical model of RV reducer is set up. Then, the RV reducer transmission error curve is achieved by solving the mathematical model using the Runge-Kutta methods under the combined action of various error factors. Through the analysis of RV reducer transmission test, it can be found that there are similar variation trend and frequency components compared the theoretical research and experimental result. The presented method is useful to the research on dynamic transmission accuracy of RV reducer, and also applies to research the transmission accuracy of other cycloid drive systems.

Sonography of acute appendicitis in pregnant women: diagnostic accuracy by the stage of gestation

International Nuclear Information System (INIS)

Kim, Sam Soo; Lee, Sang Wook; Rho, Myung Ho

2004-01-01

To evaluate the diagnostic accuracy of a diagnosis of acute appendicitis in pregnant women according to the trimester. A retrospective review was performed on 103 pregnant women who underwent sonography with clinically suspected acute appendicitis. The sonographic technique used involved either the graded compression or a non-compression method. All the sonograms were obtained after changing the patient's position and identifying the diseased appendix. The criterion for a sonographic diagnosis of acute appendicitis was the visualization of a non-compressible appendix with a maximal diameter ≥ 6 mm. The sonographic findings were correlated with the surgical findings and clinical follow-up. Acute appendicitis was confirmed by both the surgical and pathological findings in 48 out of 103 pregnant women. Ultrasound established the diagnosis in 34 of the 48 patients with proven appendicitis. There were false-positives in 2 patients and false-negatives in 14 patients. Among the 55 patients who had a normal appendix, 30 patients improved at the clinical follow-up and 25 patients had other intra-abdominal disorders. The diagnostic accuracy of the ultrasound was 94% in the first trimester, 81% in the second trimester, and 76% in the third trimester. The overall accuracy was found to be 84%, with a 71% sensitivity and a 96% specificity. No significant difference was found in the diagnostic accuracy of the ultrasound according to the trimester in which the acute appendicitis occurred. Therefore, regardless of the stage of gestation, sonography is a valuable procedure for diagnosing acute appendicitis

Patient education and follow-up as an intervention for hypertensive patients discharged from an emergency department: a randomized control trial study protocol.

Science.gov (United States)

Gleason-Comstock, Julie; Streater, Alicia; Ager, Joel; Goodman, Allen; Brody, Aaron; Kivell, Laura; Paranjpe, Aniruddha; Vickers, Jasmine; Mango, LynnMarie; Dawood, Rachelle; Levy, Phillip

2015-12-21

Persistently elevated blood pressure (BP) is a leading risk factor for cardiovascular disease development, making effective hypertension management an issue of considerable public health importance. Hypertension is particularly prominent among African Americans, who have higher disease prevalence and consistently lower BP control than Whites and Hispanics. Emergency departments (ED) have limited resources for chronic disease management, especially for under-served patients dependent upon the ED for primary care, and are not equipped to conduct follow-up. Kiosk-based patient education has been found to be effective in primary care settings, but little research has been done on the effectiveness of interactive patient education modules as ED enhanced discharge for an under-served urban minority population. Achieving Blood Pressure Control Through Enhanced Discharge (AchieveBP) is a behavioral RCT patient education intervention for patients with a history of hypertension who have uncontrolled BP at ED discharge. The project will recruit up to 200 eligible participants at the ED, primarily African-American, who will be asked to return to a nearby clinical research center for seven, thirty and ninety day visits, with a 180 day follow-up. Consenting participants will be randomized to either an attention-control or kiosk-based interactive patient education intervention. To control for potential medication effects, all participants will be prescribed similar, evidenced-based anti-hypertensive regimens and have their prescription filled onsite at the ED and during visits to the clinic. The primary target endpoint will be success in achieving BP control assessed at 180 days follow-up post-ED discharge. The secondary aim will be to assess the relationship between patient activation and self-care management. The AchieveBP trial will determine whether using interactive patient education delivered through health information technology as ED enhanced discharge with subsequent

Diagnostic accuracy of dual-energy computed tomography in patients with gout: A meta-analysis.

Science.gov (United States)

Lee, Young Ho; Song, Gwan Gyu

2017-08-01

This study aimed to evaluate the diagnostic performance of dual-energy computed tomography (DECT) for patients with gout. We searched the Medline, Embase, and Cochrane Library databases, and performed a meta-analysis on the diagnostic accuracy of DECT in patients with gout. A total of eight studies including 510 patients with gout and 268 controls (patients with non-gout inflammatory arthritis) were available for the meta-analysis. The pooled sensitivity and specificity of DECT were 84.7% (95% confidence interval [CI]: 81.3-87.7) and 93.7% (93.0-96.3), respectively. The positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 9.882 (6.122-15.95), 0.163 (0.097-0.272), and 78.10 (31.14-195.84), respectively. The area under the curve of DECT was 0.956 and the Q * index was 0.889, indicating a high diagnostic accuracy. Some between-study heterogeneity was found in the meta-analyses. However, there was no evidence of a threshold effect (Spearman correlation coefficient = 0.419; p = 0.035). In addition, meta-regression showed that the sample size, study design, and diagnostic criteria were not sources of heterogeneity, and subgroup meta-analyses did not change the overall diagnostic accuracy. Our meta-analysis of published studies demonstrates that DECT has a high diagnostic accuracy and plays an important role in the diagnosis of gout. Copyright © 2017 Elsevier Inc. All rights reserved.

Commissioning of a proton gantry equipped with dual x-ray imagers and a robotic patient positioner, and evaluation of the accuracy of single-beam image registration for this system

International Nuclear Information System (INIS)

Wang, Ning; Ghebremedhin, Abiel; Patyal, Baldev

2015-01-01

Purpose: To check the accuracy of a gantry equipped with dual x-ray imagers and a robotic patient positioner for proton radiotherapy, and to evaluate the accuracy and feasibility of single-beam registration using the robotic positioner. Methods: One of the proton treatment rooms at their institution was upgraded to include a robotic patient positioner (couch) with 6 degrees of freedom and dual orthogonal kilovoltage x-ray imaging panels. The wander of the proton beam central axis, the wander of the beamline, and the orthogonal image panel crosswires from the gantry isocenter were measured for different gantry angles. The couch movement accuracy and couch wander from the gantry isocenter were measured for couch loadings of 50–300 lb with couch rotations from 0° to ±90°. The combined accuracy of the gantry, couch, and imagers was checked using a custom-made 30 × 30 × 30 cm 3 Styrofoam phantom with beekleys embedded in it. A treatment in this room can be set up and registered at a setup field location, then moved precisely to any other treatment location without requiring additional image registration. The accuracy of the single-beam registration strategy was checked for treatments containing multiple beams with different combinations of gantry angles, couch yaws, and beam locations. Results: The proton beam central axis wander from the gantry isocenter was within 0.5 mm with gantry rotations in both clockwise (CW) and counterclockwise (CCW) directions. The maximum wander of the beamline and orthogonal imager crosswire centers from the gantry isocenter were within 0.5 and 0.8 mm, respectively, with the gantry rotations in CW and CCW directions. Vertical and horizontal couch wanders from the gantry isocenter were within 0.4 and 1.3 mm, respectively, for couch yaw from 0° to ±90°. For a treatment with multiple beams with different gantry angles, couch yaws, and beam locations, the measured displacements of treatment beam locations from the one based on the

Localization of Manufacturing Capabilities in Setting Up Nuclear Power Plants

International Nuclear Information System (INIS)

Chadda, Sushil Kumar

2011-01-01

Nuclear renaissance is now imminent and is inevitable in view of rapidly increasing global warming concerns. A steep shift towards environmentally benign sources of energy remains an unavoidable choice as continents are warming up pushing seas into human habitation and disturbing global ecology. Accordingly, Indian government in its integrated energy policy document has planned for raising nuclear power capacity to generate 63 GWe by 2030. This envisages estimated investments of US$22 billion in the next 15 to 20 years. Setting up of nuclear energy generation capacity, however, remains a painstakingly slow process primarily due to complex, multidisciplinary efforts required to crank up a reactor. A robust supply chain remains key to expediting this process. In the light of this, it is critically important to ensure supply-chain for materials and components and putting in place cost effective project management to complete the projects on time and within the budgets. In this context, the participation of industries and their preparedness to meet the challenges are necessary. This would also require investments towards up gradation of manufacturing technology, training of manpower and mobilization of resources at the construction site. The industry would also need to enhance detailing and design engineering capabilities for the plants. It is only when such capabilities have been brought up that the possibilities of time-bound setting up of nuclear plants can be realized. In this paper, various issues with regard to project cost, regulatory and licensing, technology and gestation period etc for new build plants relevant to manufacturing industry are discussed. The plans for enhancing manufacturing capabilities for the critical path items of the project schedule with viable business, ensuring returns to stakeholders and financing and investment cycle are brought out. The various steps and initiatives being taken by Bharat Forge Ltd, the flagship company of Kalyani

Accuracy of three automated 25-hydroxyvitamin D assays in hemodialysis patients

NARCIS (Netherlands)

Depreter, B.; Heijboer, A.C.; Langlois, M.R.

2013-01-01

Introduction: We evaluated the accuracy of three automated assays for 25(OH)D measurement in comparison to ID-XLC-MS/MS in hemodialysis patients, considering the importance of their vitamin D status and reported discrepant results obtained with automated assays. Methods: All three assays were

A user-friendly technical set-up for infrared photography of forensic findings.

Science.gov (United States)

Rost, Thomas; Kalberer, Nicole; Scheurer, Eva

2017-09-01

Infrared photography is interesting for a use in forensic science and forensic medicine since it reveals findings that normally are almost invisible to the human eye. Originally, infrared photography has been made possible by the placement of an infrared light transmission filter screwed in front of the camera objective lens. However, this set-up is associated with many drawbacks such as the loss of the autofocus function, the need of an external infrared source, and long exposure times which make the use of a tripod necessary. These limitations prevented up to now the routine application of infrared photography in forensics. In this study the use of a professional modification inside the digital camera body was evaluated regarding camera handling and image quality. This permanent modification consisted of the replacement of the in-built infrared blocking filter by an infrared transmission filter of 700nm and 830nm, respectively. The application of this camera set-up for the photo-documentation of forensically relevant post-mortem findings was investigated in examples of trace evidence such as gunshot residues on the skin, in external findings, e.g. hematomas, as well as in an exemplary internal finding, i.e., Wischnewski spots in a putrefied stomach. The application of scattered light created by indirect flashlight yielded a more uniform illumination of the object, and the use of the 700nm filter resulted in better pictures than the 830nm filter. Compared to pictures taken under visible light, infrared photographs generally yielded better contrast. This allowed for discerning more details and revealed findings which were not visible otherwise, such as imprints on a fabric and tattoos in mummified skin. The permanent modification of a digital camera by building in a 700nm infrared transmission filter resulted in a user-friendly and efficient set-up which qualified for the use in daily forensic routine. Main advantages were a clear picture in the viewfinder, an auto

Realization of an automatic set up to measure electrical characteristic of solid state detectors

International Nuclear Information System (INIS)

Manfredotti, C.; Crosetto, D.; Gabutti, A.; Gervino, G.; Varesio, R.

1986-01-01

An automatic set-up is described to study electrical properties of silicon detectors for nuclear research. Particularly, I-V characteristics from silicon junction prototype detectors and amorphous samples to test the data acquisition system, are presented. This set-up joins a low cost to good versatility that makes it very useful in wide application ranges in silicon detector electrical characterization

Order of 27 February 1985 setting up a Nuclear Engineering Terminology Commission

International Nuclear Information System (INIS)

1985-01-01

The Commission set up by this Order will draw up an inventory of the gaps in French nuclear engineering vocabulary, taking into account users' needs; it will also propose and revise the necessary terms in the light of present knowledge and contribute to collection and harmonisation of terminological and neological data. (NEA) [fr

Special set-up and treatment techniques for the radiotherapy of pediatric malignancies

International Nuclear Information System (INIS)

Martinez, A.; Donaldson, S.S.; Bagshaw, M.A.

1977-01-01

The prevention of serious and long term complications of treatment have become as important a consideration in the therapy of children with malignant disease as the goal of tumor control. This balance requires meticulous treatment planning and attention to the treatment preparation and immobilization techniques when radiotherapy is administered to children. Accurate localization of tumor volume and daily reproducibility is essential for delivering precise irradiation. Four special set-up and treatment techniques which have a specific usefulness in radiotherapy for pediatric malignancies are defined and illustrated with the aid of clinical cases. They include the three point set-up, the split beam technique, the isocentric technique, and the strinking field technique

Using a Robust Design Approach to Optimize Chair Set-up in Wheelchair Sport

Directory of Open Access Journals (Sweden)

David S. Haydon

2018-02-01

Full Text Available Optimisation of wheelchairs for court sports is currently a difficult and time-consuming process due to the broad range of impairments across athletes, difficulties in monitoring on-court performance, and the trade-off set-up that parameters have on key performance variables. A robust design approach to this problem can potentially reduce the amount of testing required, and therefore allow for individual on-court assessments. This study used orthogonal design with four set-up factors (seat height, depth, and angle, as well as tyre pressure at three levels (current, decreased, and increased for three elite wheelchair rugby players. Each player performed two maximal effort sprints from a stationary position in nine different set-ups, with this allowing for detailed analysis of each factor and level. Whilst statistical significance is difficult to obtain due to the small sample size, meaningful difference results aligning with previous research findings were identified and provide support for the use of this approach.

Accuracy assessment of seven global land cover datasets over China

Science.gov (United States)

Yang, Yongke; Xiao, Pengfeng; Feng, Xuezhi; Li, Haixing

2017-03-01

Land cover (LC) is the vital foundation to Earth science. Up to now, several global LC datasets have arisen with efforts of many scientific communities. To provide guidelines for data usage over China, nine LC maps from seven global LC datasets (IGBP DISCover, UMD, GLC, MCD12Q1, GLCNMO, CCI-LC, and GlobeLand30) were evaluated in this study. First, we compared their similarities and discrepancies in both area and spatial patterns, and analysed their inherent relations to data sources and classification schemes and methods. Next, five sets of validation sample units (VSUs) were collected to calculate their accuracy quantitatively. Further, we built a spatial analysis model and depicted their spatial variation in accuracy based on the five sets of VSUs. The results show that, there are evident discrepancies among these LC maps in both area and spatial patterns. For LC maps produced by different institutes, GLC 2000 and CCI-LC 2000 have the highest overall spatial agreement (53.8%). For LC maps produced by same institutes, overall spatial agreement of CCI-LC 2000 and 2010, and MCD12Q1 2001 and 2010 reach up to 99.8% and 73.2%, respectively; while more efforts are still needed if we hope to use these LC maps as time series data for model inputting, since both CCI-LC and MCD12Q1 fail to represent the rapid changing trend of several key LC classes in the early 21st century, in particular urban and built-up, snow and ice, water bodies, and permanent wetlands. With the highest spatial resolution, the overall accuracy of GlobeLand30 2010 is 82.39%. For the other six LC datasets with coarse resolution, CCI-LC 2010/2000 has the highest overall accuracy, and following are MCD12Q1 2010/2001, GLC 2000, GLCNMO 2008, IGBP DISCover, and UMD in turn. Beside that all maps exhibit high accuracy in homogeneous regions; local accuracies in other regions are quite different, particularly in Farming-Pastoral Zone of North China, mountains in Northeast China, and Southeast Hills. Special

Accuracy of bone SPECT/CT for identifying hardware loosening in patients who underwent lumbar fusion with pedicle screws

Energy Technology Data Exchange (ETDEWEB)

Hudyana, Hendrah; Maes, Alex [AZ Groeninge, Department of Nuclear Medicine, Kortrijk (Belgium); University Hospital Leuven, Department of Morphology and Medical Imaging, Leuven (Belgium); Vandenberghe, Thierry; Fidlers, Luc [AZ Groeninge, Department of Neurosurgery, Kortrijk (Belgium); Sathekge, Mike [University of Pretoria, Department of Nuclear Medicine, Pretoria (South Africa); Nicolai, Daniel [AZ Groeninge, Department of Nuclear Medicine, Kortrijk (Belgium); Wiele, Christophe van de [AZ Groeninge, Department of Nuclear Medicine, Kortrijk (Belgium); University Ghent, Department of Radiology and Nuclear Medicine, Ghent (Belgium)

2016-02-15

The aim of this retrospective study was to evaluate the accuracy of bone SPECT (single photon emission computed tomography)/CT (computed tomography) in diagnosing loosening of fixation material in patients with recurrent or persistent back pain that underwent lumbar arthrodesis with pedicle screws using surgery and clinical follow-up as gold standard A total of 48 patients (median age 49 years, range 21-81 years; 17 men) who had undergone lumbar spinal arthrodesis were included in this retrospective analysis. SPECT/CT results were compared to the gold standard of surgical evaluation or clinical follow-up. Positive SPECT/CT results were considered true positives if findings were confirmed by surgery or if clinical and other examinations were completely consistent with the positive SPECT/CT finding. They were considered false positives if surgical evaluation did not find any loose pedicle screws or if symptoms subsided with non-surgical therapy. Negative SPECT/CT scans were considered true negatives if symptoms either improved without surgical intervention or remained stable over a minimum follow-up period of 6 months. Negative SPECT/CT scans were determined to be false negatives if surgery was still required and loosening of material was found. The median length of time from primary surgery to bone SPECT/CT referral was 29.5 months (range 12-192 months). Median follow-up was 18 months (range 6-57) for subjects who did not undergo surgery. Thirteen of the 48 patients were found to be positive for loosening on bone SPECT/CT. Surgical evaluation (8 patients) and clinical follow-up (5 patients) showed that bone SPECT/CT correctly predicted loosening in 9 of 13 patients, while it falsely diagnosed loosening in 4 patients. Of 35 negative bone SPECT/CT scans, 12 were surgically confirmed. In 18 patients, bone SPECT/CT revealed lesions that could provide an alternative explanation for the symptoms of pain (active facet degeneration in 14 patients, and disc and sacroiliac

Accuracy Analysis of a Dam Model from Drone Surveys

Science.gov (United States)

Buffi, Giulia; Venturi, Sara

2017-01-01

This paper investigates the accuracy of models obtained by drone surveys. To this end, this work analyzes how the placement of ground control points (GCPs) used to georeference the dense point cloud of a dam affects the resulting three-dimensional (3D) model. Images of a double arch masonry dam upstream face are acquired from drone survey and used to build the 3D model of the dam for vulnerability analysis purposes. However, there still remained the issue of understanding the real impact of a correct GCPs location choice to properly georeference the images and thus, the model. To this end, a high number of GCPs configurations were investigated, building a series of dense point clouds. The accuracy of these resulting dense clouds was estimated comparing the coordinates of check points extracted from the model and their true coordinates measured via traditional topography. The paper aims at providing information about the optimal choice of GCPs placement not only for dams but also for all surveys of high-rise structures. The knowledge a priori of the effect of the GCPs number and location on the model accuracy can increase survey reliability and accuracy and speed up the survey set-up operations. PMID:28771185

Accuracy Analysis of a Dam Model from Drone Surveys

Directory of Open Access Journals (Sweden)

Elena Ridolfi

2017-08-01

Full Text Available This paper investigates the accuracy of models obtained by drone surveys. To this end, this work analyzes how the placement of ground control points (GCPs used to georeference the dense point cloud of a dam affects the resulting three-dimensional (3D model. Images of a double arch masonry dam upstream face are acquired from drone survey and used to build the 3D model of the dam for vulnerability analysis purposes. However, there still remained the issue of understanding the real impact of a correct GCPs location choice to properly georeference the images and thus, the model. To this end, a high number of GCPs configurations were investigated, building a series of dense point clouds. The accuracy of these resulting dense clouds was estimated comparing the coordinates of check points extracted from the model and their true coordinates measured via traditional topography. The paper aims at providing information about the optimal choice of GCPs placement not only for dams but also for all surveys of high-rise structures. The knowledge a priori of the effect of the GCPs number and location on the model accuracy can increase survey reliability and accuracy and speed up the survey set-up operations.

Accuracy Analysis of a Dam Model from Drone Surveys.

Science.gov (United States)

Ridolfi, Elena; Buffi, Giulia; Venturi, Sara; Manciola, Piergiorgio

2017-08-03

This paper investigates the accuracy of models obtained by drone surveys. To this end, this work analyzes how the placement of ground control points (GCPs) used to georeference the dense point cloud of a dam affects the resulting three-dimensional (3D) model. Images of a double arch masonry dam upstream face are acquired from drone survey and used to build the 3D model of the dam for vulnerability analysis purposes. However, there still remained the issue of understanding the real impact of a correct GCPs location choice to properly georeference the images and thus, the model. To this end, a high number of GCPs configurations were investigated, building a series of dense point clouds. The accuracy of these resulting dense clouds was estimated comparing the coordinates of check points extracted from the model and their true coordinates measured via traditional topography. The paper aims at providing information about the optimal choice of GCPs placement not only for dams but also for all surveys of high-rise structures. The knowledge a priori of the effect of the GCPs number and location on the model accuracy can increase survey reliability and accuracy and speed up the survey set-up operations.

Tuberculosis treatment delivery in high burden settings: does patient choice of supervision matter?

Science.gov (United States)

Kironde, S; Meintjies, M

2002-07-01

The Northern Cape Province, Republic of South Africa. To determine the effect of patient choice of treatment delivery option on the treatment outcomes of tuberculosis (TB) patients in a high burden setting under actual programme conditions. Cohort study involving 769 new and retreatment TB patients recruited from 45 randomly selected clinics. Patients were interviewed and subsequent follow-up was done through regular visits to the clinics to check progress through formal health records. There was a statistically significant difference (P < 0.001) between the treatment outcome of new patients (70% successful) and re-treatment patients (54% successful). Direct observation of treatment (DOT) was found to have no effect on the treatment outcome of new patients (P = 0.875), but re-treatment patients were found to fare better with than without DOT (OR 14.2, 95% CI 4.18-53.14, P < 0.001). The results obtained for new patients are similar to those of two recent randomised controlled trials on DOT. This study revealed that for new patients, undue emphasis on universal DOT might be unnecessary. It would perhaps be more beneficial to target supervision at those patients who are most likely to benefit from it (i.e., re-treatment patients). This is of particular relevance in high burden, resource-limited settings where universal DOT for all TB patients is generally unfeasible.

Prediction of Tubal Ectopic Pregnancy Using Offline Analysis of 3-Dimensional Transvaginal Ultrasonographic Data Sets: An Interobserver and Diagnostic Accuracy Study.

Science.gov (United States)

Infante, Fernando; Espada Vaquero, Mercedes; Bignardi, Tommaso; Lu, Chuan; Testa, Antonia C; Fauchon, David; Epstein, Elisabeth; Leone, Francesco P G; Van den Bosch, Thierry; Martins, Wellington P; Condous, George

2017-12-08

To assess interobserver reproducibility in detecting tubal ectopic pregnancies by reading data sets from 3-dimensional (3D) transvaginal ultrasonography (TVUS) and comparing it with real-time 2-dimensional (2D) TVUS. Images were initially classified as showing pregnancies of unknown location or tubal ectopic pregnancies on real time 2D TVUS by an experienced sonologist, who acquired 5 3D volumes. Data sets were analyzed offline by 5 observers who had to classify each case as ectopic pregnancy or pregnancy of unknown location. The interobserver reproducibility was evaluated by the Fleiss κ statistic. The performance of each observer in predicting ectopic pregnancies was compared to that of the experienced sonologist. Women were followed until they were reclassified as follows: (1) failed pregnancy of unknown location; (2) intrauterine pregnancy; (3) ectopic pregnancy; or (4) persistent pregnancy of unknown location. Sixty-one women were included. The agreement between reading offline 3D data sets and the first real-time 2D TVUS was very good (80%-82%; κ = 0.89). The overall interobserver agreement among observers reading offline 3D data sets was moderate (κ = 0.52). The diagnostic performance of experienced observers reading offline 3D data sets had accuracy of 78.3% to 85.0%, sensitivity of 66.7% to 81.3%, specificity of 79.5% to 88.4%, positive predictive value of 57.1% to 72.2%, and negative predictive value of 87.5% to 91.3%, compared to the experienced sonologist's real-time 2D TVUS: accuracy of 94.5%, sensitivity of 94.4%, specificity of 94.5%, positive predictive value of 85.0%, and negative predictive value of 98.1%. The diagnostic accuracy of 3D TVUS by reading offline data sets for predicting ectopic pregnancies is dependent on experience. Reading only static 3D data sets without clinical information does not match the diagnostic performance of real time 2D TVUS combined with clinical information obtained during the scan. © 2017 by the American

Set-up improvement in head and neck radiotherapy using a 3D off-line EPID-based correction protocol and a customised head and neck support

International Nuclear Information System (INIS)

Lin, Emile N.J. Th. van; Vight, Lisette van der; Huizenga, Henk; Kaanders, Johannes H.A.M.; Visser, Andries G.

2003-01-01

Purpose: First, to investigate the set-up improvement resulting from the introduction of a customised head and neck (HN) support system in combination with a technologist-driven off-line correction protocol in HN radiotherapy. Second, to define margins for planning target volume definition, accounting for systematic and random set-up uncertainties. Methods and materials: In 63 patients 498 treatment fractions were evaluated to develop and implement a 3D shrinking action level correction protocol. In the comparative study two different HN-supports were compared: a flexible 'standard HN-support' and a 'customised HN-support'. For all three directions (x, y and z) random and systematic set-up deviations (1 S.D.) were measured. Results: The customised HN-support improves the patient positioning compared to the standard HN-support. The 1D systematic errors in the x, y and z directions were reduced from 2.2-2.3 mm to 1.2-2.0 mm (1 S.D.). The 1D random errors for the y and z directions were reduced from 1.6 and 1.6 mm to 1.1 and 1.0 mm (1 S.D.). The correction protocol reduced the 1D systematic errors further to 0.8-1.1 mm (1 S.D.) and all deviations in any direction were within 5 mm. Treatment time per measured fraction was increased from 10 to 13 min. The total time required per patient, for the complete correction procedure, was approximately 40 min. Conclusions: Portal imaging is a powerful tool in the evaluation of the department specific patient positioning procedures. The introduction of a comfortable customised HN-support, in combination with an electronic portal imaging device-based correction protocol, executed by technologists, led to an improvement of overall patient set-up. As a result, application of proposed recipes for CTV-PTV margins indicates that these can be reduced to 3-4 mm

Accuracy of pre-contrast imaging in abdominal magnetic resonance imaging of pediatric oncology patients

International Nuclear Information System (INIS)

Mohd Zaki, Faizah; Moineddin, Rahim; Grant, Ronald; Chavhan, Govind B.

2016-01-01

Safety concerns are increasingly raised regarding the use of gadolinium-based contrast media for MR imaging. To determine the accuracy of pre-contrast abdominal MR imaging for lesion detection and characterization in pediatric oncology patients. We included 120 children (37 boys and 83 girls; mean age 8.94 years) referred by oncology services. Twenty-five had MRI for the first time and 95 were follow-up scans. Two authors independently reviewed pre-contrast MR images to note the following information about the lesions: location, number, solid vs. cystic and likely nature. Pre- and post-contrast imaging reviewed together served as the reference standard. The overall sensitivity was 88% for the first reader and 90% for the second; specificity was 94% and 91%; positive predictive value was 96% and 94%; negative predictive value was 82% and 84%; accuracy of pre-contrast imaging for lesion detection as compared to the reference standard was 90% for both readers. The difference between mean number of lesions detected on pre-contrast imaging and reference standard was not significant for either reader (reader 1, P = 0.072; reader 2, P = 0.071). There was substantial agreement (kappa values of 0.76 and 0.72 for readers 1 and 2) between pre-contrast imaging and reference standard for determining solid vs. cystic lesion and likely nature of the lesion. The addition of post-contrast imaging increased confidence of both readers significantly (P < 0.0001), but the interobserver agreement for the change in confidence was poor (kappa 0.12). Pre-contrast abdominal MR imaging has high accuracy in lesion detection in pediatric oncology patients and shows substantial agreement with the reference standard for characterization of lesions. Gadolinium-based contrast media administration cannot be completely eliminated but can be avoided in many cases, with the decision made on a case-by-case basis, taking into consideration location and type of tumor. (orig.)

Accuracy of pre-contrast imaging in abdominal magnetic resonance imaging of pediatric oncology patients

Energy Technology Data Exchange (ETDEWEB)

Mohd Zaki, Faizah [University of Toronto, Department of Diagnostic Imaging, The Hospital for Sick Children and Medical Imaging, Toronto, ON (Canada); Universiti Kebangsaan Malaysia Medical Center, Department of Radiology, Kuala Lumpur (Malaysia); Moineddin, Rahim [University of Toronto, Department of Family and Community Medicine, Toronto, ON (Canada); Grant, Ronald [University of Toronto, Department of Hematology and Oncology, The Hospital for Sick Children and Medical Imaging, Toronto, ON (Canada); Chavhan, Govind B. [University of Toronto, Department of Diagnostic Imaging, The Hospital for Sick Children and Medical Imaging, Toronto, ON (Canada)

2016-11-15

Safety concerns are increasingly raised regarding the use of gadolinium-based contrast media for MR imaging. To determine the accuracy of pre-contrast abdominal MR imaging for lesion detection and characterization in pediatric oncology patients. We included 120 children (37 boys and 83 girls; mean age 8.94 years) referred by oncology services. Twenty-five had MRI for the first time and 95 were follow-up scans. Two authors independently reviewed pre-contrast MR images to note the following information about the lesions: location, number, solid vs. cystic and likely nature. Pre- and post-contrast imaging reviewed together served as the reference standard. The overall sensitivity was 88% for the first reader and 90% for the second; specificity was 94% and 91%; positive predictive value was 96% and 94%; negative predictive value was 82% and 84%; accuracy of pre-contrast imaging for lesion detection as compared to the reference standard was 90% for both readers. The difference between mean number of lesions detected on pre-contrast imaging and reference standard was not significant for either reader (reader 1, P = 0.072; reader 2, P = 0.071). There was substantial agreement (kappa values of 0.76 and 0.72 for readers 1 and 2) between pre-contrast imaging and reference standard for determining solid vs. cystic lesion and likely nature of the lesion. The addition of post-contrast imaging increased confidence of both readers significantly (P < 0.0001), but the interobserver agreement for the change in confidence was poor (kappa 0.12). Pre-contrast abdominal MR imaging has high accuracy in lesion detection in pediatric oncology patients and shows substantial agreement with the reference standard for characterization of lesions. Gadolinium-based contrast media administration cannot be completely eliminated but can be avoided in many cases, with the decision made on a case-by-case basis, taking into consideration location and type of tumor. (orig.)

SET protein up-regulated testosterone production in the cultured preantral follicles

Directory of Open Access Journals (Sweden)

Xu Boqun

2013-02-01

Full Text Available Abstract Background We found previously that the expression of SET gene was up-regulated in polycystic ovaries. Evidences suggested that SET protein was essential for regulating both the promoter activity of CYP17A1 and the biological activity of P450c17. In this study, we explored whether SET regulated androgen production in preantral follicles. Methods The mouse preantral follicles were cultured in vitro. Testosterone secretion and expression of steroidogenic enzymes were observed in the preantral follicles treated in vitro by SET overexpression and knockdown. Results Testosterone levels in the media of the AdCMV-SET infected follicles significantly increased, and the CYP17A1 and HSD3B2 expression also significantly increased (P P  Conclusions SET played a positive role in regulating ovarian androgen biosynthesis by enhancing the transcription of steroidogenic enzymes CYP17A1 and HSD3B2, which maybe contribute to the hyperandrogenism in PCOS.

Exploring nurses' and patients' perspectives of limit setting in a forensic mental health setting.

Science.gov (United States)

Maguire, Tessa; Daffern, Michael; Martin, Trish

2014-04-01

Limit setting is an intervention that is frequently used by mental health nurses. However, limit setting is poorly conceptualized, its purpose is unclear, and there are few evidence-based guidelines to assist nurses to set limits in a safe and effective manner. What is known is that the manner in which nurses set limits influences patients' perceptions of the interactions and their emotional and behavioural responses. In this qualitative study, 12 nurses and 12 patients participated in personal, semistructured interviews that aimed to explore limit setting and to propose principles to guide practice. The findings suggested that: (i) limit setting is important to safety in mental health hospitals; (ii) engaging patients in an empathic manner is necessary when setting limits (when nurses engage in an empathic manner, the therapeutic relationship is more likely to be preserved and the risk of aggressive responses is reduced); and (iii) an authoritative (fair, respectful, consistent, and knowledgeable), rather than authoritarian (controlling and indifferent), limit-setting style enhances positive outcomes with regards to adherence, reduced likelihood of aggression, and preservation of the therapeutic relationship. In conclusion, a limit-setting style characterized by empathic responding and an authoritative, rather than authoritarian interpersonal, style is recommended. Elucidating the components of this style is critical for effective training and best practice of mental health nurses, and to reduce aggressive responses from limit setting. © 2013 Australian College of Mental Health Nurses Inc.

The hare or the tortoise? Modeling optimal speed-accuracy tradeoff settings

NARCIS (Netherlands)

van Ravenzwaaij, D.

2012-01-01

Decision making is strongly influenced by the speed-accuracy trade-off. In this dissertation, I have tackled the issue of speed versus accuracy from both a theoretical and an empirical viewpoint and have been drawn time and time again to the same inescapable conclusion: speeded decision making

Testing Delays Resulting in Increased Identification Accuracy in Line-Ups and Show-Ups.

Science.gov (United States)

Dekle, Dawn J.

1997-01-01

Investigated time delays (immediate, two-three days, one week) between viewing a staged theft and attempting an eyewitness identification. Compared lineups to one-person showups in a laboratory analogue involving 412 subjects. Results show that across all time delays, participants maintained a higher identification accuracy with the showup…

Computational psychotherapy research: scaling up the evaluation of patient-provider interactions.

Science.gov (United States)

Imel, Zac E; Steyvers, Mark; Atkins, David C

2015-03-01

In psychotherapy, the patient-provider interaction contains the treatment's active ingredients. However, the technology for analyzing the content of this interaction has not fundamentally changed in decades, limiting both the scale and specificity of psychotherapy research. New methods are required to "scale up" to larger evaluation tasks and "drill down" into the raw linguistic data of patient-therapist interactions. In the current article, we demonstrate the utility of statistical text analysis models called topic models for discovering the underlying linguistic structure in psychotherapy. Topic models identify semantic themes (or topics) in a collection of documents (here, transcripts). We used topic models to summarize and visualize 1,553 psychotherapy and drug therapy (i.e., medication management) transcripts. Results showed that topic models identified clinically relevant content, including affective, relational, and intervention related topics. In addition, topic models learned to identify specific types of therapist statements associated with treatment-related codes (e.g., different treatment approaches, patient-therapist discussions about the therapeutic relationship). Visualizations of semantic similarity across sessions indicate that topic models identify content that discriminates between broad classes of therapy (e.g., cognitive-behavioral therapy vs. psychodynamic therapy). Finally, predictive modeling demonstrated that topic model-derived features can classify therapy type with a high degree of accuracy. Computational psychotherapy research has the potential to scale up the study of psychotherapy to thousands of sessions at a time. We conclude by discussing the implications of computational methods such as topic models for the future of psychotherapy research and practice. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

A Full-size High Temperature Superconducting Coil Employed in a Wind Turbine Generator Set-up

DEFF Research Database (Denmark)

Song, Xiaowei (Andy); Mijatovic, Nenad; Kellers, Jürgen

2016-01-01

A full-size stationary experimental set-up, which is a pole pair segment of a 2 MW high temperature superconducting (HTS) wind turbine generator, has been built and tested under the HTS-GEN project in Denmark. The performance of the HTS coil is crucial to the set-up, and further to the development...... is tested in LN2 first, and then tested in the set-up so that the magnetic environment in a real generator is reflected. The experimental results are reported, followed by a finite element simulation and a discussion on the deviation of the results. The tested and estimated Ic in LN2 are 148 A and 143 A...

Patient identification errors are common in a simulated setting.

Science.gov (United States)

Henneman, Philip L; Fisher, Donald L; Henneman, Elizabeth A; Pham, Tuan A; Campbell, Megan M; Nathanson, Brian H

2010-06-01

We evaluate the frequency and accuracy of health care workers verifying patient identity before performing common tasks. The study included prospective, simulated patient scenarios with an eye-tracking device that showed where the health care workers looked. Simulations involved nurses administering an intravenous medication, technicians labeling a blood specimen, and clerks applying an identity band. Participants were asked to perform their assigned task on 3 simulated patients, and the third patient had a different date of birth and medical record number than the identity information on the artifact label specific to the health care workers' task. Health care workers were unaware that the focus of the study was patient identity. Sixty-one emergency health care workers participated--28 nurses, 16 technicians, and 17 emergency service associates--in 183 patient scenarios. Sixty-one percent of health care workers (37/61) caught the identity error (61% nurses, 94% technicians, 29% emergency service associates). Thirty-nine percent of health care workers (24/61) performed their assigned task on the wrong patient (39% nurses, 6% technicians, 71% emergency service associates). Eye-tracking data were available for 73% of the patient scenarios (133/183). Seventy-four percent of health care workers (74/100) failed to match the patient to the identity band (87% nurses, 49% technicians). Twenty-seven percent of health care workers (36/133) failed to match the artifact to the patient or the identity band before performing their task (33% nurses, 9% technicians, 33% emergency service associates). Fifteen percent (5/33) of health care workers who completed the steps to verify patient identity on the patient with the identification error still failed to recognize the error. Wide variation exists among health care workers verifying patient identity before performing everyday tasks. Education, process changes, and technology are needed to improve the frequency and accuracy of

[Comparison of set-up control for head and neck patients between radiation oncologist and therapists with the aim of partial delegation].

Science.gov (United States)

Garcia-Ramirez, M; Maugey, S; Burgaud, L; Carpentey, F; Parezys, E; Carricaburu, M

2014-11-01

The aim of this prospective study was to evaluate daily set-up by a radiation oncologist and by radiation therapists using on-board imaging of patients with head and neck cancer in order to calculate margin to PTV (planning target volume) and intent partial delegation of positioning images control. The files of 11 patients with head and neck cancer treated on a Synergy™ (Elekta™) accelerator with on-board imaging system were evaluated. Daily kV-kV images were double-blind reviewed by radiation therapists (7 participants) and by one radiation oncologist. The radiation oncologist's measures were used for margin calculation from CTV to PTV. The difference of measures and the concordance of decisions between radiation therapists and the radiation oncologist were calculated. The 325 measures made by the radiation oncologist resulted in a margin of 5mm to be applied to the CTV in each direction. Nine hundred seventy-seven measures were made by the radiation oncologist and radiation therapists with a difference of 3mm or less in 98.46%. The concordance of decision for a 4mm difference or less to the isocenter was 96.7%. This study confirms the 5mm PTV margin mostly used in ORL. The small gap between the radiation oncologist's and therapists' measures allows a partial delegation of positioning images control. Copyright © 2014 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

Practical guidelines for setting up neurosurgery skills training cadaver laboratory in India.

Science.gov (United States)

Suri, Ashish; Roy, Tara Sankar; Lalwani, Sanjeev; Deo, Rama Chandra; Tripathi, Manjul; Dhingra, Renu; Bhardwaj, Daya Nand; Sharma, Bhawani Shankar

2014-01-01

Though the necessity of cadaver dissection is felt by the medical fraternity, and described as early as 600 BC, in India, there are no practical guidelines available in the world literature for setting up a basic cadaver dissection laboratory for neurosurgery skills training. Hands-on dissection practice on microscopic and endoscopic procedures is essential in technologically demanding modern neurosurgery training where ethical issues, cost constraints, medico-legal pitfalls, and resident duty time restrictions have resulted in lesser opportunities to learn. Collaboration of anatomy, forensic medicine, and neurosurgery is essential for development of a workflow of cadaver procurement, preservation, storage, dissection, and disposal along with setting up the guidelines for ethical and legal concerns.

HUG sets up an emergency operations centre on the CERN site

CERN Multimedia

Antonella Del Rosso

2015-01-01

Discussions between CERN and the Hôpitaux universitaires de Genève (HUG), under the aegis of the Swiss authorities, have resulted in the setting-up of an emergency operations centre on the CERN site. This will be the operations base for an emergency doctor, a medical emergency vehicle and a driver. Located on the Swiss part of the Meyrin site, close to Building 57, it will be inaugurated on 20 May.   SMUR team based at CERN. CERN’s medical staff and fire-fighters dispense first aid but in medical emergencies they are obliged to call on outside services to treat and transfer patients to hospital. In the Canton of Geneva, this service is provided by HUG via the 144 emergency line. But HUG is based on the eastern side of Geneva, a long way from CERN, and response times can be substantial. In order to improve the safety of the growing number of people on the site, CERN asked Switzerland, as one of its Host States, to help it reduce the medical emergency response t...

Role of Papanicolaou Smear in the Diagnosis of Pathologic Flora in Asymptomatic Patients in Rural Health Care Set-Up

Directory of Open Access Journals (Sweden)

Siona Sabu

2017-10-01

Full Text Available Introduction: The infections of female genital tract, especially the cervix are asymptomatic in presentation and pose a diagnostic challenge. Vaginal infections can lead to cytoplasmic and nuclear abnormalities in the epithelial cells. Additionally, these infections could augur an inflammatory response of varying nature. The most common flora include Candida albicans, Gardnerella vaginalis, Trichomonas vaginalis, Human Papilloma Virus (HPV, Human Herpes Virus (HHV and Actinomyces sp. Aim: This study seeks to measure the role of Papanicolaou smear in detection of pathologic flora: Candida albicans, Gardnerella vaginalis, Trichomonas vaginalis, HPV, HHV and Actinomyces; in a rural health care set up amongst women in the reproductive and menopausal age group. Materials and Methods: A retrospective study of cervical smears by Papanicolaou method, over a 14 month period was carried out in a tertiary care centre including a total number of 150 patients. Results: Of the total of 150 samples examined, Candida species was the most frequently detected (8.7% followed by Trichomonas vaginalis (5.3% and Gardnerella vaginalis species (4.7%. HPV-induced changes were noted in a mere 2% of cases. Actinomyces species was noted in less than 1% of cases. Conclusion: The Papanicolaou test for examining cervical smear has definite uses in detecting vaginal microorganisms. Apart from detection of the usual pathogenic flora, the test has utility in defining the degree of inflammation and additional reparative changes.

First-principle modelling of forsterite surface properties: Accuracy of methods and basis sets.

Science.gov (United States)

Demichelis, Raffaella; Bruno, Marco; Massaro, Francesco R; Prencipe, Mauro; De La Pierre, Marco; Nestola, Fabrizio

2015-07-15

The seven main crystal surfaces of forsterite (Mg2 SiO4 ) were modeled using various Gaussian-type basis sets, and several formulations for the exchange-correlation functional within the density functional theory (DFT). The recently developed pob-TZVP basis set provides the best results for all properties that are strongly dependent on the accuracy of the wavefunction. Convergence on the structure and on the basis set superposition error-corrected surface energy can be reached also with poorer basis sets. The effect of adopting different DFT functionals was assessed. All functionals give the same stability order for the various surfaces. Surfaces do not exhibit any major structural differences when optimized with different functionals, except for higher energy orientations where major rearrangements occur around the Mg sites at the surface or subsurface. When dispersions are not accounted for, all functionals provide similar surface energies. The inclusion of empirical dispersions raises the energy of all surfaces by a nearly systematic value proportional to the scaling factor s of the dispersion formulation. An estimation for the surface energy is provided through adopting C6 coefficients that are more suitable than the standard ones to describe O-O interactions in minerals. A 2 × 2 supercell of the most stable surface (010) was optimized. No surface reconstruction was observed. The resulting structure and surface energy show no difference with respect to those obtained when using the primitive cell. This result validates the (010) surface model here adopted, that will serve as a reference for future studies on adsorption and reactivity of water and carbon dioxide at this interface. © 2015 Wiley Periodicals, Inc.

Accuracy of the all patient refined diagnosis related groups classification system in congenital heart surgery.

Science.gov (United States)

Parnell, Aimee S; Shults, Justine; Gaynor, J William; Leonard, Mary B; Dai, Dingwei; Feudtner, Chris

2014-02-01

Administrative data are increasingly used to evaluate clinical outcomes and quality of care in pediatric congenital heart surgery (CHS) programs. Several published analyses of large pediatric administrative data sets have relied on the All Patient Refined Diagnosis Related Groups (APR-DRG, version 24) diagnostic classification system. The accuracy of this classification system for patients undergoing CHS is unclear. We performed a retrospective cohort study of all 14,098 patients 0 to 5 years of age undergoing any of six selected congenital heart operations, ranging in complexity from isolated closure of a ventricular septal defect to single-ventricle palliation, at 40 tertiary-care pediatric centers in the Pediatric Health Information Systems database between 2007 and 2010. Assigned APR-DRGs (cardiac versus noncardiac) were compared using χ2 or Fisher's exact tests between those patients admitted during the first day of life versus later and between those receiving extracorporeal membrane oxygenation support versus those not. Recursive partitioning was used to assess the greatest determinants of APR-DRG type in the model. Every patient admitted on day 1 of life was assigned to a noncardiac APR-DRG (pDRG (pDRG experienced a significantly increased mortality (pDRG coding has systematic misclassifications, which may result in inaccurate reporting of CHS case volumes and mortality. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Accuracy of spectral and finite difference schemes in 2D advection problems

DEFF Research Database (Denmark)

Naulin, V.; Nielsen, A.H.

2003-01-01

In this paper we investigate the accuracy of two numerical procedures commonly used to solve 2D advection problems: spectral and finite difference (FD) schemes. These schemes are widely used, simulating, e.g., neutral and plasma flows. FD schemes have long been considered fast, relatively easy...... that the accuracy of FD schemes can be significantly improved if one is careful in choosing an appropriate FD scheme that reflects conservation properties of the nonlinear terms and in setting up the grid in accordance with the problem....

Set-up of light nuclei multidetector

International Nuclear Information System (INIS)

Drouet, A.

1985-01-01

In order to study mechanisms of reactions produced by heavy ions in the GANIL energy range (15-100 MeV/A), a multidetector capable to detect large multiplicities for particles and light nuclei is necessary. The multidetector set up covers the 3-30 0 angular range and consists of 96 counters (NE102 plastic scintillator sheet, 2mm thick). The apparatus must identify the nuclear charge of the detected particles. Using the apparatus at GANIL leaded to carry out data processing tools in conversationnal mode and to write on experimental area programs performing and monitoring data acquisition. A test carried out with a 44 MeV/A argon beam showed that the apparatus was working properly: the identification in nuclear charge between Z=1 (proton) and Z=7 (nitrogen) is good. Results of the test allow to draw light production curves in the NE102 plastic scintillator for the following ions: 1 H, 4 He, 7 Li, 9 Be, 11 B, 12 C, 14 N, in the 13 to 44 MeV/A energy range [fr

The possibility to use 'energy plus transmutation' set-up for neutron ...

Indian Academy of Sciences (India)

Neutron field was measured in different places of this set- up using different .... to see that the proton integral was around 1013 protons for all experiments. The shape of the .... The lines are drawn to guide the eyes, only statistical errors are ...

Effectiveness of PET Scan in Postoperative Long Term Follow up of Patients with Nonsmall Cell Lung Cancer

Directory of Open Access Journals (Sweden)

Atilla Pekcolaklar

2012-01-01

Full Text Available Aim: There is very few data about the use of positron emission tomography [PET] in the long term follow up of patients operated for lung cancer. We aimed to evaluate the effectiveness of PET scan in detecting distant metastases in the long term follow up of asymptomatic patients operated for non-small cell lung cancer [NSCLC]. Material and Method: PET scan was performed to sixty five asymptomatic patients. The patients who had a positive PET scan for metastasis underwent MRI and/or biopsy to verify metastasis. Result: : Mean age of the patients was 58.09 8.64 [44-82] years, and 57 [87.7 %] of them were male. Forty eight [73.8%] of the patients had epidermoid cell, 15 [23.1%] had adeno and 2 [%3.1] had large cell carcinoma. Postoperative stage of 1 [1.5%] patient was 1A, 14 [21.5%] of them were stage 1B, 1 [1.5%] of them was stage 2A, 27 [41.5%] of them were stage 2B and 22 [33.8%] of them were stage 3A. PET scan detected metastasis in 7 [10.8%] patients. In one patient PET scan was proven to be false positive. Sites of metastases in PET scan were lung in 3 [4.5%] patients, vertebra in 3 [4.6%] patients and tibia in 1 [1.5%] patient. In detecting distant metastases accuracy rate of PET was calculated as 98%, sensitivity was 100%, and specificity was 98%. Discussion: In asymptomatic patients with NSCLC, PET imaging appears to be useful as an alternative to conventional imaging to rule out unsuspected systemic disease in the postoperative long term follow up.

ACCURACY ANALYSIS OF A LOW-COST PLATFORM FOR POSITIONING AND NAVIGATION

Directory of Open Access Journals (Sweden)

S. Hofmann

2012-07-01

Full Text Available This paper presents an accuracy analysis of a platform based on low-cost components for landmark-based navigation intended for research and teaching purposes. The proposed platform includes a LEGO MINDSTORMS NXT 2.0 kit, an Android-based Smartphone as well as a compact laser scanner Hokuyo URG-04LX. The robot is used in a small indoor environment, where GNSS is not available. Therefore, a landmark map was produced in advance, with the landmark positions provided to the robot. All steps of procedure to set up the platform are shown. The main focus of this paper is the reachable positioning accuracy, which was analyzed in this type of scenario depending on the accuracy of the reference landmarks and the directional and distance measuring accuracy of the laser scanner. Several experiments were carried out, demonstrating the practically achievable positioning accuracy. To evaluate the accuracy, ground truth was acquired using a total station. These results are compared to the theoretically achievable accuracies and the laser scanner’s characteristics.

Balancing dose and image registration accuracy for cone beam tomosynthesis (CBTS) for breast patient setup

International Nuclear Information System (INIS)

Winey, B. A.; Zygmanski, P.; Cormack, R. A.; Lyatskaya, Y.

2010-01-01

Purpose: To balance dose reduction and image registration accuracy in breast setup imaging. In particular, the authors demonstrate the relationship between scan angle and dose delivery for cone beam tomosynthesis (CBTS) when employed for setup verification of breast cancer patients with surgical clips. Methods: The dose measurements were performed in a female torso phantom for varying scan angles of CBTS. Setup accuracy was measured using three registration methods: Clip centroid localization accuracy and the accuracy of two semiautomatic registration algorithms. The dose to the organs outside of the ipsilateral breast and registration accuracy information were compared to determine the optimal scan angle for CBTS for breast patient setup verification. Isocenter positions at the center of the patient and at the breast-chest wall interface were considered. Results: Image registration accuracy was within 1 mm for the CBTS scan angles θ above 20 deg. for some scenarios and as large as 80 deg. for the worst case, depending on the imaged breast and registration algorithm. Registration accuracy was highest based on clip centroid localization. For left and right breast imaging with the isocenter at the chest wall, the dose to the contralateral side of the patient was very low (<0.5 cGy) for all scan angles considered. For central isocenter location, the optimal scan angles were 30 deg. - 50 deg. for the left breast imaging and 40 deg. - 50 deg. for the right breast imaging, with the difference due to the geometric asymmetry of the current clinical imaging system. Conclusions: The optimal scan angles for CBTS imaging were found to be between 10 deg. and 50 deg., depending on the isocenter location and ipsilateral breast. Use of the isocenter at the breast-chest wall locations always resulted in greater accuracy of image registration (<1 mm) at smaller angles (10 deg. - 20 deg.) and at lower doses (<0.1 cGy) to the contralateral organs. For chest wall isocenters, doses

Patient responses to research recruitment and follow-up surveys: findings from a diverse multicultural health care setting in Qatar

Directory of Open Access Journals (Sweden)

Amal Khidir

2016-01-01

Full Text Available Abstract Background Health care researchers working in the Arabian Gulf need information on how to optimize recruitment and retention of study participants in extremely culturally diverse settings. Implemented in Doha, Qatar in 2012 with 4 language groups, namely Arabic, English, Hindi, and Urdu, this research documents persons’ responses to recruitment, consent, follow-up, and reminder procedures during psychometric testing of the Multicultural Assessment Instrument (MAI, a novel self- or interviewer-administered survey. Methods Bilingual research assistants recruited adults in outpatient clinics by approaching persons in particular who appeared to be from a target language group. Participants completed the MAI, a second acculturation instrument used for content-validity assessment, and a demographics questionnaire. Participants were asked to take the MAI again in 2–3 weeks, in person or by post, to assess test-retest reliability. Recruitment data were analyzed by using nonparametric statistics. Results Of 1503 persons approached during recruitment, 400 enrolled (27 %—100 per language group. The enrollment rates in the language groups were: Arabic-32 %; English-33 %; Hindi-18 %; Urdu-30 %. The groups varied somewhat in their preferences regarding consent procedure, follow-up survey administration, contact mode for follow-up reminders, and disclosure of personal mailing address (for postal follow-up. Over all, telephone was the preferred medium for follow-up reminders. Of 64 persons who accepted a research assistant’s invitation for in-person follow-up, 40 participants completed the interview (follow-up rate, 63 %; among 126 persons in the postal group with a deliverable address, 29 participants mailed back a completed follow-up survey (response rate, 23 %. Conclusions Researchers in the Arabian Gulf face challenges to successfully identify, enroll, and retain eligible study participants. Although bilingual assistants�

A fast-response production-inventory model for deteriorating seasonal products with learning in set-ups

Directory of Open Access Journals (Sweden)

Ibraheem Abdul

2011-10-01

Full Text Available The classical production-inventory model assumes that both demand and set-up costs are constant. However, in real manufacturing environment, managers usually embark on continuous improvement programmes that often lead to more effective use of tools and machineries and consequently reduction in set-up costs. In fact, constant emphasis on reduction of set-up costs is usually cited as one of the factors responsible for the efficiency of Japanese manufacturing methods. On the other hand, the demand for seasonal product is often characterized by a mixture of time-dependent patterns over the entire season. This paper investigates the effect of learning-based reduction in set-up costs on the optimal schedules and costs of a production-inventory system for deteriorating seasonal products. The demand pattern is a general three-phase ramp-type demand function that represents the various phases of demand commonly observed in many seasonal products in the market. A two-parameter Weibull-distribution function is used for the deterioration of items in order to make the model more generalized and realistic. The study further presents two different multi-period production strategies that can ensure a fast-response to customers’ demand and compare them with the usual single period strategy. The Numerical example and sensitivity analysis shows that learning-based reduction in set-up costs leads to higher production frequency and shorter production runs which are vital aspects of the just-in-time (JIT philosophy.

Personal noise dosimeters: Accuracy and reliability in varied settings

Directory of Open Access Journals (Sweden)

Sheri Lynn Cook-Cunningham

2014-01-01

Full Text Available This study investigated the accuracy, reliability, and characteristics of three brands of personal noise dosimeters (N = 7 units in both pink noise (PN environments and natural environments (NEs through the acquisition of decibel readings, Leq readings and noise doses. Acquisition periods included repeated PN conditions, choir room rehearsals and participant (N = 3 Leq and noise dosages procured during a day in the life of a music student. Among primary results: (a All dosimeters exhibited very strong positive correlations for PN measurements across all instruments; (b all dosimeters were within the recommended American National Standard Institute (ANSI SI.25-1991 standard of ±2 dB (A of a reference measurement; and (c all dosimeters were within the recommended ANSI SI.25-1991 standard of ±2 dB (A when compared with each other. Results were discussed in terms of using personal noise dosimeters within hearing conservation and research contexts and recommendations for future research. Personal noise dosimeters were studied within the contexts of PN environments and NEs (choral classroom and the day in the life of collegiate music students. This quantitative study was a non-experimental correlation design. Three brands of personal noise dosimeters (Cirrus doseBadge, Quest Edge Eg5 and Etymotic ER200D were tested in two environments, a PN setting and a natural setting. There were two conditions within each environment. In the PN environment condition one, each dosimeter was tested individually in comparison with two reference measuring devices (Ivie and Easera while PN was generated by a Whites Instrument PN Tube. In condition two, the PN procedures were replicated for longer periods while all dosimeters measured the sound levels simultaneously. In the NE condition one, all dosimeters were placed side by side on a music stand and recorded sound levels of choir rehearsals over a 7-h rehearsal period. In NE, condition two noise levels were measured

Diagnostic accuracy of {sup 18}F-FDG PET/CT for detection of suspected recurrence in patients with oesophageal carcinoma

Energy Technology Data Exchange (ETDEWEB)

Sharma, Punit; Jain, Sachin; Karunanithi, Sellam; Malhotra, Arun; Bal, Chandrasekhar; Kumar, Rakesh [All India Institute of Medical Sciences, Department of Nuclear Medicine, New Delhi (India); Pal, Sujoy [All India Institute of Medical Sciences, Department of Surgical Gastroenterology, New Delhi (India); Julka, Pramod Kumar [All India Institute of Medical Sciences, Department of Radiation Oncology, New Delhi (India); Thulkar, Sanjay [All India Institute of Medical Sciences, Department of Radiodiagnosis, New Delhi (India)

2014-06-15

To evaluate the role of {sup 18}F-FDG PET/CT in the detection of recurrence in patients with oesophageal carcinoma, suspected clinically or following conventional investigations. This was a retrospective study. Data from 180 patients (age 56.3 ± 10.4 years; 126 men, 54 women) with histopathologically proven oesophageal carcinoma (squamous cell 115, adenocarcinoma 59, neuroendocrine carcinoma 4, small cell 1, poorly differentiated 1) who had undergone 227 {sup 18}F-FDG PET/CT studies for suspected recurrence were analysed. Recurrence was suspected clinically or following conventional investigations. PET/CT images were revaluated by two nuclear medicine physicians in consensus. Findings were grouped into local, nodal and distant recurrence. Results were compared to those from contrast-enhanced (CE) CT when available (109 patients). Clinical/imaging follow-up (minimum 6 months) with histopathology (when available) was taken as the reference standard. Of the 227 {sup 18}F-FDG PET/CT studies,166 were positive and 61 were negative for recurrent disease. PET/CT showed local recurrence in 134, nodal recurrence in 115 and distant recurrence in 47, with more than one site of recurrence in 34. The PET/CT findings were true-positive in 153 studies, true-negative in 54, false-positive in 13 and false-negative in 7. The sensitivity of {sup 18}F-FDG PET/CT was 96 %, the specificity was 81 %, the positive and negative predictive values were 92 % and 89 %, respectively, and the accuracy was 91 %. PET/CT showed similar accuracy in patients with squamous cell carcinoma and in those with adenocarcinoma (P = 0.181).{sup 18}F-FDG PET/CT was more specific than CECT (67 % vs. 21 %; P < 0.0001). PET/CT was superior to CECT for the detection of nodal recurrence (P < 0.0001), but not local recurrence (P = 0.093) or distant metastases (P = 0.441). {sup 18}F-FDG PET/CT shows high accuracy in the detection of suspected recurrence in patients with oesophageal carcinoma. It is more specific than

Setting up and Running a School Library. Information Collection and Exchange Publication No. ED204

Science.gov (United States)

Baird, Nicola

2012-01-01

This book explains how teachers can set up and run a successful school library. In it you will find advice and information on how to: (1) set up a small library and build bookshelves; (2) select books for your library; (3) make a written record of your school's books, pamphlets and other library stock such as newspapers, magazines, audio tapes and…

Subtraction method of computing QCD jet cross sections at NNLO accuracy

Science.gov (United States)

Trócsányi, Zoltán; Somogyi, Gábor

2008-10-01

We present a general subtraction method for computing radiative corrections to QCD jet cross sections at next-to-next-to-leading order accuracy. The steps needed to set up this subtraction scheme are the same as those used in next-to-leading order computations. However, all steps need non-trivial modifications, which we implement such that that those can be defined at any order in perturbation theory. We give a status report of the implementation of the method to computing jet cross sections in electron-positron annihilation at the next-to-next-to-leading order accuracy.

Subtraction method of computing QCD jet cross sections at NNLO accuracy

Energy Technology Data Exchange (ETDEWEB)

Trocsanyi, Zoltan [University of Debrecen and Institute of Nuclear Research of the Hungarian Academy of Sciences, H-4001 Debrecen P.O.Box 51 (Hungary)], E-mail: Zoltan.Trocsanyi@cern.ch; Somogyi, Gabor [University of Zuerich, Winterthurerstrasse 190, CH-8057 Zuerich (Switzerland)], E-mail: sgabi@physik.unizh.ch

2008-10-15

We present a general subtraction method for computing radiative corrections to QCD jet cross sections at next-to-next-to-leading order accuracy. The steps needed to set up this subtraction scheme are the same as those used in next-to-leading order computations. However, all steps need non-trivial modifications, which we implement such that that those can be defined at any order in perturbation theory. We give a status report of the implementation of the method to computing jet cross sections in electron-positron annihilation at the next-to-next-to-leading order accuracy.

Accuracy of acoustic respiration rate monitoring in pediatric patients.

Science.gov (United States)

Patino, Mario; Redford, Daniel T; Quigley, Thomas W; Mahmoud, Mohamed; Kurth, C Dean; Szmuk, Peter

2013-12-01

Rainbow acoustic monitoring (RRa) utilizes acoustic technology to continuously and noninvasively determine respiratory rate from an adhesive sensor located on the neck. We sought to validate the accuracy of RRa, by comparing it to capnography, impedance pneumography, and to a reference method of counting breaths in postsurgical children. Continuous respiration rate data were recorded from RRa and capnography. In a subset of patients, intermittent respiration rate from thoracic impedance pneumography was also recorded. The reference method, counted respiratory rate by the retrospective analysis of the RRa, and capnographic waveforms while listening to recorded breath sounds were used to compare respiration rate of both capnography and RRa. Bias, precision, and limits of agreement of RRa compared with capnography and RRa and capnography compared with the reference method were calculated. Tolerance and reliability to the acoustic sensor and nasal cannula were also assessed. Thirty-nine of 40 patients (97.5%) demonstrated good tolerance of the acoustic sensor, whereas 25 of 40 patients (62.5%) demonstrated good tolerance of the nasal cannula. Intermittent thoracic impedance produced erroneous respiratory rates (>50 b·min(-1) from the other methods) on 47% of occasions. The bias ± SD and limits of agreement were -0.30 ± 3.5 b·min(-1) and -7.3 to 6.6 b·min(-1) for RRa compared with capnography; -0.1 ± 2.5 b·min(-1) and -5.0 to 5.0 b·min(-1) for RRa compared with the reference method; and 0.2 ± 3.4 b·min(-1) and -6.8 to 6.7 b·min(-1) for capnography compared with the reference method. When compared to nasal capnography, RRa showed good agreement and similar accuracy and precision but was better tolerated in postsurgical pediatric patients. © 2013 John Wiley & Sons Ltd.

The new cold neutron tomography set-up at SINQ

CERN Document Server

Baechler, S; Cauwels, P; Dierick, M; Jolie, J; Materna, T; Mondelaers, W

2002-01-01

A new cold neutron tomography set-up is operational at the neutron spallation source SINQ of the Paul Scherrer Institute (PSI) in Villigen, Switzerland. The detection system is based on a sup 6 LiF/ZnS:Ag conversion screen and a CCD camera. Several tests have been carried out to characterize the quality of the tomography system, such as homogeneity, reproducibility, L/D-ratio and spatial resolution. The high flux and the good efficiency of the detector lead to very short exposure times. Thus, a typical set of tomography scans can be performed in only 20 min. Then, 3D computed tomography objects were calculated using the filtered back-projection reconstruction method. Initial results of various samples show that cold neutron tomography can be a useful tool for industry, geology and dentistry. Furthermore, suitable applications can be found in the field of archaeology.

Evaluation of radiographers’ mammography screen-reading accuracy in Australia

International Nuclear Information System (INIS)

Debono, Josephine C; Poulos, Ann E; Houssami, Nehmat; Turner, Robin M; Boyages, John

2015-01-01

This study aimed to evaluate the accuracy of radiographers’ screen-reading mammograms. Currently, radiologist workforce shortages may be compromising the BreastScreen Australia screening program goal to detect early breast cancer. The solution to a similar problem in the United Kingdom has successfully encouraged radiographers to take on the role as one of two screen-readers. Prior to consideration of this strategy in Australia, educational and experiential differences between radiographers in the United Kingdom and Australia emphasise the need for an investigation of Australian radiographers’ screen-reading accuracy. Ten radiographers employed by the Westmead Breast Cancer Institute with a range of radiographic (median = 28 years), mammographic (median = 13 years) and BreastScreen (median = 8 years) experience were recruited to blindly and independently screen-read an image test set of 500 mammograms, without formal training. The radiographers indicated the presence of an abnormality using BI-RADS®. Accuracy was determined by comparison with the gold standard of known outcomes of pathology results, interval matching and client 6-year follow-up. Individual sensitivity and specificity levels ranged between 76.0% and 92.0%, and 74.8% and 96.2% respectively. Pooled screen-reader accuracy across the radiographers estimated sensitivity as 82.2% and specificity as 89.5%. Areas under the reading operating characteristic curve ranged between 0.842 and 0.923. This sample of radiographers in an Australian setting have adequate accuracy levels when screen-reading mammograms. It is expected that with formal screen-reading training, accuracy levels will improve, and with support, radiographers have the potential to be one of the two screen-readers in the BreastScreen Australia program, contributing to timeliness and improved program outcomes

Evaluation of radiographers’ mammography screen-reading accuracy in Australia

Energy Technology Data Exchange (ETDEWEB)

Debono, Josephine C, E-mail: josephine.debono@bci.org.au [Westmead Breast Cancer Institute, Westmead, New South Wales (Australia); Poulos, Ann E [Discipline of Medical Radiation Sciences, Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales (Australia); Houssami, Nehmat [Screening and Test Evaluation Program, School of Public Health (A27), Sydney Medical School, University of Sydney, Sydney, New South Wales (Australia); Turner, Robin M [School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales (Australia); Boyages, John [Macquarie University Cancer Institute, Macquarie University Hospital, Australian School of Advanced Medicine, Macquarie University, Sydney, New South Wales (Australia); Westmead Breast Cancer Institute, Westmead, New South Wales (Australia)

2015-03-15

This study aimed to evaluate the accuracy of radiographers’ screen-reading mammograms. Currently, radiologist workforce shortages may be compromising the BreastScreen Australia screening program goal to detect early breast cancer. The solution to a similar problem in the United Kingdom has successfully encouraged radiographers to take on the role as one of two screen-readers. Prior to consideration of this strategy in Australia, educational and experiential differences between radiographers in the United Kingdom and Australia emphasise the need for an investigation of Australian radiographers’ screen-reading accuracy. Ten radiographers employed by the Westmead Breast Cancer Institute with a range of radiographic (median = 28 years), mammographic (median = 13 years) and BreastScreen (median = 8 years) experience were recruited to blindly and independently screen-read an image test set of 500 mammograms, without formal training. The radiographers indicated the presence of an abnormality using BI-RADS®. Accuracy was determined by comparison with the gold standard of known outcomes of pathology results, interval matching and client 6-year follow-up. Individual sensitivity and specificity levels ranged between 76.0% and 92.0%, and 74.8% and 96.2% respectively. Pooled screen-reader accuracy across the radiographers estimated sensitivity as 82.2% and specificity as 89.5%. Areas under the reading operating characteristic curve ranged between 0.842 and 0.923. This sample of radiographers in an Australian setting have adequate accuracy levels when screen-reading mammograms. It is expected that with formal screen-reading training, accuracy levels will improve, and with support, radiographers have the potential to be one of the two screen-readers in the BreastScreen Australia program, contributing to timeliness and improved program outcomes.

Accuracy of a wireless localization system for radiotherapy

International Nuclear Information System (INIS)

Balter, James M.; Wright, J. Nelson; Newell, Laurence J.; Friemel, Barry; Dimmer, Steven; Cheng, Yuki; Wong, John; Vertatschitsch, Edward; Mate, Timothy P.

2005-01-01

Purpose: A system has been developed for patient positioning based on real-time localization of implanted electromagnetic transponders (beacons). This study demonstrated the accuracy of the system before clinical trials. Methods and materials: We describe the overall system. The localization component consists of beacons and a source array. A rigid phantom was constructed to place the beacons at known offsets from a localization array. Tests were performed at distances of 80 and 270 mm from the array and at positions in the array plane of up to 8 cm offset. Tests were performed in air and saline to assess the effect of tissue conductivity and with multiple transponders to evaluate crosstalk. Tracking was tested using a dynamic phantom creating a circular path at varying speeds. Results: Submillimeter accuracy was maintained throughout all experiments. Precision was greater proximal to the source plane (σx = 0.006 mm, σy = 0.01 mm, σz = 0.006 mm), but continued to be submillimeter at the end of the designed tracking range at 270 mm from the array (σx = 0.27 mm, σy = 0.36 mm, σz = 0.48 mm). The introduction of saline and the use of multiple beacons did not affect accuracy. Submillimeter accuracy was maintained using the dynamic phantom at speeds of up to 3 cm/s. Conclusion: This system has demonstrated the accuracy needed for localization and monitoring of position during treatment

Prognostic and accuracy data of multidetector CT coronary angiography in an established clinical service

Energy Technology Data Exchange (ETDEWEB)

Van Lingen, R. [Department of Cardiology, Derriford Hospital, Plymouth, Devon (United Kingdom)], E-mail: Robin.vanLingen@rcht.cornwall.nhs.uk; Kakani, N.; Veitch, A.; Manghat, N.E.; Roobottom, C.A. [Department of Clinical Radiology, Derriford Hospital, Plymouth, Devon (United Kingdom); Morgan-Hughes, G.J. [Department of Cardiology, Derriford Hospital, Plymouth, Devon (United Kingdom)

2009-06-15

Aim: To assess the accuracy of clinical coronary computed tomography angiography (CTA) data compared to invasive coronary angiography, and to determine the prognostic value of a negative coronary CTA examination in symptomatic, intermediate-risk patients. Methods: Thirty-seven months of coronary CTA data were audited. Seventy-eight patients were identified who had undergone coronary CTA followed by invasive coronary angiography (ICA) to determine the accuracy of CTA versus ICA. One hundred and seventy-eight patients were identified who had a 'negative' coronary CTA to enable evaluation of the prognostic value of a negative CTA examination. Results: Of the 78 patients in the accuracy analysis group there were 43 true-negative, two false-negative, 26 true-positive, and seven false-positive results producing a sensitivity of 92.9%, specificity of 86%, negative predictive value of 95.6%, and positive predictive value of 78.8%. The 178 patients who had a negative coronary CTA examination were followed up for a mean of 366 days and were all alive (0% mortality) with no episodes of myocardial infarction or unstable angina; two patients underwent elective revascularization procedures (1.1%). Conclusion: According to medium-term analysis, the accuracy of the clinical coronary CTA programme is in line with published trial data, producing excellent sensitivity and negative predictive values. The finding of a negative coronary CTA in symptomatic, intermediate-risk patients appears to confer a good prognosis, at mean follow-up of 1 year, with no deaths or episodes of myocardial infarction or unstable angina. This suggests that the prognostic value of a negative coronary CTA may be similar to that conferred by negative myocardial perfusion scintigraphy or stress echocardiography.

Characteristics of patients in an eating disorder sample who dropped out: 2-year follow-up.

Science.gov (United States)

Gómez Del Barrio, Andrés; Vellisca Gonzalez, María Yolanda; González Gómez, Jana; Latorre Marín, José Ignacio; Carral-Fernández, Laura; Orejudo Hernandez, Santos; Madrazo Río-Hortega, Inés; Moreno Malfaz, Laura

2017-07-17

This manuscript explores the characteristics of individuals diagnosed with an eating disorder who dropped out of treatment, compared with those who completed it. The participants were 196 patients diagnosed with eating disorders (according to DSM-IV-TR criteria) who consecutively began treatment for the first time in an eating disorders unit. They were assessed at baseline with a set of questionnaires evaluating eating habits, temperament, and general psychopathology. During the follow-up period, patients who dropped out were re-assessed via a telephone interview. In the course of a 2-year follow-up, a total of 80 (40.8%) patients were labeled as dropouts, and 116 (59.2%) remaining subjects were considered completers. High TCI scores in the character dimensions of Disorderliness (NS4) (p out of treatment. Level III: Cohort Study.

Broadband short pulse measurement by autocorrelation with a sum-frequency generation set-up

International Nuclear Information System (INIS)

Glotin, F.; Jaroszynski, D.; Marcouille, O.

1995-01-01

Previous spectral and laser pulse length measurements carried out on the CLIO FEL at wavelength λ=8.5 μm suggested that very short light pulses could be generated, about 500 fs wide (FWHM). For these measurements a Michelson interferometer with a Te crystal, as a non-linear detector, was used as a second order autocorrelation device. More recent measurements in similar conditions have confirmed that the laser pulses observed are indeed single: they are not followed by other pulses distant by the slippage length Nλ. As the single micropulse length is likely to depend on the slippage, more measurements at different wavelengths would be useful. This is not directly possible with our actual interferometer set-up, based on a phase-matched non-linear crystal. However, we can use the broadband non-linear medium provided by one of our users' experiments: Sum-Frequency Generation over surfaces. With such autocorrelation set-up, interference fringes are no more visible, but this is largely compensated by the frequency range provided. First tests at 8 μm have already been performed to validate the technic, leading to results similar to those obtained with our previous Michelson set-up

Evaluation of {sup 131}I scintigraphy and stimulated thyroglobulin levels in the follow up of patients with DTC: a retrospective analysis of 1420 patients

Energy Technology Data Exchange (ETDEWEB)

Gonzalez Carvalho, Jose Manuel; Schober, Otmar; Wenning, Christian; Riemann, Burkhard; Vrachimis, Alexis [University Hospital Muenster, Department of Nuclear Medicine, Muenster (Germany); Goerlich, Dennis [Westfaelische Wilhelms-Universitaet Muenster, Institute of Biostatistics and Clinical Research, Muenster (Germany); Verburg, Frederik Anton [University Hospital Giessen and Marburg, Department of Nuclear Medicine, Marburg (Germany)

2017-05-15

To study the clinical yield of diagnostic whole body {sup 131}I scintigraphy (DxWBS) in the follow-up of differentiated thyroid carcinoma (DTC) patients in relation to stimulated thyroglobulin (sTg) in the initial post-ablation setting, as well as in the setting of repeated monitoring in course of further DTC follow-up. Data of 1420 thyroidectomized and radioiodine remnant-ablated DTC patients following a well-defined therapy and standardized follow-up protocol were evaluated. DxWBS and sTg were evaluated separately and in combination for various follow-up time points. The factual administration of the recorded indication for further oncologic therapy (excluding radioiodine therapies given for minimal normal remnants) within the following 4 months after follow-up served as the standard of reference. Furthermore, DxWBS was compared to post therapy WBS and SPECT(/CT) if available. Subgroup analysis was carried out for DTC patients < 45 years old at diagnosis without distant metastasis. The diagnostic impact of cervical ultrasound was not assessed. sTg can identify the patients at risk better than DxWBS. Furthermore, the most sensitive time point to assess response appears to be a time point beyond 3 months after RRA. When information received from both imaging and laboratory measurements are concordant, i.e. both construe absence of remaining disease, only a small fraction of patients (<2%) required treatment in the future. The strongest effect was observed 12 months after RRA. Only 0.9% of the negative DxWBS patients with concordant sTg below the functional sensitivity at this time point required treatment thereafter. A complete omission of DxWBS in the post-RRA surveillance of DTC is justified once DxWBS is negative and sTg is below the functional sensitivity (with no evidence of thyroglobulin antibodies), as patients showing this combination of test results (especially 12 months after RRA) show an at worst marginal risk of recurrence. In all other cases DxWBS may

Assessing the Accuracy and Readability of Online Health Information for Patients With Pancreatic Cancer.

Science.gov (United States)

Storino, Alessandra; Castillo-Angeles, Manuel; Watkins, Ammara A; Vargas, Christina; Mancias, Joseph D; Bullock, Andrea; Demirjian, Aram; Moser, A James; Kent, Tara S

2016-09-01

The degree to which patients are empowered by written educational materials depends on the text's readability level and the accuracy of the information provided. The association of a website's affiliation or focus on treatment modality with its readability and accuracy has yet to be thoroughly elucidated. To compare the readability and accuracy of patient-oriented online resources for pancreatic cancer by treatment modality and website affiliation. An online search of 50 websites discussing 5 pancreatic cancer treatment modalities (alternative therapy, chemotherapy, clinical trials, radiation therapy, and surgery) was conducted. The website's affiliation was identified. Readability was measured by 9 standardized tests, and accuracy was assessed by an expert panel. Nine standardized tests were used to compute the median readability level of each website. The median readability scores were compared among treatment modality and affiliation categories. Accuracy was determined by an expert panel consisting of 2 medical specialists and 2 surgical specialists. The 4 raters independently evaluated all websites belonging to the 5 treatment modalities (a score of 1 indicates that readability and accuracy based on the focus of the treatment modality and the website's affiliation. Websites discussing surgery (with a median readability level of 13.7 and an interquartile range [IQR] of 11.9-15.6) were easier to read than those discussing radiotherapy (median readability level, 15.2 [IQR, 13.0-17.0]) (P = .003) and clinical trials (median readability level, 15.2 [IQR, 12.8-17.0]) (P = .002). Websites of nonprofit organizations (median readability level, 12.9 [IQR, 11.2-15.0]) were easier to read than media (median readability level, 16.0 [IQR, 13.4-17.0]) (P readability level, 14.8 [IQR, 12.9-17.0]) (P readability level, 14.0 [IQR, 12.1-16.1]) were easier to read than media websites (P = .001). Among treatment modalities, alternative therapy websites exhibited the

Mapping Suitable Sites for Setting up Wind Farms: A Case Study of ...

African Journals Online (AJOL)

Mapping Suitable Sites for Setting up Wind Farms: A Case Study of Nyanga District. ... Ethiopian Journal of Environmental Studies and Management ... sources and continuous power shortages make wind energy a very attractive alternative to ...

ALBERTA - HEC test beam set-up in June 1999

CERN Multimedia

Vinter, M.

1999-01-01

Photo1 - HEC 2 (rear) being set up in the "clean" room. Photo2 - HEC 2 (rear) being craned onto rotating C. Photo3 - HEC 2 (rear) being rotated. Photo4 - A now well rotated HEC 2 (rear) is being craned off the C. Photo5 - HEC 2 (rear) installed in the cryostat. Photo6 - Part of the basic frame (the frame that sits in the very bottom of the cryostat). Photo7 - Part of the basic frame (one of the two frames which the 3 calorimeter modules sit on). Photo8 - The marriage frame.

Effect of normalization methods on the performance of supervised learning algorithms applied to HTSeq-FPKM-UQ data sets: 7SK RNA expression as a predictor of survival in patients with colon adenocarcinoma.

Science.gov (United States)

Shahriyari, Leili

2017-11-03

One of the main challenges in machine learning (ML) is choosing an appropriate normalization method. Here, we examine the effect of various normalization methods on analyzing FPKM upper quartile (FPKM-UQ) RNA sequencing data sets. We collect the HTSeq-FPKM-UQ files of patients with colon adenocarcinoma from TCGA-COAD project. We compare three most common normalization methods: scaling, standardizing using z-score and vector normalization by visualizing the normalized data set and evaluating the performance of 12 supervised learning algorithms on the normalized data set. Additionally, for each of these normalization methods, we use two different normalization strategies: normalizing samples (files) or normalizing features (genes). Regardless of normalization methods, a support vector machine (SVM) model with the radial basis function kernel had the maximum accuracy (78%) in predicting the vital status of the patients. However, the fitting time of SVM depended on the normalization methods, and it reached its minimum fitting time when files were normalized to the unit length. Furthermore, among all 12 learning algorithms and 6 different normalization techniques, the Bernoulli naive Bayes model after standardizing files had the best performance in terms of maximizing the accuracy as well as minimizing the fitting time. We also investigated the effect of dimensionality reduction methods on the performance of the supervised ML algorithms. Reducing the dimension of the data set did not increase the maximum accuracy of 78%. However, it leaded to discovery of the 7SK RNA gene expression as a predictor of survival in patients with colon adenocarcinoma with accuracy of 78%. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Risk Factors for Mortality in Hemodialysis Patients: Two-Year Follow-Up Study

Directory of Open Access Journals (Sweden)

Maria do Sameiro-Faria

2013-01-01

Full Text Available Background. End-stage renal disease (ESRD patients under hemodialysis (HD have high mortality rate. Inflammation, dyslipidemia, disturbances in erythropoiesis, iron metabolism, endothelial function, and nutritional status have been reported in these patients. Our aim was to identify any significant association of death with these disturbances, by performing a two-year follow-up study. Methods and Results. A large set of data was obtained from 189 HD patients (55.0% male; 66.4 ± 13.9 years old, including hematological data, lipid profile, iron metabolism, nutritional, inflammatory, and endothelial (dysfunction markers, and dialysis adequacy. Results. 35 patients (18.5% died along the follow-up period. Our data showed that the type of vascular access, C-reactive protein (CRP, and triglycerides (TG are significant predictors of death. The risk of death was higher in patients using central venous catheter (CVC (Hazard ratio [HR] =3.03, 95% CI = 1.49–6.13, with higher CRP levels (fourth quartile, compared with those with lower levels (first quartile (HR = 17.3, 95% CI = 2.40–124.9. Patients with higher TG levels (fourth quartile presented a lower risk of death, compared with those with the lower TG levels (first quartile (HR = 0.18, 95% CI = 0.05–0.58. Conclusions. The use of CVC, high CRP, and low TG values seem to be independent risk factors for mortality in HD patients.

Scratch to state-of-the-art: setting up a new robotic facility in a developing country.

Science.gov (United States)

Bora, G S; Mavuduru, R S; Devana, S K; Singh, S K; Mandal, A K

2018-03-01

The potential challenges encountered for setting up a robotic assisted surgical facility in developing country like India are many. We describe the initial hurdles and troubleshooting in establishing a facility of such kind. This experience might help to decrease initial hiccups in setting up such an innovative technology at other institutes.

Diagnostic accuracy of procalcitonin in critically ill immunocompromised patients

Directory of Open Access Journals (Sweden)

Legriel Stéphane

2011-08-01

Full Text Available Abstract Background Recognizing infection is crucial in immunocompromised patients with organ dysfunction. Our objective was to assess the diagnostic accuracy of procalcitonin (PCT in critically ill immunocompromised patients. Methods This prospective, observational study included patients with suspected sepsis. Patients were classified into one of three diagnostic groups: no infection, bacterial sepsis, and nonbacterial sepsis. Results We included 119 patients with a median age of 54 years (interquartile range [IQR], 42-68 years. The general severity (SAPSII and organ dysfunction (LOD scores on day 1 were 45 (35-62.7 and 4 (2-6, respectively, and overall hospital mortality was 32.8%. Causes of immunodepression were hematological disorders (64 patients, 53.8%, HIV infection (31 patients, 26%, and solid cancers (26 patients, 21.8%. Bacterial sepsis was diagnosed in 58 patients and nonbacterial infections in nine patients (7.6%; 52 patients (43.7% had no infection. PCT concentrations on the first ICU day were higher in the group with bacterial sepsis (4.42 [1.60-22.14] vs. 0.26 [0.09-1.26] ng/ml in patients without bacterial infection, P 0.5 ng/ml had 100% sensitivity but only 63% specificity for diagnosing bacterial sepsis. The area under the receiver operating characteristic (ROC curve was 0.851 (0.78-0.92. In multivariate analyses, PCT concentrations > 0.5 ng/ml on day 1 independently predicted bacterial sepsis (odds ratio, 8.6; 95% confidence interval, 2.53-29.3; P = 0.0006. PCT concentrations were not significantly correlated with hospital mortality. Conclusion Despite limited specificity in critically ill immunocompromised patients, PCT concentrations may help to rule out bacterial infection.

Diagnostic accuracy of procalcitonin in critically ill immunocompromised patients.

Science.gov (United States)

Bele, Nicolas; Darmon, Michael; Coquet, Isaline; Feugeas, Jean-Paul; Legriel, Stéphane; Adaoui, Nadir; Schlemmer, Benoît; Azoulay, Elie

2011-08-24

Recognizing infection is crucial in immunocompromised patients with organ dysfunction. Our objective was to assess the diagnostic accuracy of procalcitonin (PCT) in critically ill immunocompromised patients. This prospective, observational study included patients with suspected sepsis. Patients were classified into one of three diagnostic groups: no infection, bacterial sepsis, and nonbacterial sepsis. We included 119 patients with a median age of 54 years (interquartile range [IQR], 42-68 years). The general severity (SAPSII) and organ dysfunction (LOD) scores on day 1 were 45 (35-62.7) and 4 (2-6), respectively, and overall hospital mortality was 32.8%. Causes of immunodepression were hematological disorders (64 patients, 53.8%), HIV infection (31 patients, 26%), and solid cancers (26 patients, 21.8%). Bacterial sepsis was diagnosed in 58 patients and nonbacterial infections in nine patients (7.6%); 52 patients (43.7%) had no infection. PCT concentrations on the first ICU day were higher in the group with bacterial sepsis (4.42 [1.60-22.14] vs. 0.26 [0.09-1.26] ng/ml in patients without bacterial infection, P 0.5 ng/ml had 100% sensitivity but only 63% specificity for diagnosing bacterial sepsis. The area under the receiver operating characteristic (ROC) curve was 0.851 (0.78-0.92). In multivariate analyses, PCT concentrations > 0.5 ng/ml on day 1 independently predicted bacterial sepsis (odds ratio, 8.6; 95% confidence interval, 2.53-29.3; P = 0.0006). PCT concentrations were not significantly correlated with hospital mortality. Despite limited specificity in critically ill immunocompromised patients, PCT concentrations may help to rule out bacterial infection.

Diagnostic Accuracy of Dual-Source Computerized Tomography Coronary Angiography in Symptomatic Patients Presenting to a Referral Cardiovascular Center During Daily Clinical Practice

International Nuclear Information System (INIS)

Mahdavi, Arash; Mohammadzadeh, Ali; Joodi, Golsa; Tabatabaei, Mohammad Reza; Sheikholeslami, Farhad; Motevalli, Marzieh

2016-01-01

There are numerous studies that address the diagnostic value of dual-source computed tomography (DSCT) as an alternative to conventional coronary angiography (CCA). However, the benefit of application of DSCT in a real world clinical setting should be evaluated. To determine the diagnostic accuracy of DSCT technique compared with CCA as the gold standard method in detection of coronary artery stenosis among symptomatic patients who are presented to a referral cardiovascular center during daily clinical practice. Evaluating the medical records of a tertiary care referral cardiovascular center, 47 patients who had undergone DSCT and CCA, and also met the inclusion and exclusion criteria of the study were selected. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios (LRs) of the DSCT imaging technique were calculated. In total, 97.8% of the segments (628/642) could be visualized with diagnostic image quality via DSCT coronary angiography. The mean heart rate during DSCT was 69.2 ± 12.2 bpm (range: 39 - 83 bpm), and the mean Agatston score was 507.7 ± 590.5 (range: 0 - 2328). Per segment analysis of the findings revealed that the sensitivity, specificity, PPV, NPV, positive LR (PLR) and negative LR (NLR) of DSCT technique for evaluation of patients with coronary artery disease were 93.7%, 96.8%, 92.7%, 97.2%, 29.4, and 0.066, respectively. Also per vessel, analysis of the findings showed a sensitivity of 97.1%, a specificity of 94.0%, PPV of 95.3%, NPV of 96.3%, PLR of 16.1, and NLR of 0.030. Our results indicate that DSCT coronary angiography provides high diagnostic accuracy for the evaluation of CAD patients during daily routine practice of a referral cardiovascular setting

A simple and convenient set-up for high-temperature Brillouin light scattering

International Nuclear Information System (INIS)

Guerette, Michael; Huang Liping

2012-01-01

An emulated platelet geometry (or reflection-induced platelet geometry) is employed to collect photons scattered from both longitudinal and transverse acoustic waves travelling within a bulk transparent sample sitting on a reflective Pt plate. Temperature of the sample was controlled with a Linkam TS1500 optical furnace (maximum temperature of 1500 °C). This simple and convenient set-up allows a full determination of elastic constants of transparent materials in situ as a function of temperature from Brillouin light scattering. Structural information can be gained at the same time by guiding the scattered light into a Raman spectrometer using a flipping mirror or a beam splitter. We will demonstrate the applications of this set-up in transparent inorganic glasses, but it can be easily extended to any other transparent materials, either crystalline or amorphous in nature. (paper)

Improving Accuracy for Image Fusion in Abdominal Ultrasonography

Directory of Open Access Journals (Sweden)

Caroline Ewertsen

2012-08-01

Full Text Available Image fusion involving real-time ultrasound (US is a technique where previously recorded computed tomography (CT or magnetic resonance images (MRI are reformatted in a projection to fit the real-time US images after an initial co-registration. The co-registration aligns the images by means of common planes or points. We evaluated the accuracy of the alignment when varying parameters as patient position, respiratory phase and distance from the co-registration points/planes. We performed a total of 80 co-registrations and obtained the highest accuracy when the respiratory phase for the co-registration procedure was the same as when the CT or MRI was obtained. Furthermore, choosing co-registration points/planes close to the area of interest also improved the accuracy. With all settings optimized a mean error of 3.2 mm was obtained. We conclude that image fusion involving real-time US is an accurate method for abdominal examinations and that the accuracy is influenced by various adjustable factors that should be kept in mind.

Retrospective assessment of interobserver agreement and accuracy in classifications and measurements in subsolid nodules with solid components less than 8mm: which window setting is better?

Energy Technology Data Exchange (ETDEWEB)

Yoo, Roh-Eul [Seoul National University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Seoul National University Medical Research Center, Institute of Radiation Medicine, Seoul (Korea, Republic of); Goo, Jin Mo; Park, Chang Min [Seoul National University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Seoul National University College of Medicine, Cancer Research Institute, Seoul (Korea, Republic of); Hwang, Eui Jin; Yoon, Soon Ho; Lee, Chang Hyun [Seoul National University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Ahn, Soyeon [Seoul National University Bundang Hospital, Medical Research Collaborating Center, Seongnam-si (Korea, Republic of)

2017-04-15

To compare interobserver agreements among multiple readers and accuracy for the assessment of solid components in subsolid nodules between the lung and mediastinal window settings. Seventy-seven surgically resected nodules with solid components smaller than 8 mm were included in this study. In both lung and mediastinal windows, five readers independently assessed the presence and size of solid component. Bootstrapping was used to compare the interobserver agreement between the two window settings. Imaging-pathology correlation was performed to evaluate the accuracy. There were no significant differences in the interobserver agreements between the two windows for both identification (lung windows, k = 0.51; mediastinal windows, k = 0.57) and measurements (lung windows, ICC = 0.70; mediastinal windows, ICC = 0.69) of solid components. The incidence of false negative results for the presence of invasive components and the median absolute difference between the solid component size and the invasive component size were significantly higher on mediastinal windows than on lung windows (P < 0.001 and P < 0.001, respectively). The lung window setting had a comparable reproducibility but a higher accuracy than the mediastinal window setting for nodule classifications and solid component measurements in subsolid nodules. (orig.)

Monitoring electro-magnetic field in urban areas: new set-ups and results

Energy Technology Data Exchange (ETDEWEB)

Lubritto, C.; Petraglia, A.; Paribello, G.; Formosi, R.; Rosa, M. de; Vetromile, C.; Palmieri, A.; D' Onofrio, A. [Seconda Universita di Napoli, Dipt. di Scienze Ambientali, Caserta (Italy); Di Bella, G.; Giannini, V. [Vector Group, Roma (Italy)

2006-07-01

In this paper two different set-ups for continuous monitoring of electromagnetic levels are presented: the first one (Continuous Time E.M.F. Monitoring System) is based upon a network of fixed stations, allowing a detailed field monitoring as function of the time; the second one (Mobile Measurements Units) resorts to portable stations mounted on standard bicycles, allowing a positional screening in limited time intervals. For both set-ups a particular attention has been paid to the data management, by means of tools like web geographic information systems (Web-Gis). Moreover the V.I.C.R.E.M./E.L.F. software has been used for a predictive analysis of the electromagnetic field levels along with the geo referenced data coming from the field measurements. Starting from these results it has been realized that there is a need for an efficient and correct action of monitoring and information/formation in this domain, where dis-information or bad information is very often spread in the population, in particular in a field where the process of the appreciation and assessment of risk does not necessarily make use of a rationale, technically-informed procedure, but the judgement is rather based on a personal feeling, which may derive from a limited, unstructured set of information, using a set of qualitative attributes rather than a quantity. (N.C.)

Monitoring electro-magnetic field in urban areas: new set-ups and results

International Nuclear Information System (INIS)

Lubritto, C.; Petraglia, A.; Paribello, G.; Formosi, R.; Rosa, M. de; Vetromile, C.; Palmieri, A.; D'Onofrio, A.; Di Bella, G.; Giannini, V.

2006-01-01

In this paper two different set-ups for continuous monitoring of electromagnetic levels are presented: the first one (Continuous Time E.M.F. Monitoring System) is based upon a network of fixed stations, allowing a detailed field monitoring as function of the time; the second one (Mobile Measurements Units) resorts to portable stations mounted on standard bicycles, allowing a positional screening in limited time intervals. For both set-ups a particular attention has been paid to the data management, by means of tools like web geographic information systems (Web-Gis). Moreover the V.I.C.R.E.M./E.L.F. software has been used for a predictive analysis of the electromagnetic field levels along with the geo referenced data coming from the field measurements. Starting from these results it has been realized that there is a need for an efficient and correct action of monitoring and information/formation in this domain, where dis-information or bad information is very often spread in the population, in particular in a field where the process of the appreciation and assessment of risk does not necessarily make use of a rationale, technically-informed procedure, but the judgement is rather based on a personal feeling, which may derive from a limited, unstructured set of information, using a set of qualitative attributes rather than a quantity. (N.C.)

Investigation on Superior Performance by Fractional Controller for Cart-Servo Laboratory Set-Up

Directory of Open Access Journals (Sweden)

Ameya Anil Kesarkar

2014-01-01

Full Text Available In this paper, an investigation is made on the superiority of fractional PID controller (PI^alpha D^beta over conventional PID for the cart-servo laboratory set-up. The designed controllers are optimum in the sense of Integral Absolute Error (IAE and Integral Square Error (ISE. The paper contributes in three aspects: 1 Acquiring nonlinear mathematical model for the cart-servo laboratory set-up, 2 Designing fractional and integer order PID for minimizing IAE, ISE, 3 Analyzing the performance of designed controllers for simulated plant model as well as real plant. The results show a significantly superior performance by PI^alpha D^beta as compared to the conventional PID controller.

Demonstration of a software design and statistical analysis methodology with application to patient outcomes data sets.

Science.gov (United States)

Mayo, Charles; Conners, Steve; Warren, Christopher; Miller, Robert; Court, Laurence; Popple, Richard

2013-11-01

With emergence of clinical outcomes databases as tools utilized routinely within institutions, comes need for software tools to support automated statistical analysis of these large data sets and intrainstitutional exchange from independent federated databases to support data pooling. In this paper, the authors present a design approach and analysis methodology that addresses both issues. A software application was constructed to automate analysis of patient outcomes data using a wide range of statistical metrics, by combining use of C#.Net and R code. The accuracy and speed of the code was evaluated using benchmark data sets. The approach provides data needed to evaluate combinations of statistical measurements for ability to identify patterns of interest in the data. Through application of the tools to a benchmark data set for dose-response threshold and to SBRT lung data sets, an algorithm was developed that uses receiver operator characteristic curves to identify a threshold value and combines use of contingency tables, Fisher exact tests, Welch t-tests, and Kolmogorov-Smirnov tests to filter the large data set to identify values demonstrating dose-response. Kullback-Leibler divergences were used to provide additional confirmation. The work demonstrates the viability of the design approach and the software tool for analysis of large data sets.

Matter power spectrum and the challenge of percent accuracy

OpenAIRE

Schneider, Aurel; Teyssier, Romain; Potter, Doug; Stadel, Joachim; Onions, Julian; Reed, Darren S.; Smith, Robert E.; Springel, Volker; Pearce, Frazer R.; Scoccimarro, Roman

2015-01-01

Future galaxy surveys require one percent precision in the theoretical knowledge of the power spectrum over a large range including very nonlinear scales. While this level of accuracy is easily obtained in the linear regime with perturbation theory, it represents a serious challenge for small scales where numerical simulations are required. In this paper we quantify the precision of present-day $N$-body methods, identifying main potential error sources from the set-up of initial conditions to...

Treating 4,000 diabetic patients in Cambodia, a high-prevalence but resource-limited setting: a 5-year study

Directory of Open Access Journals (Sweden)

Keuky Lim

2009-07-01

Full Text Available Abstract Background Despite the worldwide increasing burden of diabetes, there has been no corresponding scale-up of treatment in developing countries and limited evidence of program effectiveness. In 2002, in collaboration with the Ministry of Health of Cambodia, Médecins Sans Frontières initiated an outpatient program of subsidized diabetic care in two hospital-based chronic disease clinics in rural settings. We aimed to describe the outcomes of newly and previously diagnosed diabetic patients enrolled from 2002 to 2008. Methods We calculated the mean and proportion of patients who met the recommended treatment targets, and the drop from baseline values for random blood glucose (RBG, hemoglobin A1c (HbA1c, blood pressure (BP, and body mass index (BMI at regular intervals. Analysis was restricted to patients not lost to follow-up. We used the t test to compare baseline and subsequent paired values. Results Of 4404 patients enrolled, 2,872 (65% were still in care at the time of the study, 24 (0.5% had died, and 1,508 (34% were lost tofollow-up. Median age was 53 years, 2,905 (66% were female and 4,350 (99% had type 2 diabetes. Median (interquartile range (IQR follow-up was 20 months (5 to 39.5 months. A total of 24% (51/210 of patients had a HbA1c concentration of P P P P 2 after 1 year. Factors associated with loss to follow-up were male sex, age >60 years, living outside the province, normal BMI on admission, high RBG on last visit, and coming late for the last consultation. Conclusion Significant and clinically important improvements in glycemia and BP were observed, but a relatively low proportion of diabetic patients reached treatment targets. These results and the high loss to follow-up rate highlight the challenges of delivering diabetic care in rural, resource-limited settings.

Development of the patient setting system for BNCT at JRR-4

International Nuclear Information System (INIS)

Kumada, H.; Yamamoto, K.; Torii, Y.

2000-01-01

A new treatment planning software: Computational Dosimetry System (JCDS) is in progress its development for BNCT with epithermal neutron beam in JAERI. Irradiation conditions such as beam angle to a patient are calculated by JCDS. In order to implement these conditions, it is necessary to precisely set the patient to actual irradiation position simulated by JCDS beforehand. Therefore, the Patient Setting System, which accurately and quickly sets the patient to the irradiation position, is being developed with JCDS concurrently. In this report, the current status of the development of JCDS and the Patient Setting System in JAERI will be described. (author)

Accuracy and congruence of patient and physician weight-related discussions: from Project CHAT (Communicating Health: Analyzing Talk)

Science.gov (United States)

Bodner, Michael E.; Dolor, Rowena J.; Óstbye, Truls; Lyna, Pauline; Alexander, Stewart C.; Tulsky, James A.; Pollak, Kathryn I.

2014-01-01

Objective Primary care providers should counsel overweight patients to lose weight. Rates of self-reported weight-related counseling vary, perhaps due to self-report bias. We assessed accuracy and congruence of weight-related discussions among patients, physicians, and audio-recorded encounters. Methods We audio recorded encounters between physicians (n=40) and their overweight/obese patients (n=461) at five community-based practices. We coded weight-related content and surveyed patients and physicians immediately after the visit. Generalized linear mixed models assessed factors associated with accuracy. Results Overall, accuracy was moderate: patient (67%), physician (70%), and congruence (62%). When encounters contained weight-related content were analyzed, patients (98%) and physicians (97%) were highly accurate and congruent (95%) but when weight was not discussed patients and physicians were more inaccurate and incongruent (patient 36%; physician 44%; 28% congruence). Physicians less comfortable discussing weight were more likely to misreport that weight was discussed [OR = 4.5 (95% CI=1.88–10.75, p<0.001)]. White physicians with African-American patients were more likely to report accurately no discussion about weight than White physicians with White patients OR=0.30 (95% CI=0.13–0.69, p<0.01). Conclusion Physician and patient self-report of weight-related discussions were highly accurate and congruent when audio-recordings indicated weight was discussed, but not when recordings indicated no weight discussions. Physician overestimation of weight discussions when weight is not discussed constitutes missed opportunities for health interventions. PMID:24390888

Diagnostic Accuracy of MRI-guided Percutaneous Transthoracic Needle Biopsy of Solitary Pulmonary Nodules

Energy Technology Data Exchange (ETDEWEB)

Liu, Shangang, E-mail: 1198685580@qq.com [University of Jinan-Shandong Academy of Medical Science, Department of Radiation Oncology, Shandong Cancer Hospital and Institute, School of Medicine and Life Sciences (China); Li, Chengli, E-mail: chenglilichina@yeah.net [Shandong University, Department of Interventional MRI, Shandong Medical Imaging Research Institute (China); Yu, Xuejuan, E-mail: yuxuejuan2011@126.com [University of Jinan-Shandong Academy of Medical Science, Department of Radiation Oncology, Shandong Cancer Hospital and Institute, School of Medicine and Life Sciences (China); Liu, Ming, E-mail: mingliuyxs@163.com [Shandong University, Department of Interventional MRI, Shandong Medical Imaging Research Institute (China); Fan, Tingyong, E-mail: FTY681105@sohu.com; Chen, Dong, E-mail: 857984870@qq.com; Zhang, Pinliang, E-mail: zhangpinliang@163.com; Ren, Ruimei, E-mail: liusg708@qq.com [University of Jinan-Shandong Academy of Medical Science, Department of Radiation Oncology, Shandong Cancer Hospital and Institute, School of Medicine and Life Sciences (China)

2015-04-15

ObjectiveThe purpose of our study was to evaluate the diagnostic accuracy of MRI-guided percutaneous transthoracic needle biopsy (PTNB) of solitary pulmonary nodules (SPNs).MethodsRetrospective review of 69 patients who underwent MR-guided PTNB of SPNs was performed. Each case was reviewed for complications. The final diagnosis was established by surgical pathology of the nodule or clinical and imaging follow-up. Pneumothorax rate and diagnostic accuracy were compared between two groups according to nodule diameter (≤2 vs. >2 cm) using χ{sup 2} chest and Fisher’s exact test, respectively.ResultsThe success rate of single puncture was 95.6 %. Twelve (17.4 %) patients had pneumothorax, with 1 (1.4 %) requiring chest tube insertion. Mild hemoptysis occurred in 7 (7.2 %) patients. All of the sample material was sufficient for histological diagnostic evaluation. Pathological analysis of biopsy specimens showed 46 malignant, 22 benign, and 1 nondiagnostic nodule. The final diagnoses were 49 malignant nodules and 20 benign nodules basing on postoperative histopathology and clinical follow-up data. One nondiagnostic sample was excluded from calculating diagnostic performance. A sensitivity, specificity, accuracy, positive predictive value, and negative predictive value in diagnosing SPNs were 95.8, 100, 97.0, 100, and 90.9 %, respectively. Pneumothorax rate, diagnostic sensitivity, and accuracy were not significantly different between the two groups (P > 0.05).ConclusionsMRI-guided PTNB is safe, feasible, and high accurate diagnostic technique for pathologic diagnosis of pulmonary nodules.

Quantification, validation, and follow-up of small bowel motility in Crohn's disease

Science.gov (United States)

Cerrolaza, Juan J.; Peng, Jennifer Q.; Safdar, Nabile M.; Conklin, Laurie; Sze, Raymond; Linguraru, Marius George

2015-03-01

The use of magnetic resonance enterography (MRE) has become a mainstay in the evaluation, assessment and follow up of inflammatory bowel diseases, such as Crohn's disease (CD), thanks to its high image quality and its non-ionizing nature. In particular, the advent of faster MRE sequences less sensitive to image-motion artifacts offers the possibility to obtain visual, structural and functional information of the patient's small bowel. However, the inherent subjectivity of the mere visual inspection of these images often hinders the accurate identification and monitoring of the pathological areas. In this paper, we present a framework that provides quantitative and objective motility information of the small bowel from free-breathing MRE dynamic sequences. After compensating for the breathing motion of the patient, we create personalized peristaltic activity maps via optical flow analysis. The result is the creation of a new set of images providing objective and precise functional information of the small bowel. The accuracy of the new method was also evaluated from two different perspectives: objective accuracy (1.1 ± 0.6 mm/s of error), i.e., the ability of the system to provide quantitative and accurate information about the motility of moving bowel landmarks, and subjective accuracy (avg. difference of 0.7 ± 0.7 in a range of 1 to 5), i.e., the degree of agreement with the subjective evaluation of an expert. Finally, the practical utility of the new method was successfully evaluated in a preliminary study with 32 studies of healthy and CD cases, showing its potential for the fast and accurate assessment and follow up of CD in the small bowel.

Diagnostic accuracy of the defining characteristics of the excessive fluid volume diagnosis in hemodialysis patients

Directory of Open Access Journals (Sweden)

Maria Isabel da Conceição Dias Fernandes

2015-12-01

Full Text Available Objective: to evaluate the accuracy of the defining characteristics of the excess fluid volume nursing diagnosis of NANDA International, in patients undergoing hemodialysis. Method: this was a study of diagnostic accuracy, with a cross-sectional design, performed in two stages. The first, involving 100 patients from a dialysis clinic and a university hospital in northeastern Brazil, investigated the presence and absence of the defining characteristics of excess fluid volume. In the second step, these characteristics were evaluated by diagnostic nurses, who judged the presence or absence of the diagnosis. To analyze the measures of accuracy, sensitivity, specificity, and positive and negative predictive values were calculated. Approval was given by the Research Ethics Committee under authorization No. 148.428. Results: the most sensitive indicator was edema and most specific were pulmonary congestion, adventitious breath sounds and restlessness. Conclusion: the more accurate defining characteristics, considered valid for the diagnostic inference of excess fluid volume in patients undergoing hemodialysis were edema, pulmonary congestion, adventitious breath sounds and restlessness. Thus, in the presence of these, the nurse may safely assume the presence of the diagnosis studied.

Computer-facilitated rapid HIV testing in emergency care settings: provider and patient usability and acceptability.

Science.gov (United States)

Spielberg, Freya; Kurth, Ann E; Severynen, Anneleen; Hsieh, Yu-Hsiang; Moring-Parris, Daniel; Mackenzie, Sara; Rothman, Richard

2011-06-01

Providers in emergency care settings (ECSs) often face barriers to expanded HIV testing. We undertook formative research to understand the potential utility of a computer tool, "CARE," to facilitate rapid HIV testing in ECSs. Computer tool usability and acceptability were assessed among 35 adult patients, and provider focus groups were held, in two ECSs in Washington State and Maryland. The computer tool was usable by patients of varying computer literacy. Patients appreciated the tool's privacy and lack of judgment and their ability to reflect on HIV risks and create risk reduction plans. Staff voiced concerns regarding ECS-based HIV testing generally, including resources for follow-up of newly diagnosed people. Computer-delivered HIV testing support was acceptable and usable among low-literacy populations in two ECSs. Such tools may help circumvent some practical barriers associated with routine HIV testing in busy settings though linkages to care will still be needed.

Experimental set-up for advanced aeroelastic tests on sectional models

Czech Academy of Sciences Publication Activity Database

Král, Radomil; Pospíšil, Stanislav; Náprstek, Jiří

2016-01-01

Roč. 40, č. 1 (2016), s. 3-13 ISSN 0732-8818 R&D Projects: GA ČR GA103/09/0094; GA AV ČR IAA200710902; GA MŠk(CZ) ED1.1.00/02.0060 Institutional support: RVO:68378297 Keywords : bridge aeroelasticity * wind tunnel * experimental set-up * non- linear response Subject RIV: JM - Building Engineering Impact factor: 0.932, year: 2016 http://link.springer.com/article/10.1007%2Fs40799-015-0004-6

The use of Landsat-4 MSS digital data in temporal data sets and the evaluation of scene-to-scene registration accuracy

Science.gov (United States)

Anderson, J. E.

1985-01-01

The MSS sensor on Landsat 4 is, in certain performance aspects, diferent from those of Landsats 1 through 3. These differences created some concern in the NASA research community as to whether individual data sets can be registered accurately enough to produce acceptable data sets for multitemporal data analysis. The use of Landsat 4 MSS digital data in temporal data sets is examined and a method is presented for estimating temporal registration accuracy based on the use of an X-Y digitizer and grey tone electrostatic plots. Results indicate that the RMS temporal registration errors are not significantly different from the temporal data sets generated using Landsat 4 and Landsat 2 data (33.35 meters) and the temporal data set constructed from two Landsat 2 data sets (33.61 meters). A derivation of the model used to evaluate the temporal registration is included.

X-ray fluorescence (XRF) set-up with a low power X-ray tube

International Nuclear Information System (INIS)

Gupta, Sheenu; Deep, Kanan; Jain, Lalita; Ansari, M.A.; Mittal, Vijay Kumar; Mittal, Raj

2010-01-01

The X-ray fluorescence set-up with a 100 W X-ray tube comprises a computer controlled system developed for remote operation and monitoring of tube and an adjustable stable 3D arrangement to procure variable excitation energies with low scattered background. The system was tested at different filament currents/anode voltages. The MDL of the set-up at 0.05-1.00 mA/4-12 kV is found ∼(1-100) ppm for K and L excitations and ∼(200-700) ppm for M excitations of elements and improves with filament current and anode voltage. Moreover, L measurements for Sm and Eu at five K X-ray energies of elements(Z=29-40) and analytical determination in some synthetic samples were undertaken.

Experimental Study of Drag Resistance using a Laboratory Scale Rotary Set-Up

DEFF Research Database (Denmark)

Erik Weinell, Claus; Olsen, Kenneth N.; Christoffersen, Martin W.

2003-01-01

This work covers an experimental study of the drag resistance of different painted surfaces and simulated large-scale irregularities, viz. dry spraying, weld seams, barnacle fouling and paint remains. A laboratory scale rotary set-up was used to determine the drag resistance, and the surface...

Diagnostic accuracy of three different MRI protocols in patients with inflammatory bowel disease

International Nuclear Information System (INIS)

Jesuratnam-Nielsen, Kayalvily; Løgager, Vibeke Berg; Munkholm, Pia; Thomsen, Henrik S

2015-01-01

Magnetic resonance imaging (MRI) is used for workup and control of inflammatory bowel disease (IBD); however, disagreement remains as to how the MRI should be performed. To compare prospectively the diagnostic accuracy of MRI with neither oral nor intravenous contrast medium (plain MRI), magnetic resonance follow-through (MRFT) and MR enteroclysis (MRE) using MRE as the reference standard in patients with inflammatory bowel disease. Plain MRI and MRE were carried out in addition to MRFT. All patients underwent both plain MR and MRFT on the same day and MRE within seven days. For the evaluation, the bowel was divided into nine segments. One radiologist, blinded to clinical findings, evaluated bowel wall thickness, diffusion weighted imaging (DWI), mural hyperenhancement, and other inflammatory changes in each bowel segment. Twenty patients (6 men, 14 women; median age, 43.5 years; age range, 26–76 years) underwent all three examinations; 10 with Crohn’s disease (CD), three with ulcerative colitis (UC), and seven with IBD unclassified (IBD-U). Sensitivity, specificity, and accuracy were in the range of 0–75%, 81–96%, and 75–95% for wall thickening, and 0–37%, 59–89%, and 50–86% for DWI in plain MRI, respectively. Sensitivity, specificity, and accuracy were in the range of 0–50%, 96–100%, and 90–100% for wall thickening, 0–50%, 84–97%, and 82–95% for DWI, and 0–71%, 94–100%, and 85–100% for mural hyperenhancement in MRFT, respectively. The use of oral and intravenous contrast agent improves detection of bowel lesions resulting in MRFT remaining the superior choice over plain MRI for diagnostic workup in patients with IBD

Diagnostic accuracy of 64-slice multidetector CT for detection of in-stent restenosis in an unselected, consecutive patient population

Energy Technology Data Exchange (ETDEWEB)

Haraldsdottir, Sigurdis, E-mail: sigurdisha@gmail.com [Boston Medical Center, 72 East Concord Street (Evans 124), Boston, MA, 02118 (United States); Gudnason, Thorarinn, E-mail: thorgudn@landspitali.is [Landspitali University Hospital, Hringbraut, 101 Reykjavik (Iceland); Sigurdsson, Axel F., E-mail: axelfsig@landspitali.is [Landspitali University Hospital, Hringbraut, 101 Reykjavik (Iceland); Gudjonsdottir, Jonina, E-mail: jonina@rd.is [Rontgen Domus Medica, Egilsgata 3, 101 Reykjavik (Iceland); Lehman, Sam J., E-mail: slehman@partners.org [Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA 02114 (United States); Eyjolfsson, Kristjan, E-mail: kristey@landspitali.is [Landspitali University Hospital, Hringbraut, 101 Reykjavik (Iceland); Scheving, Sigurpall S., E-mail: sigurpal@landspitali.is [Landspitali University Hospital, Hringbraut, 101 Reykjavik (Iceland); Gibson, C. Michael, E-mail: mgibson@perfuse.org [Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115 (United States); Hoffmann, Udo, E-mail: uhoffmann@partners.org [Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA 02114 (United States); Jonsdottir, Birna, E-mail: birna@rd.is [Rontgen Domus Medica, Egilsgata 3, 101 Reykjavik (Iceland); Andersen, Karl, E-mail: andersen@landspitali.is [Landspitali University Hospital, Hringbraut, 101 Reykjavik (Iceland)

2010-11-15

Objectives: To investigate the diagnostic accuracy of 64-slice multidetector computed tomography (64-CT) for detection of in-stent restenosis (ISR) in an unselected, consecutive patient population. Background: Detection of in-stent restenosis by cardiac CT would be a major advance for the evaluation of patients suspected of having ISR. However, the diagnostic accuracy of current generation 64-CT in this context is not fully established. Methods: We conducted a prospective study on patients with stable angina or acute coronary syndrome with no prior history of coronary artery disease. Six months after percutaneous coronary intervention (PCI) with stent placement they underwent a 64-CT scan (Toshiba Multi-Slice Aquilion 64) and consequently a repeat coronary angiography for comparison. Cardiac CT data sets were analyzed for the presence of in-stent restenosis by two independent expert readers blinded to the coronary angiographic data. Results: Ninety-three patients with a total of 140 stents were evaluated. Males comprised 82% of the study group and the mean age was 63 {+-} 10 years. The mean time from PCI to the repeat coronary angiography was 208 {+-} 37 days and the mean time from 64-CT to repeat coronary angiography was 3.7 {+-} 4.9 days. The restenosis rate according to coronary angiography was 26%. Stent diameter, strut thickness, heart rate and body mass index (BMI) significantly affected image quality. The sensitivity, specificity, positive and negative predictive values of 64-CT for detection of in-stent restenosis were 27%, 95%, 67% and 78%, respectively. Conclusions: Current generation, 64-slice CT, remains limited in its ability to accurately detect in-stent restenosis.

Accuracy and precision of four common peripheral temperature measurement methods in intensive care patients.

Science.gov (United States)

Asadian, Simin; Khatony, Alireza; Moradi, Gholamreza; Abdi, Alireza; Rezaei, Mansour

2016-01-01

An accurate determination of body temperature in critically ill patients is a fundamental requirement for initiating the proper process of diagnosis, and also therapeutic actions; therefore, the aim of the study was to assess the accuracy and precision of four noninvasive peripheral methods of temperature measurement compared to the central nasopharyngeal measurement. In this observational prospective study, 237 patients were recruited from the intensive care unit of Imam Ali Hospital of Kermanshah. The patients' body temperatures were measured by four peripheral methods; oral, axillary, tympanic, and forehead along with a standard central nasopharyngeal measurement. After data collection, the results were analyzed by paired t-test, kappa coefficient, receiver operating characteristic curve, and using Statistical Package for the Social Sciences, version 19, software. There was a significant meaningful correlation between all the peripheral methods when compared with the central measurement (Ptemperatures of right and left tympanic membranes and the standard central nasopharyngeal measurement (88%). Paired t-test demonstrated an acceptable precision with forehead (P=0.132), left (P=0.18) and right (P=0.318) tympanic membranes, oral (P=1.00), and axillary (P=1.00) methods. Sensitivity and specificity of both the left and right tympanic membranes were more than for other methods. The tympanic and forehead methods had the highest and lowest accuracy for measuring body temperature, respectively. It is recommended to use the tympanic method (right and left) for assessing a patient's body temperature in the intensive care units because of high accuracy and acceptable precision.

Automatic radiation dose monitoring for CT of trauma patients with different protocols: feasibility and accuracy

International Nuclear Information System (INIS)

Higashigaito, K.; Becker, A.S.; Sprengel, K.; Simmen, H.-P.; Wanner, G.; Alkadhi, H.

2016-01-01

Aim: To demonstrate the feasibility and accuracy of automatic radiation dose monitoring software for computed tomography (CT) of trauma patients in a clinical setting over time, and to evaluate the potential of radiation dose reduction using iterative reconstruction (IR). Materials and methods: In a time period of 18 months, data from 378 consecutive thoraco-abdominal CT examinations of trauma patients were extracted using automatic radiation dose monitoring software, and patients were split into three cohorts: cohort 1, 64-section CT with filtered back projection, 200 mAs tube current–time product; cohort 2, 128-section CT with IR and identical imaging protocol; cohort 3, 128-section CT with IR, 150 mAs tube current–time product. Radiation dose parameters from the software were compared with the individual patient protocols. Image noise was measured and image quality was semi-quantitatively determined. Results: Automatic extraction of radiation dose metrics was feasible and accurate in all (100%) patients. All CT examinations were of diagnostic quality. There were no differences between cohorts 1 and 2 regarding volume CT dose index (CTDI_v_o_l; p=0.62), dose–length product (DLP), and effective dose (ED, both p=0.95), while noise was significantly lower (chest and abdomen, both −38%, p<0.017). Compared to cohort 1, CTDI_v_o_l, DLP, and ED in cohort 3 were significantly lower (all −25%, p<0.017), similar to the noise in the chest (–32%) and abdomen (–27%, both p<0.017). Compared to cohort 2, CTDI_v_o_l (–28%), DLP, and ED (both –26%) in cohort 3 was significantly lower (all, p<0.017), while noise in the chest (+9%) and abdomen (+18%) was significantly higher (all, p<0.017). Conclusion: Automatic radiation dose monitoring software is feasible and accurate, and can be implemented in a clinical setting for evaluating the effects of lowering radiation doses of CT protocols over time. - Highlights: • Automatic dose monitoring software can be

Patient engagement in the inpatient setting: a systematic review.

Science.gov (United States)

Prey, Jennifer E; Woollen, Janet; Wilcox, Lauren; Sackeim, Alexander D; Hripcsak, George; Bakken, Suzanne; Restaino, Susan; Feiner, Steven; Vawdrey, David K

2014-01-01

To systematically review existing literature regarding patient engagement technologies used in the inpatient setting. PubMed, Association for Computing Machinery (ACM) Digital Library, Institute of Electrical and Electronics Engineers (IEEE) Xplore, and Cochrane databases were searched for studies that discussed patient engagement ('self-efficacy', 'patient empowerment', 'patient activation', or 'patient engagement'), (2) involved health information technology ('technology', 'games', 'electronic health record', 'electronic medical record', or 'personal health record'), and (3) took place in the inpatient setting ('inpatient' or 'hospital'). Only English language studies were reviewed. 17 articles were identified describing the topic of inpatient patient engagement. A few articles identified design requirements for inpatient engagement technology. The remainder described interventions, which we grouped into five categories: entertainment, generic health information delivery, patient-specific information delivery, advanced communication tools, and personalized decision support. Examination of the current literature shows there are considerable gaps in knowledge regarding patient engagement in the hospital setting and inconsistent use of terminology regarding patient engagement overall. Research on inpatient engagement technologies has been limited, especially concerning the impact on health outcomes and cost-effectiveness. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The "expert patient" approach for non-communicable disease management in low and middle income settings: When the reality confronts the rhetoric.

Science.gov (United States)

Xiao, Yue

2015-09-01

This paper seeks to explore the relevance between the Western "expert patient" rhetoric and the reality of non-communicable diseases (NCDs) control and management in low and middle income settings from the health sociological perspective. It firstly sets up a conceptual framework of the "expert patient" or the patient self-management approach, showing the rhetoric of the initiative in the developed countries. Then by examining the situation of NCDs control and management in low income settings, the paper tries to evaluate the possibilities of implementing the "expert patient" approach in these countries. Kober and Van Damme's study on the relevance of the "expert patient" for an HIV/AIDS program in low income settings is critically studied to show the relevance of the developed countries' rhetoric of the "expert patient" approach for the reality of developing countries. In addition, the MoPoTsyo diabetes peer educator program is analyzed to show the challenges faced by the low income countries in implementing patient self-management programs. Finally, applications of the expert patient approach in China are discussed as well, to remind us of the possible difficulties in introducing it into rural settings.

Accuracy of MR markers for differentiating Progressive Supranuclear Palsy from Parkinson's disease

Directory of Open Access Journals (Sweden)

Stefano Zanigni

2016-01-01

Conclusion: Although several quantitative brain MR markers provided high diagnostic accuracy in differentiating Progressive Supranuclear Palsy-Richardson's Syndrome from Parkinson's disease, the morphometric assessment of midbrain area is the best single diagnostic marker and should be routinely included in the neuroradiological work-up of parkinsonian patients.

Automated syndrome detection in a set of clinical facial photographs.

Science.gov (United States)

Boehringer, Stefan; Guenther, Manuel; Sinigerova, Stella; Wurtz, Rolf P; Horsthemke, Bernhard; Wieczorek, Dagmar

2011-09-01

Computer systems play an important role in clinical genetics and are a routine part of finding clinical diagnoses but make it difficult to fully exploit information derived from facial appearance. So far, automated syndrome diagnosis based on digital, facial photographs has been demonstrated under study conditions but has not been applied in clinical practice. We have therefore investigated how well statistical classifiers trained on study data comprising 202 individuals affected by one of 14 syndromes could classify a set of 91 patients for whom pictures were taken under regular, less controlled conditions in clinical practice. We found a classification accuracy of 21% percent in the clinical sample representing a ratio of 3.0 over a random choice. This contrasts with a 60% accuracy or 8.5 ratio in the training data. Producing average images in both groups from sets of pictures for each syndrome demonstrates that the groups exhibit large phenotypic differences explaining discrepancies in accuracy. A broadening of the data set is suggested in order to improve accuracy in clinical practice. In order to further this goal, a software package is made available that allows application of the procedures and contributions toward an improved data set. Copyright © 2011 Wiley-Liss, Inc.

Patients' preference for exercise setting and its influence on the health benefits gained from exercise-based cardiac rehabilitation.

Science.gov (United States)

Tang, Lars H; Kikkenborg Berg, Selina; Christensen, Jan; Lawaetz, Jannik; Doherty, Patrick; Taylor, Rod S; Langberg, Henning; Zwisler, Ann-Dorthe

2017-04-01

To assess patient preference for exercise setting and examine if choice of setting influences the long-term health benefit of exercise-based cardiac rehabilitation. Patients participating in a randomised controlled trial following either heart valve surgery, or radiofrequency ablation for atrial fibrillation were given the choice to perform a 12-week exercise programme in either a supervised centre-based, or a self-management home-based setting. Exercise capacity and physical and mental health outcomes were assessed for up to 24months after hospital discharge. Outcomes between settings were compared using a time×setting interaction using a mixed effects regression model. Across the 158 included patients, an equivalent proportion preferred to undertake exercise rehabilitation in a centre-based setting (55%, 95% CI: 45% to 63%) compared to a home-based setting (45%, 95% CI: 37% to 53%, p=0.233). At baseline, those who preferred a home-based setting reported better physical health (mean difference in physical component score: 5.0, 95% CI 2.3 to 7.4; p=0.001) and higher exercise capacity (mean between group difference 15.9watts, 95% CI 3.7 to 28.1; p=0.011). With the exception of the depression score in the Hospital Anxiety and Depression Score (F(3.65), p=0.004), there was no evidence of a significant difference in outcomes between settings. The preference of patients to participate in home-based and centre-based exercise programmes appears to be equivalent and provides similar health benefits. Whilst these findings support that patients should be given the choice between exercise-settings when initiating cardiac rehabilitation, further confirmatory evidence is needed. Copyright © 2017. Published by Elsevier B.V.

Predicting death from kala-azar: construction, development, and validation of a score set and accompanying software.

Science.gov (United States)

Costa, Dorcas Lamounier; Rocha, Regina Lunardi; Chaves, Eldo de Brito Ferreira; Batista, Vivianny Gonçalves de Vasconcelos; Costa, Henrique Lamounier; Costa, Carlos Henrique Nery

2016-01-01

Early identification of patients at higher risk of progressing to severe disease and death is crucial for implementing therapeutic and preventive measures; this could reduce the morbidity and mortality from kala-azar. We describe a score set composed of four scales in addition to software for quick assessment of the probability of death from kala-azar at the point of care. Data from 883 patients diagnosed between September 2005 and August 2008 were used to derive the score set, and data from 1,031 patients diagnosed between September 2008 and November 2013 were used to validate the models. Stepwise logistic regression analyses were used to derive the optimal multivariate prediction models. Model performance was assessed by its discriminatory accuracy. A computational specialist system (Kala-Cal(r)) was developed to speed up the calculation of the probability of death based on clinical scores. The clinical prediction score showed high discrimination (area under the curve [AUC] 0.90) for distinguishing death from survival for children ≤2 years old. Performance improved after adding laboratory variables (AUC 0.93). The clinical score showed equivalent discrimination (AUC 0.89) for older children and adults, which also improved after including laboratory data (AUC 0.92). The score set also showed a high, although lower, discrimination when applied to the validation cohort. This score set and Kala-Cal(r) software may help identify individuals with the greatest probability of death. The associated software may speed up the calculation of the probability of death based on clinical scores and assist physicians in decision-making.

Emergency Sonography Aids Diagnostic Accuracy of Torso Injuries: A Study in a Resource Limited Setting

Directory of Open Access Journals (Sweden)

Charles Edward Tunuka

2014-01-01

Full Text Available Introduction. Clinical evaluation of patients with torso trauma is often a diagnostic challenge. Extended focused assessment with sonography for trauma (EFAST is an emergency ultrasound scan that adds to the evaluation of intrathoracic abdominal and pericardial cavities done in FAST (focused assessment with sonography for trauma. Objective. This study compares EFAST (the index test with the routine standard of care (SoC investigations (the standard reference test for torso trauma injuries. Methods. A cross-sectional descriptive study was conducted over a 3-month period. Eligible patients underwent EFAST scanning and the SoC assessment. The diagnostic accuracy of EFAST was calculated using sensitivity and specificity scores. Results. We recruited 197 patients; the M : F ratio was 5 : 1, with mean age of 27 years (SD 11. The sensitivity of EFAST was 100%, the specificity was 97%, the PPV was 87%, and the NPV was 100%. It took 5 minutes on average to complete an EFAST scan. 168 (85% patients were EFAST-scanned. Most patients (82 (48% were discharged on the same day of hospitalization, while 7 (4% were still at the hospital after two weeks. The mortality rate was 18 (9%. Conclusion. EFAST is a reliable method of diagnosing torso injuries in a resource limited context.

The feasibility and accuracy of enhanced MR pulmonary perfusion imaging in evaluating therapeutic effect of pulmonary embolism

International Nuclear Information System (INIS)

Wang Nana; Lv Biao; Zhao Zhaoqi; Huang Xiaoyong; Lu Dongxu; Mi Hongzhi; Yu Weiyong

2010-01-01

Objective: To investigate the feasibility and accuracy of enhanced magnetic resonance pulmonary perfusion imaging (MRPP) in the diagnosis and follow-up of pulmonary embolism (PE). Methods: Sixty patients suspected of PE underwent MRPP. Twenty-seven patients also underwent radionuclide perfusion imaging. 22 patients repeated MRPP examination after 3 day to 1 month antieoagulation or thrombolytic therapy. The feasibility and accuracy of MRPP in the diagnosis and follow-up of PE were evaluated according to the transformation rate of signal (TROS), time-signal curve and some parameters of main pulmonary artery (such as peak value of flow, mean flow velocity and flow rate). The t test and rank sum test were used for the statistics. Results: MRPP showed a high agreement with radionuclide perfusion imaging. TROS was (2.86 ± 2.48) vs(6.72 ± 2.54) (t=3.370, P 0.05). Conclusion: MRPP shows a high agreement with radionuclide perfusion imaging and is a useful method for the diagnosis and follow-up of PE. (authors)

CHALLENGES IN SETTING UP QUALITY CONTROL IN DIAGNOSTIC RADIOLOGY FACILITIES IN NIGERIA.

Science.gov (United States)

Inyang, S O; Egbe, N O; Ekpo, E

2015-01-01

The Nigerian Nuclear Regulatory Authority (NNRA) was established to regulate and control the use of radioactive and radiation emitting sources in Nigeria. Quality control (QC) on diagnostic radiology equipment form part of the fundamental requirements for the authorization of diagnostic radiology facilities in the Country. Some quality control tests (output, exposure linearity and reproducibility) were measured on the x-ray machines in the facilities that took part in the study. Questionnaire was developed to evaluate the frequencies at which QC tests were conducted in the facilities and the challenges in setting up QC. Results show great variation in the values of the QC parameters measured. Inadequate cooperation by facilities management, lack of QC equipment and insufficient staff form the major challenges in setting up QC in the facilities under study. The responses on the frequencies at which QC tests should be conducted did not correspond to the recommended standards; indicating that personnel were not familiar with QC implementation and may require further training on QC.

Patient portal readiness among postpartum patients in a safety net setting.

Science.gov (United States)

Wieland, Daryl; Gibeau, Anne; Dewey, Caitlin; Roshto, Melanie; Frankel, Hilary

2017-07-05

Maternity patients interact with the healthcare system over an approximately ten-month interval, requiring multiple visits, acquiring pregnancy-specific education, and sharing health information among providers. Many features of a web-based patient portal could help pregnant women manage their interactions with the healthcare system; however, it is unclear whether pregnant women in safety-net settings have the resources, skills or interest required for portal adoption. In this study of postpartum patients in a safety net hospital, we aimed to: (1) determine if patients have the technical resources and skills to access a portal, (2) gain insight into their interest in health information, and (3) identify the perceived utility of portal features and potential barriers to adoption. We developed a structured questionnaire to collect demographics from postpartum patients and measure use of technology and the internet, self-reported literacy, interest in health information, awareness of portal functions, and perceived barriers to use. The questionnaire was administered in person to women in an inpatient setting. Of the 100 participants surveyed, 95% reported routine internet use and 56% used it to search for health information. Most participants had never heard of a patient portal, yet 92% believed that the portal functions were important. The two most appealing functions were to check results and manage appointments. Most participants in this study have the required resources such as a device and familiarity with the internet to access a patient portal including an interest in interacting with a healthcare institution via electronic means. Pregnancy is a critical episode of care where active engagement with the healthcare system can influence outcomes. Healthcare systems and portal developers should consider ways to tailor a portal to address the specific health needs of a maternity population including those in a safety net setting.

Assessing Patient Activation among High-Need, High-Cost Patients in Urban Safety Net Care Settings.

Science.gov (United States)

Napoles, Tessa M; Burke, Nancy J; Shim, Janet K; Davis, Elizabeth; Moskowitz, David; Yen, Irene H

2017-12-01

We sought to examine the literature using the Patient Activation Measure (PAM) or the Patient Enablement Instrument (PEI) with high-need, high-cost (HNHC) patients receiving care in urban safety net settings. Urban safety net care management programs serve low-income, racially/ethnically diverse patients living with multiple chronic conditions. Although many care management programs track patient progress with the PAM or the PEI, it is not clear whether the PAM or the PEI is an effective and appropriate tool for HNHC patients receiving care in urban safety net settings in the United States. We searched PubMed, EMBASE, Web of Science, and PsycINFO for articles published between 2004 and 2015 that used the PAM and between 1998 and 2015 that used the PEI. The search was limited to English-language articles conducted in the United States and published in peer-reviewed journals. To assess the utility of the PAM and the PEI in urban safety net care settings, we defined a HNHC patient sample as racially/ethnically diverse, low socioeconomic status (SES), and multimorbid. One hundred fourteen articles used the PAM. All articles using the PEI were conducted outside the U.S. and therefore were excluded. Nine PAM studies (8%) included participants similar to those receiving care in urban safety net settings, three of which were longitudinal. Two of the three longitudinal studies reported positive changes following interventions. Our results indicate that research on patient activation is not commonly conducted on racially and ethnically diverse, low SES, and multimorbid patients; therefore, there are few opportunities to assess the appropriateness of the PAM in such populations. Investigators expressed concerns with the potential unreliability and inappropriate nature of the PAM on multimorbid, older, and low-literacy patients. Thus, the PAM may not be able to accurately assess patient progress among HNHC patients receiving care in urban safety net settings. Assessing

The accuracy of radiology speech recognition reports in a multilingual South African teaching hospital

International Nuclear Information System (INIS)

Toit, Jacqueline du; Hattingh, Retha; Pitcher, Richard

2015-01-01

Speech recognition (SR) technology, the process whereby spoken words are converted to digital text, has been used in radiology reporting since 1981. It was initially anticipated that SR would dominate radiology reporting, with claims of up to 99% accuracy, reduced turnaround times and significant cost savings. However, expectations have not yet been realised. The limited data available suggest SR reports have significantly higher levels of inaccuracy than traditional dictation transcription (DT) reports, as well as incurring greater aggregate costs. There has been little work on the clinical significance of such errors, however, and little is known of the impact of reporter seniority on the generation of errors, or the influence of system familiarity on reducing error rates. Furthermore, there have been conflicting findings on the accuracy of SR amongst users with English as first- and second-language respectively. The aim of the study was to compare the accuracy of SR and DT reports in a resource-limited setting. The first 300 SR and the first 300 DT reports generated during March 2010 were retrieved from the hospital’s PACS, and reviewed by a single observer. Text errors were identified, and then classified as either clinically significant or insignificant based on their potential impact on patient management. In addition, a follow-up analysis was conducted exactly 4 years later. Of the original 300 SR reports analysed, 25.6% contained errors, with 9.6% being clinically significant. Only 9.3% of the DT reports contained errors, 2.3% having potential clinical impact. Both the overall difference in SR and DT error rates, and the difference in ‘clinically significant’ error rates (9.6% vs. 2.3%) were statistically significant. In the follow-up study, the overall SR error rate was strikingly similar at 24.3%, 6% being clinically significant. Radiologists with second-language English were more likely to generate reports containing errors, but level of seniority

Understanding the digital divide in the clinical setting: the technology knowledge gap experienced by US safety net patients during teleretinal screening.

Science.gov (United States)

George, Sheba; Moran, Erin; Fish, Allison; Ogunyemi, Lola

2013-01-01

Differential access to everyday technology and healthcare amongst safety net patients is associated with low technological and health literacies, respectively. These low rates of literacy produce a complex patient "knowledge gap" that influences the effectiveness of telehealth technologies. To understand this "knowledge gap", six focus groups (2 African-American and 4 Latino) were conducted with patients who received teleretinal screenings in U.S. urban safety-net settings. Findings indicate that patients' "knowledge gap" is primarily produced at three points: (1) when patients' preexisting personal barriers to care became exacerbated in the clinical setting; (2) through encounters with technology during screening; and (3) in doctor-patient follow-up. This "knowledge gap" can produce confusion and fear, potentially affecting patients' confidence in quality of care and limiting their disease management ability. In rethinking the digital divide to include the consequences of this knowledge gap faced by patients in the clinical setting, we suggest that patient education focus on both their disease and specific telehealth technologies deployed in care delivery.

A randomised trial of Supine versus Prone breast radiotherapy (SuPr study): Comparing set-up errors and respiratory motion

International Nuclear Information System (INIS)

Kirby, Anna M.; Evans, Philip M.; Helyer, Sarah J.; Donovan, Ellen M.; Convery, Helen M.; Yarnold, John R.

2011-01-01

Purpose: To test a prone position against the international-standard supine position in women undergoing whole-breast-radiotherapy (WBRT) after wide-local-excision (WLE) of early breast cancer (BC) in terms of feasibility, set-up errors, and respiratory motion. Methods: Following WLE of BC with insertion of tumour-bed clips, patients underwent 4D-CT for WBRT-planning in supine and prone positions (the latter using an in-house-designed platform). Patients were randomised to undergo WBRT fractions 1-7 in one position, switching to the alternate position for fractions 8-15 (40 Gy/15-fractions total). Cone-beam CT-images (CBCT) were acquired prior to fractions 1, 4, 7, 8, 11 and 14. CBCT data were matched to planning-CT data using (i) chest-wall and (ii) clips. Systematic and random errors were calculated. Maximal displacement of chest-wall and clips with respiration was measured on 4D-CT. Clinical- to planning-target-volume (CTV-PTV) margins were calculated. Patient-comfort-scores and treatment-times were evaluated. Results: Twenty-five patients were randomized. 192/192 (100%) planned supine fractions and 173/192 (90%) prone fractions were completed. 3D population systematic errors were 1.3-1.9 mm (supine) and 3.1-4.3 mm (prone) (p = 0.02) and random errors 2.6-3.2 mm (supine) and 3.8-5.4 mm (prone) (p = 0.02). Prone positioning reduced chest-wall and clip motion (0.5 ± 0.2 mm (prone) versus 2.7 ± 0.5 mm (supine) (p < 0.001)) with respiration. Calculated CTV-PTV margins were greater for prone (12-16 mm) than for supine treatment (10 mm). Patient-comfort-scores and treatment times were comparable (p = 0.06). Conclusions: Set-up errors were greater using our prone technique than for our standard supine technique, resulting in the need for larger CTV-PTV margins in the prone position. Further work is required to optimize the prone treatment-platform and technique before it can become a standard treatment option at our institution.

Healthcare professional versus patient goal setting in intermittent allergic rhinitis.

Science.gov (United States)

O'Connor, J; Seeto, C; Saini, B; Bosnic-Anticevich, S; Krass, I; Armour, C; Smith, L

2008-01-01

To examine the impact of healthcare professional versus patient goal setting for the self-management of intermittent allergic rhinitis (AR) on symptom severity and quality of life. This was a 6 week, parallel group study. Group A participants, with pharmacist facilitation, nominated personally relevant goals and strategies relating to their AR. Group B participants had their goals and strategies set by the pharmacist. The main outcome measures used included perceived symptom severity and quality of life. In addition, goals and strategies data from participants of both groups were collected and analysed. Both groups demonstrated significant improvements in symptom severity and quality of life scores however Group B symptom severity scores improved more. Group B set a greater number of goals and strategies which were better structured and more task specific. This is the first study to investigate the impact of goal setting on patient behaviour in a chronic yet episodic illness. Our results suggest that self-management goals set by the healthcare professional which are clinically indicated but tailored to the patient's nominated symptoms yields better outcomes than goals nominated by the patient. A brief, structured intervention, tailored to patient symptoms, can enhance self-management of intermittent allergic rhinitis.

Set up for Success: An Examination of the Ronald E. McNair Postbaccalaureate Achievement Program's Mentoring Component

Science.gov (United States)

Wyre, Dwuena Cene

2011-01-01

Often, individuals are set up to fail. However, effective mentoring can set individuals up to succeed. This nonexperimental cross-sectional, predictive study examines the Ronald E. McNair Postbaccalaureate Achievement Program's mentoring component. Specific focus is placed on faculty mentor competency and its impact on McNair student intent to…

High-accuracy drilling with an image guided light weight robot: autonomous versus intuitive feed control.

Science.gov (United States)

Tauscher, Sebastian; Fuchs, Alexander; Baier, Fabian; Kahrs, Lüder A; Ortmaier, Tobias

2017-10-01

Assistance of robotic systems in the operating room promises higher accuracy and, hence, demanding surgical interventions become realisable (e.g. the direct cochlear access). Additionally, an intuitive user interface is crucial for the use of robots in surgery. Torque sensors in the joints can be employed for intuitive interaction concepts. Regarding the accuracy, they lead to a lower structural stiffness and, thus, to an additional error source. The aim of this contribution is to examine, if an accuracy needed for demanding interventions can be achieved by such a system or not. Feasible accuracy results of the robot-assisted process depend on each work-flow step. This work focuses on the determination of the tool coordinate frame. A method for drill axis definition is implemented and analysed. Furthermore, a concept of admittance feed control is developed. This allows the user to control feeding along the planned path by applying a force to the robots structure. The accuracy is researched by drilling experiments with a PMMA phantom and artificial bone blocks. The described drill axis estimation process results in a high angular repeatability ([Formula: see text]). In the first set of drilling results, an accuracy of [Formula: see text] at entrance and [Formula: see text] at target point excluding imaging was achieved. With admittance feed control an accuracy of [Formula: see text] at target point was realised. In a third set twelve holes were drilled in artificial temporal bone phantoms including imaging. In this set-up an error of [Formula: see text] and [Formula: see text] was achieved. The results of conducted experiments show that accuracy requirements for demanding procedures such as the direct cochlear access can be fulfilled with compliant systems. Furthermore, it was shown that with the presented admittance feed control an accuracy of less then [Formula: see text] is achievable.

Explained variation and predictive accuracy in general parametric statistical models: the role of model misspecification

DEFF Research Database (Denmark)

Rosthøj, Susanne; Keiding, Niels

2004-01-01

When studying a regression model measures of explained variation are used to assess the degree to which the covariates determine the outcome of interest. Measures of predictive accuracy are used to assess the accuracy of the predictions based on the covariates and the regression model. We give a ...... a detailed and general introduction to the two measures and the estimation procedures. The framework we set up allows for a study of the effect of misspecification on the quantities estimated. We also introduce a generalization to survival analysis....

The pattern of trauma in private general medical practice set-up Port ...

African Journals Online (AJOL)

BACKGROUND: Private general medical practice establishments appear to be treating a significant number of trauma cases including more serious ones. Aim: To find out the extent of such treatment of trauma and what has made this possible. METHODS: All trauma cases treated in a private general medical practice set up ...

Diagnostic Accuracy of Fall Risk Assessment Tools in People With Diabetic Peripheral Neuropathy

Science.gov (United States)

Pohl, Patricia S.; Mahnken, Jonathan D.; Kluding, Patricia M.

2012-01-01

Background Diabetic peripheral neuropathy affects nearly half of individuals with diabetes and leads to increased fall risk. Evidence addressing fall risk assessment for these individuals is lacking. Objective The purpose of this study was to identify which of 4 functional mobility fall risk assessment tools best discriminates, in people with diabetic peripheral neuropathy, between recurrent “fallers” and those who are not recurrent fallers. Design A cross-sectional study was conducted. Setting The study was conducted in a medical research university setting. Participants The participants were a convenience sample of 36 individuals between 40 and 65 years of age with diabetic peripheral neuropathy. Measurements Fall history was assessed retrospectively and was the criterion standard. Fall risk was assessed using the Functional Reach Test, the Timed “Up & Go” Test, the Berg Balance Scale, and the Dynamic Gait Index. Sensitivity, specificity, positive and negative likelihood ratios, and overall diagnostic accuracy were calculated for each fall risk assessment tool. Receiver operating characteristic curves were used to estimate modified cutoff scores for each fall risk assessment tool; indexes then were recalculated. Results Ten of the 36 participants were classified as recurrent fallers. When traditional cutoff scores were used, the Dynamic Gait Index and Functional Reach Test demonstrated the highest sensitivity at only 30%; the Dynamic Gait Index also demonstrated the highest overall diagnostic accuracy. When modified cutoff scores were used, all tools demonstrated improved sensitivity (80% or 90%). Overall diagnostic accuracy improved for all tests except the Functional Reach Test; the Timed “Up & Go” Test demonstrated the highest diagnostic accuracy at 88.9%. Limitations The small sample size and retrospective fall history assessment were limitations of the study. Conclusions Modified cutoff scores improved diagnostic accuracy for 3 of 4 fall risk

Secondary electron images obtained with a standard PEEM set up

International Nuclear Information System (INIS)

Benka, O.; Zeppenfeld, P.

2004-01-01

Secondary electron images excited by 3 to 4.3 keV electrons are obtained with a standard photoelectron electron emission microscope (PEEM) set up equipped with an imaging energy filter (IEF). The electron gun was mounted on a standard PEEM entrance flange at an angle of 25 o with respect to the sample surface. A low extraction voltage of 500 V was used to minimize the deflection of the electron beam by the PEEM extraction electrode. The secondary electron images are compared to photoelectron images excited by a standard 4.9 eV UV lamp. In the case of a Cu pattern on a Si substrate it is found that the lateral resolution without the IEF is about the same for electron and photon excitation but that the relative electron emission intensities are very different. The use of the IEF-reduces the lateral resolution. Images for secondary electron energies between eV 1 and eV 2 were obtained by setting the IEF to -V 1 and -V 2 ∼ -(V 1 + 5V) potentials and taking the difference of both images. Images up to 100 eV electron energies were recorded. The lateral resolution is in the range of μm. The material contrast obtained in these difference images are discussed in terms of a secondary electron and photoelectron emission model and secondary electron energy spectra measured with a LEED-Auger spectrometer. (author)

IAEA Sets Up Team to Drive Nuclear Safety Action Plan

International Nuclear Information System (INIS)

2011-01-01

Full text: The International Atomic Energy Agency is setting up a Nuclear Safety Action Team to oversee prompt implementation of the IAEA Action Plan on Nuclear Safety and ensure proper coordination among all stakeholders. The 12-point Action Plan, drawn up in the wake of the Fukushima Daiichi accident, was approved by the Agency's Board of Governors on 13 September and endorsed by all 151 Member States at its General Conference last week. The team will work within the Agency's Department of Nuclear Safety and Security, headed by Deputy Director General Denis Flory, and will coordinate closely with the Director General's Office for Policy. ''The Action Plan requires immediate follow-up,'' Director General Yukiya Amano said. ''This compact, dedicated team will assist Deputy Director General Flory in implementing the measures agreed in the Action Plan.'' Gustavo Caruso, Head of the Regulatory Activities Section in the IAEA's Division of Installation Safety, has been designated as the team's Special Coordinator for the implementation of the Action Plan. The IAEA has already started implementing its responsibilities under the Action Plan, including development of an IAEA methodology for stress tests for nuclear power plants. The methodology will be ready in October. (IAEA)

Intelligent data analysis: the best approach for chronic heart failure (CHF) follow up management.

Science.gov (United States)

Mohammadzadeh, Niloofar; Safdari, Reza; Baraani, Alireza; Mohammadzadeh, Farshid

2014-08-01

Intelligent data analysis has ability to prepare and present complex relations between symptoms and diseases, medical and treatment consequences and definitely has significant role in improving follow-up management of chronic heart failure (CHF) patients, increasing speed ​​and accuracy in diagnosis and treatments; reducing costs, designing and implementation of clinical guidelines. The aim of this article is to describe intelligent data analysis methods in order to improve patient monitoring in follow and treatment of chronic heart failure patients as the best approach for CHF follow up management. Minimum data set (MDS) requirements for monitoring and follow up of CHF patient designed in checklist with six main parts. All CHF patients that discharged in 2013 from Tehran heart center have been selected. The MDS for monitoring CHF patient status were collected during 5 months in three different times of follow up. Gathered data was imported in RAPIDMINER 5 software. Modeling was based on decision trees methods such as C4.5, CHAID, ID3 and k-Nearest Neighbors algorithm (K-NN) with k=1. Final analysis was based on voting method. Decision trees and K-NN evaluate according to Cross-Validation. Creating and using standard terminologies and databases consistent with these terminologies help to meet the challenges related to data collection from various places and data application in intelligent data analysis. It should be noted that intelligent analysis of health data and intelligent system can never replace cardiologists. It can only act as a helpful tool for the cardiologist's decisions making.

Increasing Free Throw Accuracy through Behavior Modeling and Goal Setting.

Science.gov (United States)

Erffmeyer, Elizabeth S.

A two-year behavior-modeling training program focusing on attention processes, retention processes, motor reproduction, and motivation processes was implemented to increase the accuracy of free throw shooting for a varsity intercollegiate women's basketball team. The training included specific learning keys, progressive relaxation, mental…

Minimum standard guidelines of care on requirements for setting up a laser room

Directory of Open Access Journals (Sweden)

Dhepe Niteen

2009-08-01

Full Text Available Introduction, definition, rationale and scope: Lasers are now becoming an integral part of dermatological practice in India, with more and more dermatologists starting laser dermatology practice. Lasers, when are used with care, by properly trained operators, in carefully designed environment, can deliver a range of useful aesthetic and dermatologic treatments. Facility: Laser treatment is an office procedure, hence it does not require hospital set-up. The laser room facility requires careful planning keeping in mind safety of both patient and operator, convenience of operating, and optimum handling of costly equipments. The facility should be designed to handle procedures under local anesthesia and sedation. Facilities, staff and equipment to handle any emergencies should be available. Location: A room in existing dermatology clinic can be adequately converted to a laser room. Dimensions of laser room, its door and patient′s table should be such that it should facilitate easy movement of patient, machine trolley, operator and assistant in case of routine procedures and in emergency. Physician Qualification: Any dermatologist with MD or diploma in dermatology can do laser procedures, provided he/ she has acquired necessary skills by virtue of training, observing a competent dermatologist. Such training may be obtained during post graduation or later in specified workshops or courses under a competent dermatologist or at centre which routinely performs such procedures. Electricity and uninterrupted power supply: Laser equipments should be connected to stabilizer or UPS circuits only. Preferably an on line UPS as recommended by the laser company should be installed. Earthing of the equipment is essential to avoid damage to the equipment and electrical shocks to the operator. Sufficient power back up to complete the procedure if power is off midway, is essential. Air-conditioning: Laser machines should be operated in low ambient temperature, with

Setting up a child eye care centre: the Mercy Eye Hospital, Abak ...

African Journals Online (AJOL)

Aim: To document and share our experience in setting up a Child Eye Care Centre within a rural mission eye hospital and document subsequent development of services. Method: The location of the project was Mercy Eye Hospital (MEH) Abak, Akwa Ibom State in the South South zone of Nigeria). Consent to commence ...

Ability of the rhTSH stimulation test to predict relapse in patients with differentiated thyroid carcinoma, after long-term follow-up

Science.gov (United States)

MARCELINO, MAFALDA; LOPES, ANA FILIPA; MADUREIRA, DEOLINDA; FERREIRA, TERESA C.; LIMBERT, EDWARD; LEITE, VALERIANO

2015-01-01

The analysis of serum thyroglobulin (Tg) following thyroid-stimulating hormone (TSH) stimulation (sTg) has been recommended in the follow-up of differentiated thyroid carcinoma (DTC) patients, however, its routine use remains controversial. The aim of the current study was to evaluate the accuracy of sTg testing following recombinant human (rh) TSH stimulation in DTC patients, with a follow-up of 12.4 years. Retrospective studies were conducted of 125 DTC patients, who underwent rhTSH stimulation testing between 1999 and 2002. The exclusion criteria were: Patients with anti-Tg antibodies, Tg levels >1 ng/ml under TSH suppression and the absence of radioactive iodine (RAI) ablation therapy following surgery. In total, 49 patients were included in the study and all had been previously treated with total or near total thyroidectomy (with or without central neck dissection) and RAI, postoperatively. The Tg functional sensitivity was 1.0 ng/ml. The follow-up for patients was performed annually. During the median follow-up of 12.4 years after the rhTSH stimulation test, nine patients exhibited recurrence (18.4%). Of the nine patients, six exhibited sTg levels >2 ng/ml (positive result) and three exhibited levels <2 ng/ml (negative result). Relapse occurred at a mean of 5.9 years following the rhTSH stimulation test. The positive predictive value and negative predictive value (NPV) of positive sTg were 50 and 91.9%, respectively, with a sensitivity of 66.6% and a specificity of 85.0%. The rhTSH-stimulated Tg levels have a high NPV, allowing the identification of the patients who are free of the tumour. These results are consistent with the previously published data; however, to the best of our knowledge, this is the study with the longest follow-up duration after rhTSH stimulation. PMID:25663898

Standardized network order sets in rural Ontario: a follow-up report on successes and sustainability.

Science.gov (United States)

Rawn, Andrea; Wilson, Katrina

2011-01-01

Unifying, implementing and sustaining a large order set project requires strategic placement of key organizational professionals to provide ongoing user education, communication and support. This article will outline the successful strategies implemented by the Grey Bruce Health Network, Evidence-Based Care Program to reduce length of stay, increase patient satisfaction and increase the use of best practices resulting in quality outcomes, safer practice and better allocation of resources by using standardized Order Sets within a network of 11 hospital sites. Audits conducted in 2007 and again in 2008 revealed a reduced length of stay of 0.96 in-patient days when order sets were used on admission and readmission for the same or a related diagnosis within one month decreased from 5.5% without order sets to 3.5% with order sets.

Set-up of proportional counter L2 for 14C measurements with improved precision

International Nuclear Information System (INIS)

Goslar, T.; Pazdur, A.; Pazdur, M.F.; Walanus, A.; Zastawny, A.

1990-01-01

Radiocarbon dating with improved precision denotes determination of conventional radiocarbon dates with accuracy equal to ca ± 25 yr. The paper presents some fundamental data concerning construction and design of the proportional counter L2, the results of calibration of the counter, including detailed information on changes of the background counting rate. The counter L2 enables dating of samples up to 50 000 yr. For samples younger than 3000 yr the error of dating is equal to ca ± 25 yr. 4 figs., 1 tab., 9 refs. (author)

In vivo dosimetry of high-dose fractionated irradiation in an experimental set-up with rats

Energy Technology Data Exchange (ETDEWEB)

Fortan, L; Van Hecke, H; Van Duyse, B; De Neve, W; De Meerleer, B [Ghent Rijksuniversiteit (Belgium). Kliniek voor Radiotherapie en Kerngeneeskunde; Pattyn, P; Van Renthergem, K [Ghent University (Belgium). Dept. of Surgery

1995-12-01

The feasibility to irradiate a limited section of a rat abdomen with well-defined edges was assessed. Because of the relative small volume involved, in vivo dosimetry with TLDs was necessary in providing us information about the accuracy of the irradiation method. Three to five days prior to the start of the radiotherapy treatment, two plastic strips - each containing a TLD-dosimeter (Harshaw TLD10 LiF rods, 1 mm dia x 6 mm) sealed in polyethylene tubing, and a lead bean - were implanted in the rat abdomen. The plastic strips made a closed loop around the bowel, through the mesenterium, and were fixed with a single stitch on the inner abdominal wall. One loop was made in the hepatic area; another was made in the lower abdomen, around the rectosigmoid. Conscious animals were irradiated using a purpose-build plexi-holder, with rear legs immobilised to avoid longitudinal movements. The implanted lead beans enabled us to simulate the rat prior to each radiation session. This way, the radiation field could be set up individually for each rat, in such way that the rectosigmoid area received full dose and the hepatic area received no irradiation dose at all. Irradiation was carried out, using 5 MV photons of a linear accelerator. Fifteen animals per group were irradiated according a conventional (2.0 Gy / fraction; 5 fractions / week) or a hyperfractionated (1.6 Gy / fraction; 2 daily fractions; 5 days / week) schedule, with different total doses. Prior to implantation, TLDs were individually calibrated and checked for stability. After removal from the abdomen . TLDs were tested again for accuracy. TLDs with an unacceptable read-out curve were rejected (about 2 to 4 TLDs per group of 15). The obtained accumulated doses - as determined by TLD read-outs-were comparable to the theoretical doses, indicating that fractionated radiation of small fields, with well defined mark off, in rats is feasible.

In vivo dosimetry of high-dose fractionated irradiation in an experimental set-up with rats

International Nuclear Information System (INIS)

Fortan, L.; Van Hecke, H.; Van Duyse, B.; De Neve, W.; De Meerleer, B.; Pattyn, P.; Van Renthergem, K.

1995-01-01

The feasibility to irradiate a limited section of a rat abdomen with well-defined edges was assessed. Because of the relative small volume involved, in vivo dosimetry with TLDs was necessary in providing us information about the accuracy of the irradiation method. Three to five days prior to the start of the radiotherapy treatment, two plastic strips - each containing a TLD-dosimeter (Harshaw TLD10 LiF rods, 1 mm dia x 6 mm) sealed in polyethylene tubing, and a lead bean - were implanted in the rat abdomen. The plastic strips made a closed loop around the bowel, through the mesenterium, and were fixed with a single stitch on the inner abdominal wall. One loop was made in the hepatic area; another was made in the lower abdomen, around the rectosigmoid. Conscious animals were irradiated using a purpose-build plexi-holder, with rear legs immobilised to avoid longitudinal movements. The implanted lead beans enabled us to simulate the rat prior to each radiation session. This way, the radiation field could be set up individually for each rat, in such way that the rectosigmoid area received full dose and the hepatic area received no irradiation dose at all. Irradiation was carried out, using 5 MV photons of a linear accelerator. Fifteen animals per group were irradiated according a conventional (2.0 Gy / fraction; 5 fractions / week) or a hyperfractionated (1.6 Gy / fraction; 2 daily fractions; 5 days / week) schedule, with different total doses. Prior to implantation, TLDs were individually calibrated and checked for stability. After removal from the abdomen . TLDs were tested again for accuracy. TLDs with an unacceptable read-out curve were rejected (about 2 to 4 TLDs per group of 15). The obtained accumulated doses - as determined by TLD read-outs-were comparable to the theoretical doses, indicating that fractionated radiation of small fields, with well defined mark off, in rats is feasible

Report on the set-up of a holographic interferometer

International Nuclear Information System (INIS)

Koster, J.N.

1977-10-01

Holographic interferometry is well suited for visualizing temperature, density, pressure and concentration fields in transparent fluids. The holographic real-time interferometer allows a continuous observation of stationary and instationary flow processes. After the explanation of the measuring technique, the problems arising during the interferometer set-up as well as the necessary adjusting operations are described. For heat transfer problems new possibilities for the application of holographic interferometry are revealed. Convection in boxes, temperature fields around heated or cooled bodies, concentration and diffusion processes in two phase-flows, mixtures and solutions as well as melting and freezing processes may be investigated. On the basis of particular examples some applications are presented. (orig.) [de

Barriers to ART adherence & follow ups among patients attending ART centres in Maharashtra, India.

Science.gov (United States)

Joglekar, N; Paranjape, R; Jain, R; Rahane, G; Potdar, R; Reddy, K S; Sahay, S

2011-12-01

Adherence to ART is a patient specific issue influenced by a variety of situations that a patient may encounter, especially in resource-limited settings. A study was conducted to understand factors and influencers of adherence to ART and their follow ups among patients attending ART centres in Maharashtra, India. Between January and March 2009, barriers to ART adherence among 32 patients at three selected ART centres functioning under national ART roll-out programme in Maharashtra, India, were studied using qualitative methods. Consenting patients were interviewed to assess barriers to ART adherence. Constant comparison method was used to identify grounded codes. Patients reported multiple barriers to ART adherence and follow up as (i) Financial barriers where the contributing factors were unemployment, economic dependency, and debt, (ii) social norm of attending family rituals, and fulfilling social obligations emerged as socio-cultural barriers, (iii) patients' belief, attitude and behaviour towards medication and self-perceived stigma were the reasons for sub-optimal adherence, and (iv) long waiting period, doctor-patient relationship and less time devoted in counselling at the center contributed to missed visits. Mainstreaming ART can facilitate access and address 'missed doses' due to travel and migration. A 'morning' and 'evening' ART centre/s hours may reduce work absenteeism and help in time management. Proactive 'adherence probing' and probing on internalized stigma might optimize adherence. Adherence probing to prevent transitioning to suboptimal adherence among patients stable on ART is recommended.

Individual differences in eyewitness identification accuracy between sequential and simultaneous line-ups: consequences for police practice and jury decisions

OpenAIRE

Dominic Willmott; Nicole Sherretts

2016-01-01

Background Although previous research has indicated that sequential line-up procedures result in fewer mistaken identifications, this was found to be at the expense of accurate identifications more typical within simultaneous procedures. Hence, there remains a lack of agreement about which procedure is superior, and the interaction such procedures have with eyewitness confidence. The interaction between witness demographics and identification accuracy also remains unclear. Part...

Dermoscopy, Digital Dermoscopy and Other Diagnostic Tools in the Early Detection of Melanoma and Follow-up of High-risk Skin Cancer Patients.

Science.gov (United States)

Thomas, Luc; Puig, Susana

2017-07-05

Early detection is a key strategy for reducing the mortality and economic burden associated with melanoma. Dermoscopy is a non-invasive and cost-effective tool for melanoma diagnosis, which has been shown to be a reliable and sensitive method for detecting early-stage skin cancer and reducing the number of unnecessary excisions. Patients at high risk of developing melanoma require long-term surveillance. Use of digital dermoscopy follow-up of these patients has led to improved outcomes. Combined follow-up programmes using total-body photography and digital dermoscopy have led to further improvements in early diagnosis and diagnostic accuracy. Dermoscopy is now widely used by dermatologists, but the public health impact of this tool is yet to be evaluated. Despite the clear advantages of dermoscopy and digital follow-up meth-ods, dermoscopy training and access to digital dermoscopy among dermatologists and general practitioners needs to be improved.

Building up STEM education professional learning community in school setting: Case of Khon Kaen Wittayayon School

Science.gov (United States)

Thana, Aduldej; Siripun, Kulpatsorn; Yuenyong, Chokchai

2018-01-01

The STEM education is new issue of teaching and learning in school setting. Building up STEM education professional learning community may provide some suggestions for further collaborative work of STEM Education from grounded up. This paper aimed to clarify the building up STEM education learning community in Khon Kaen Wittayayon (KKW) School setting. Participants included Khon Kaen University researchers, Khon Kaen Wittayayon School administrators and teachers. Methodology regarded interpretative paradigm. The tools of interpretation included participant observation, interview and document analysis. Data was analyzed to categories of condition for building up STEM education professional learning community. The findings revealed that the actions of developing STEM learning activities and research showed some issues of KKW STEM community of inquiry and improvement. The paper will discuss what and how the community learns about sharing vision of STEM Education, supportive physical and social conditions of KKW, sharing activities of STEM, and good things from some key STEM teachers' ambition. The paper may has implication of supporting STEM education in Thailand school setting.

Improved Accuracy of Percutaneous Biopsy Using “Cross and Push” Technique for Patients Suspected with Malignant Biliary Strictures

Energy Technology Data Exchange (ETDEWEB)

Patel, Prashant, E-mail: p.patel@bham.ac.uk [University of Birmingham, School of Cancer Sciences, Vincent Drive (United Kingdom); Rangarajan, Balaji; Mangat, Kamarjit, E-mail: kamarjit.mangat@uhb.nhs.uk, E-mail: kamarjit.mangat@nhs.net [University Hospital Birmingham NHS Trust, Department of Radiology (United Kingdom)

2015-08-15

PurposeVarious methods have been used to sample biliary strictures, including percutaneous fine-needle aspiration biopsy, intraluminal biliary washings, and cytological analysis of drained bile. However, none of these methods has proven to be particularly sensitive in the diagnosis of biliary tract malignancy. We report improved diagnostic accuracy using a modified technique for percutaneous transluminal biopsy in patients with this disease.Materials and MethodsFifty-two patients with obstructive jaundice due to a biliary stricture underwent transluminal forceps biopsy with a modified “cross and push” technique with the use of a flexible biopsy forceps kit commonly used for cardiac biopsies. The modification entailed crossing the stricture with a 0.038-in. wire leading all the way down into the duodenum. A standard or long sheath was subsequently advanced up to the stricture over the wire. A Cook 5.2-Fr biopsy forceps was introduced alongside the wire and the cup was opened upon exiting the sheath. With the biopsy forceps open, within the stricture the sheath was used to push and advance the biopsy cup into the stricture before the cup was closed and the sample obtained. The data were analysed retrospectively.ResultsWe report the outcomes of this modified technique used on 52 consecutive patients with obstructive jaundice secondary to a biliary stricture. The sensitivity and accuracy were 93.3 and 94.2 %, respectively. There was one procedure-related late complication.ConclusionWe propose that the modified “cross and push” technique is a feasible, safe, and more accurate option over the standard technique for sampling strictures of the biliary tree.

Improved Accuracy of Percutaneous Biopsy Using “Cross and Push” Technique for Patients Suspected with Malignant Biliary Strictures

International Nuclear Information System (INIS)

Patel, Prashant; Rangarajan, Balaji; Mangat, Kamarjit

2015-01-01

PurposeVarious methods have been used to sample biliary strictures, including percutaneous fine-needle aspiration biopsy, intraluminal biliary washings, and cytological analysis of drained bile. However, none of these methods has proven to be particularly sensitive in the diagnosis of biliary tract malignancy. We report improved diagnostic accuracy using a modified technique for percutaneous transluminal biopsy in patients with this disease.Materials and MethodsFifty-two patients with obstructive jaundice due to a biliary stricture underwent transluminal forceps biopsy with a modified “cross and push” technique with the use of a flexible biopsy forceps kit commonly used for cardiac biopsies. The modification entailed crossing the stricture with a 0.038-in. wire leading all the way down into the duodenum. A standard or long sheath was subsequently advanced up to the stricture over the wire. A Cook 5.2-Fr biopsy forceps was introduced alongside the wire and the cup was opened upon exiting the sheath. With the biopsy forceps open, within the stricture the sheath was used to push and advance the biopsy cup into the stricture before the cup was closed and the sample obtained. The data were analysed retrospectively.ResultsWe report the outcomes of this modified technique used on 52 consecutive patients with obstructive jaundice secondary to a biliary stricture. The sensitivity and accuracy were 93.3 and 94.2 %, respectively. There was one procedure-related late complication.ConclusionWe propose that the modified “cross and push” technique is a feasible, safe, and more accurate option over the standard technique for sampling strictures of the biliary tree

3D source localization of interictal spikes in epilepsy patients with MRI lesions

Science.gov (United States)

Ding, Lei; Worrell, Gregory A.; Lagerlund, Terrence D.; He, Bin

2006-08-01

The present study aims to accurately localize epileptogenic regions which are responsible for epileptic activities in epilepsy patients by means of a new subspace source localization approach, i.e. first principle vectors (FINE), using scalp EEG recordings. Computer simulations were first performed to assess source localization accuracy of FINE in the clinical electrode set-up. The source localization results from FINE were compared with the results from a classic subspace source localization approach, i.e. MUSIC, and their differences were tested statistically using the paired t-test. Other factors influencing the source localization accuracy were assessed statistically by ANOVA. The interictal epileptiform spike data from three adult epilepsy patients with medically intractable partial epilepsy and well-defined symptomatic MRI lesions were then studied using both FINE and MUSIC. The comparison between the electrical sources estimated by the subspace source localization approaches and MRI lesions was made through the coregistration between the EEG recordings and MRI scans. The accuracy of estimations made by FINE and MUSIC was also evaluated and compared by R2 statistic, which was used to indicate the goodness-of-fit of the estimated sources to the scalp EEG recordings. The three-concentric-spheres head volume conductor model was built for each patient with three spheres of different radii which takes the individual head size and skull thickness into consideration. The results from computer simulations indicate that the improvement of source spatial resolvability and localization accuracy of FINE as compared with MUSIC is significant when simulated sources are closely spaced, deep, or signal-to-noise ratio is low in a clinical electrode set-up. The interictal electrical generators estimated by FINE and MUSIC are in concordance with the patients' structural abnormality, i.e. MRI lesions, in all three patients. The higher R2 values achieved by FINE than MUSIC

3D source localization of interictal spikes in epilepsy patients with MRI lesions

International Nuclear Information System (INIS)

Ding Lei; Worrell, Gregory A; Lagerlund, Terrence D; He Bin

2006-01-01

The present study aims to accurately localize epileptogenic regions which are responsible for epileptic activities in epilepsy patients by means of a new subspace source localization approach, i.e. first principle vectors (FINE), using scalp EEG recordings. Computer simulations were first performed to assess source localization accuracy of FINE in the clinical electrode set-up. The source localization results from FINE were compared with the results from a classic subspace source localization approach, i.e. MUSIC, and their differences were tested statistically using the paired t-test. Other factors influencing the source localization accuracy were assessed statistically by ANOVA. The interictal epileptiform spike data from three adult epilepsy patients with medically intractable partial epilepsy and well-defined symptomatic MRI lesions were then studied using both FINE and MUSIC. The comparison between the electrical sources estimated by the subspace source localization approaches and MRI lesions was made through the coregistration between the EEG recordings and MRI scans. The accuracy of estimations made by FINE and MUSIC was also evaluated and compared by R 2 statistic, which was used to indicate the goodness-of-fit of the estimated sources to the scalp EEG recordings. The three-concentric-spheres head volume conductor model was built for each patient with three spheres of different radii which takes the individual head size and skull thickness into consideration. The results from computer simulations indicate that the improvement of source spatial resolvability and localization accuracy of FINE as compared with MUSIC is significant when simulated sources are closely spaced, deep, or signal-to-noise ratio is low in a clinical electrode set-up. The interictal electrical generators estimated by FINE and MUSIC are in concordance with the patients' structural abnormality, i.e. MRI lesions, in all three patients. The higher R 2 values achieved by FINE than MUSIC

Atomic Cholesky decompositions: A route to unbiased auxiliary basis sets for density fitting approximation with tunable accuracy and efficiency

Science.gov (United States)

Aquilante, Francesco; Gagliardi, Laura; Pedersen, Thomas Bondo; Lindh, Roland

2009-04-01

Cholesky decomposition of the atomic two-electron integral matrix has recently been proposed as a procedure for automated generation of auxiliary basis sets for the density fitting approximation [F. Aquilante et al., J. Chem. Phys. 127, 114107 (2007)]. In order to increase computational performance while maintaining accuracy, we propose here to reduce the number of primitive Gaussian functions of the contracted auxiliary basis functions by means of a second Cholesky decomposition. Test calculations show that this procedure is most beneficial in conjunction with highly contracted atomic orbital basis sets such as atomic natural orbitals, and that the error resulting from the second decomposition is negligible. We also demonstrate theoretically as well as computationally that the locality of the fitting coefficients can be controlled by means of the decomposition threshold even with the long-ranged Coulomb metric. Cholesky decomposition-based auxiliary basis sets are thus ideally suited for local density fitting approximations.

Errors in imaging patients in the emergency setting.

Science.gov (United States)

Pinto, Antonio; Reginelli, Alfonso; Pinto, Fabio; Lo Re, Giuseppe; Midiri, Federico; Muzj, Carlo; Romano, Luigia; Brunese, Luca

2016-01-01

Emergency and trauma care produces a "perfect storm" for radiological errors: uncooperative patients, inadequate histories, time-critical decisions, concurrent tasks and often junior personnel working after hours in busy emergency departments. The main cause of diagnostic errors in the emergency department is the failure to correctly interpret radiographs, and the majority of diagnoses missed on radiographs are fractures. Missed diagnoses potentially have important consequences for patients, clinicians and radiologists. Radiologists play a pivotal role in the diagnostic assessment of polytrauma patients and of patients with non-traumatic craniothoracoabdominal emergencies, and key elements to reduce errors in the emergency setting are knowledge, experience and the correct application of imaging protocols. This article aims to highlight the definition and classification of errors in radiology, the causes of errors in emergency radiology and the spectrum of diagnostic errors in radiography, ultrasonography and CT in the emergency setting.

Multidimensional evaluation of a radio frequency identification wi-fi location tracking system in an acute-care hospital setting.

Science.gov (United States)

Okoniewska, Barbara; Graham, Alecia; Gavrilova, Marina; Wah, Dannel; Gilgen, Jonathan; Coke, Jason; Burden, Jack; Nayyar, Shikha; Kaunda, Joseph; Yergens, Dean; Baylis, Barry; Ghali, William A

2012-01-01

Real-time locating systems (RTLS) have the potential to enhance healthcare systems through the live tracking of assets, patients and staff. This study evaluated a commercially available RTLS system deployed in a clinical setting, with three objectives: (1) assessment of the location accuracy of the technology in a clinical setting; (2) assessment of the value of asset tracking to staff; and (3) assessment of threshold monitoring applications developed for patient tracking and inventory control. Simulated daily activities were monitored by RTLS and compared with direct research team observations. Staff surveys and interviews concerning the system's effectiveness and accuracy were also conducted and analyzed. The study showed only modest location accuracy, and mixed reactions in staff interviews. These findings reveal that the technology needs to be refined further for better specific location accuracy before full-scale implementation can be recommended.

Anhui Tongling Invests 1 Billion Yuan to Set up “Copper Industry Fund”

Institute of Scientific and Technical Information of China (English)

2012-01-01

<正>On September 12, the signing ceremony for "Anhui Copper Industry Fund" set up by Anhui Tongling Development & Investment Group Co., Ltd. and Shanghai V. Stone Investment Management Co., Ltd. was held in Tongling. The fund is 1 billion yuan.

Multiple sequence alignment accuracy and phylogenetic inference.

Science.gov (United States)

Ogden, T Heath; Rosenberg, Michael S

2006-04-01

Phylogenies are often thought to be more dependent upon the specifics of the sequence alignment rather than on the method of reconstruction. Simulation of sequences containing insertion and deletion events was performed in order to determine the role that alignment accuracy plays during phylogenetic inference. Data sets were simulated for pectinate, balanced, and random tree shapes under different conditions (ultrametric equal branch length, ultrametric random branch length, nonultrametric random branch length). Comparisons between hypothesized alignments and true alignments enabled determination of two measures of alignment accuracy, that of the total data set and that of individual branches. In general, our results indicate that as alignment error increases, topological accuracy decreases. This trend was much more pronounced for data sets derived from more pectinate topologies. In contrast, for balanced, ultrametric, equal branch length tree shapes, alignment inaccuracy had little average effect on tree reconstruction. These conclusions are based on average trends of many analyses under different conditions, and any one specific analysis, independent of the alignment accuracy, may recover very accurate or inaccurate topologies. Maximum likelihood and Bayesian, in general, outperformed neighbor joining and maximum parsimony in terms of tree reconstruction accuracy. Results also indicated that as the length of the branch and of the neighboring branches increase, alignment accuracy decreases, and the length of the neighboring branches is the major factor in topological accuracy. Thus, multiple-sequence alignment can be an important factor in downstream effects on topological reconstruction.

Analysis of Regional Timelines To Set Up a Global Phase III Clinical Trial in Breast Cancer: the Adjuvant Lapatinib and/or Trastuzumab Treatment Optimization Experience

OpenAIRE

Metzger-Filho, Otto; Azambuja, Evandro de; Bradbury, Ian; Saini, Kamal S.; Bines, Jose; Simon, Sergio D. [UNIFESP; Van Dooren, Veerle; Aktan, Gursel; Pritchard, Kathleen I.; Wolff, Antonio C.; Smith, Ian; Jackisch, Christian; Lang, Istvan; Untch, Michael; Boyle, Frances

2013-01-01

Purpose. This study measured the time taken for setting up the different facets of Adjuvant Lapatinib and/or Trastuzumab Treatment Optimization (ALTTO), an international phase III study being conducted in 44 participating countries.Methods. Time to regulatory authority (RA) approval, time to ethics committee/institutional review board (EC/IRB) approval, time from study approval by EC/IRB to first randomized patient, and time from first to last randomized patient were prospectively collected i...

18F-FDG PET/contrast enhanced CT in the standard follow-up of patients with lymphoma.

Science.gov (United States)

García Vicente, A M; Talavera Rubio, M P; Dominguez Ferreras, E; Calle Primo, C; Amo-Salas, M; Tello Galán, M J; Jiménez Londoño, G A; Jiménez Aragón, F; Hernández Ruiz, B; Soriano Castrejón, Á

To assess the diagnostic accuracy of 18 F-FDG PET/contrast enhanced computed tomography (ceCT) in the detection of asymptomatic recurrences in patients with lymphoma. Patients with lymphoma and clinical complete remission underwent 18 F-FDG PET/ceCT for standard follow-up. 18 F-FDG PET and ceCT were evaluated blindly by two independent observers, and classified as positive or negative for recurrence. Additionally a combined evaluation of both techniques was performed. The final diagnosis was established by histopathological analysis or a clinical follow-up longer than 6 months. Statistical diagnostic parameters and concordance levels between both diagnostic techniques were calculated. A total of 114 explorations on 90 patients were analyzed. Only 4 patients were diagnosed as asymptomatic recurrence during the follow-up. 18 F-FDG PET/ceCT, 18 F-FDG PET and ceCT showed an association with the final diagnosis (p=0.002 and χ 2 =11.96; p<0.001 and χ 2 =15.60; p=0.001 and χ 2 =11.96, respectively). The concordance between 18 F-FDG PET and ceCT was moderate/high and significant (kappa=0.672; p<0.001). A sensitivity and specificity of 50% and 88% was obtained for the 18 F-FDG PET/ceCT civ, 50% and 93% for the 18 F-FDG PET, and 50% and 91% for the ceCT. The combined use of 18 F-FDG PET/ceCT did not offer any advantage compared to any isolated diagnostic technique in the detection of asymptomatic lymphoma recurrence. Copyright © 2017 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

Contribution to the development of the multidetector AMPHORA. Design of the electronic set up

International Nuclear Information System (INIS)

Stassi, P.

1989-01-01

The multidetector AMPHORA has been designed and built to be used to detect and identify all the particles produced in intermediate energy heavy ion reactions. This installation consist of 140 detectors built with CsI(TI) + NE102A and CsI(TI) + NE213 scintillators, covering nearly 81% of the solid angle around the target. These detectors can identify light charged particles, intermediate mass fragments and neutrons. The electronic set up associated is compact and requires little manual adjustment. It is built with special CAMAC modules which have the folowing functions: A 4 channel constant fraction discriminator and gate generator, a 16 channel charge to digital converter (12 bits), a 8 channel time to digital converter (12 bits), a 16 channel pile-up detector and a fast decision module. This thesis contains a detailed explanation of the principle and operation of the set up. It also contains a part which describes the way to connect all the modules of the electronic configuration for AMPHORA [fr

Diagnostic Accuracy 99mTc-DISIDA Scintigraphy in Biliary Atresia

International Nuclear Information System (INIS)

Hyun, In Young; Lee, Dong Soo; Lee, Kyung Han; Kim, Jong Ho; Chung, June Key; Suh, Jung Key; Lee, Myung Chul; Koh, Chang Soon

1994-01-01

We evaluated the diagnostic accuracy of 99m Tc-DISIDA scintigraphy as a mean of differentiating biliary atresia from neonatal hepatitis. 99m Tc-DISIDA scintigraphy was visually interpreted by assessing the presence or absence of radioactivity in the intestine or gall bladder. In patients without intestinal radioactivity, we measured the hepatic retention index and the hepatic uptake index. The hepatic retention index was expressed as the amount of change of liver activity from 5 minutes to 30 minutes postinjection. The hepatic uptake index was graded visually with 5 minute images using the following scoring scheme :grade 0 (normal hepatic uptake), grade 1 (decreased hepatic up take), grade 2 (hepatic uptake equal to cardiac uptake), and grade 3 (hepatic uptake less than cardiac uptake). Age, total bilirubin, and hepatic uptake index were compared between the biliary atresia and the neonatal hepatitis group, between neonatal hepatitis patients with and without intestinal radioactivity, and between the biliary atresia and neonatal hepatitis patients with absent intestinal radioactivity. The results were as follows : l) None of the 30 biliary atresia patients showed intestinal radioactivity, while 31/40 neonatal hepatitis patients showed intestinal radioactivity. The sensitivity, specificity, and accuracy of the presence of intestinal radioactivity or the diagnosis of biliary atresia was 100%, 78%, and 87%, respectively. 2) In patients with absent intestinal radioactivity the mean hepatic retention index was 1.5 ± 0.6 in the 16 biliary atresia patient,s, and 1.1 ± 0.2 in the 7 neonatal hepatitis patients(p 99m Tc-DISIDA scintigraphy is accurate in the differential diagnosis of biliary atresia and neonatal hepatitis. In patients without intestinal radioactivity, the hepatic retention index and hepatic uptake index, along with the patients age and total bilirubin level may supplement diagnosis and improve diagnostic accuracy.

SU-F-T-119: Development of Heart Prediction Model to Increase Accuracy of Dose Reconstruction for Radiotherapy Patients

International Nuclear Information System (INIS)

Mosher, E; Choi, M; Lee, C; Jones, E

2016-01-01

Purpose: To assess individual variation in heart volume and location in order to develop a prediction model of the heart. This heart prediction model will be used to calculate individualized heart doses for radiotherapy patients in epidemiological studies. Methods: Chest CT images for 30 adult male and 30 adult female patients were obtained from NIH Clinical Center. Image-analysis computer programs were used to segment the whole heart and 8 sub-regions and to measure the volume of each sub- region and the dimension of the whole heart. An analytical dosimetry method was used for the 30 adult female patients to estimate mean heart dose during conventional left breast radiotherapy. Results: The average volumes of the whole heart were 803.37 cm"3 (COV 18.8%) and 570.19 cm"3 (COV 18.8%) for adult male and female patients, respectively, which are comparable with the international reference volumes of 807.69 cm"3 for males and 596.15 cm"3 for females. Some patient characteristics were strongly correlated (R"2>0.5) with heart volume and heart dimensions (e.g., Body Mass Index vs. heart depth in males: R"2=0.54; weight vs. heart width in the adult females: R"2=0.63). We found that the mean heart dose 3.805 Gy (assuming prescribed dose of 50 Gy) in the breast radiotherapy simulations of the 30 adult females could be an underestimate (up to 1.6-fold) or overestimate (up to 1.8-fold) of the patient-specific heart dose. Conclusion: The study showed the significant variation in patient heart volumes and dimensions, resulting in substantial dose errors when a single average heart model is used for retrospective dose reconstruction. We are completing a multivariate analysis to develop a prediction model of the heart. This model will increase accuracy in dose reconstruction for radiotherapy patients and allow us to individualize heart dose calculations for patients whose CT images are not available.

SU-F-T-119: Development of Heart Prediction Model to Increase Accuracy of Dose Reconstruction for Radiotherapy Patients

Energy Technology Data Exchange (ETDEWEB)

Mosher, E; Choi, M; Lee, C [Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD (United States); Jones, E [Radiology and Imaging Sciences Clinical Center, National Institutes of Health, Bethesda, MD (United States)

2016-06-15

Purpose: To assess individual variation in heart volume and location in order to develop a prediction model of the heart. This heart prediction model will be used to calculate individualized heart doses for radiotherapy patients in epidemiological studies. Methods: Chest CT images for 30 adult male and 30 adult female patients were obtained from NIH Clinical Center. Image-analysis computer programs were used to segment the whole heart and 8 sub-regions and to measure the volume of each sub- region and the dimension of the whole heart. An analytical dosimetry method was used for the 30 adult female patients to estimate mean heart dose during conventional left breast radiotherapy. Results: The average volumes of the whole heart were 803.37 cm{sup 3} (COV 18.8%) and 570.19 cm{sup 3} (COV 18.8%) for adult male and female patients, respectively, which are comparable with the international reference volumes of 807.69 cm{sup 3} for males and 596.15 cm{sup 3} for females. Some patient characteristics were strongly correlated (R{sup 2}>0.5) with heart volume and heart dimensions (e.g., Body Mass Index vs. heart depth in males: R{sup 2}=0.54; weight vs. heart width in the adult females: R{sup 2}=0.63). We found that the mean heart dose 3.805 Gy (assuming prescribed dose of 50 Gy) in the breast radiotherapy simulations of the 30 adult females could be an underestimate (up to 1.6-fold) or overestimate (up to 1.8-fold) of the patient-specific heart dose. Conclusion: The study showed the significant variation in patient heart volumes and dimensions, resulting in substantial dose errors when a single average heart model is used for retrospective dose reconstruction. We are completing a multivariate analysis to develop a prediction model of the heart. This model will increase accuracy in dose reconstruction for radiotherapy patients and allow us to individualize heart dose calculations for patients whose CT images are not available.

Accuracy of near-patient vs. inbuilt spirometry for monitoring tidal volumes in an in-vitro paediatric lung model.

Science.gov (United States)

Morgenroth, S; Thomas, J; Cannizzaro, V; Weiss, M; Schmidt, A R

2018-03-01

Spirometric monitoring provides precise measurement and delivery of tidal volumes within a narrow range, which is essential for lung-protective strategies that aim to reduce morbidity and mortality in mechanically-ventilated patients. Conventional anaesthesia ventilators include inbuilt spirometry to monitor inspiratory and expiratory tidal volumes. The GE Aisys CS 2 anaesthesia ventilator allows additional near-patient spirometry via a sensor interposed between the proximal end of the tracheal tube and the respiratory tubing. Near-patient and inbuilt spirometry of two different GE Aisys CS 2 anaesthesia ventilators were compared in an in-vitro study. Assessments were made of accuracy and variability in inspiratory and expiratory tidal volume measurements during ventilation of six simulated paediatric lung models using the ASL 5000 test lung. A total of 9240 breaths were recorded and analysed. Differences between inspiratory tidal volumes measured with near-patient and inbuilt spirometry were most significant in the newborn setting (p tidal volume measurements with near-patient spirometry were consistently more accurate than with inbuilt spirometry for all lung models (p tidal volumes decreased with increasing tidal volumes, and was smaller with near-patient than with inbuilt spirometry. The variability in measured tidal volumes was higher during expiration, especially with inbuilt spirometry. In conclusion, the present in-vitro study shows that measurements with near-patient spirometry are more accurate and less variable than with inbuilt spirometry. Differences between measurement methods were most significant in the smallest patients. We therefore recommend near-patient spirometry, especially for neonatal and paediatric patients. © 2018 The Association of Anaesthetists of Great Britain and Ireland.

Utility of an Algorithm to Increase the Accuracy of Medication History in an Obstetrical Setting.

Science.gov (United States)

Corbel, Aline; Baud, David; Chaouch, Aziz; Beney, Johnny; Csajka, Chantal; Panchaud, Alice

2016-01-01

In an obstetrical setting, inaccurate medication histories at hospital admission may result in failure to identify potentially harmful treatments for patients and/or their fetus(es). This prospective study was conducted to assess average concordance rates between (1) a medication list obtained with a one-page structured medication history algorithm developed for the obstetrical setting and (2) the medication list reported in medical records and obtained by open-ended questions based on standard procedures. Both lists were converted into concordance rate using a best possible medication history approach as the reference (information obtained by patients, prescribers and community pharmacists' interviews). The algorithm-based method obtained a higher average concordance rate than the standard method, with respectively 90.2% [CI95% 85.8-94.3] versus 24.6% [CI95%15.3-34.4] concordance rates (phistory in our obstetric population, without using substantial resources. Its implementation is an effective first step to the medication reconciliation process, which has been recognized as a very important component of patients' drug safety.

Accuracy of combined maxillary and mandibular repositioning and of soft tissue prediction in relation to maxillary antero-superior repositioning combined with mandibular set back A computerized cephalometric evaluation of the immediate postsurgical outcome using the TIOPS planning system

DEFF Research Database (Denmark)

Donatsky, Ole; Bjørn-Jørgensen, Jens; Hermund, Niels Ulrich

2009-01-01

surgical planning system (TIOPS). MATERIAL AND METHODS: Out of 100 prospectively and consecutively treated patients, 52 patients manifested dentofacial deformities requiring bimaxillary orthognathic surgery with maxillary antero-superior repositioning combined with mandibular set back and so were included......AIM: The purpose of the present study was to evaluate the immediate postsurgical outcome of planned and predicted hard and soft tissue positional changes in relation to maxillary antero-superior repositioning combined with mandibular set back using the computerized, cephalometric, orthognathic...... positional changes were transferred to model surgery on a three-dimensional articulator system (SAM) and finally to surgery. Five to six weeks after surgery, the actually obtained hard and soft tissue profile changes were cephalometricly assessed. RESULTS: The mean accuracy of the planned and predicted hard...

A reference dataset for deformable image registration spatial accuracy evaluation using the COPDgene study archive

International Nuclear Information System (INIS)

Castillo, Richard; Castillo, Edward; Wood, Abbie M; Ludwig, Michelle S; Guerrero, Thomas; Fuentes, David; Ahmad, Moiz

2013-01-01

Landmark point-pairs provide a strategy to assess deformable image registration (DIR) accuracy in terms of the spatial registration of the underlying anatomy depicted in medical images. In this study, we propose to augment a publicly available database (www.dir-lab.com) of medical images with large sets of manually identified anatomic feature pairs between breath-hold computed tomography (BH-CT) images for DIR spatial accuracy evaluation. Ten BH-CT image pairs were randomly selected from the COPDgene study cases. Each patient had received CT imaging of the entire thorax in the supine position at one-fourth dose normal expiration and maximum effort full dose inspiration. Using dedicated in-house software, an imaging expert manually identified large sets of anatomic feature pairs between images. Estimates of inter- and intra-observer spatial variation in feature localization were determined by repeat measurements of multiple observers over subsets of randomly selected features. 7298 anatomic landmark features were manually paired between the 10 sets of images. Quantity of feature pairs per case ranged from 447 to 1172. Average 3D Euclidean landmark displacements varied substantially among cases, ranging from 12.29 (SD: 6.39) to 30.90 (SD: 14.05) mm. Repeat registration of uniformly sampled subsets of 150 landmarks for each case yielded estimates of observer localization error, which ranged in average from 0.58 (SD: 0.87) to 1.06 (SD: 2.38) mm for each case. The additions to the online web database (www.dir-lab.com) described in this work will broaden the applicability of the reference data, providing a freely available common dataset for targeted critical evaluation of DIR spatial accuracy performance in multiple clinical settings. Estimates of observer variance in feature localization suggest consistent spatial accuracy for all observers across both four-dimensional CT and COPDgene patient cohorts. (paper)

Accuracy of nursing diagnosis "readiness for enhanced hope" in patients with chronic kidney disease.

Science.gov (United States)

Silva, Renan Alves; Melo, Geórgia Alcântara Alencar; Caetano, Joselany Áfio; Lopes, Marcos Venícios Oliveira; Butcher, Howard Karl; Silva, Viviane Martins da

2017-07-06

To analyse the accuracy of the nursing diagnosis readiness for enhanced hope in patients with chronic kidney disease. This is a cross-sectional study with 62 patients in the haemodialysis clinic conducted from August to November 2015. The Hearth Hope Scale was used to create definitions of the defining characteristics of the North American Nursing Diagnosis Association International. We analysed the measures of sensitivity, specificity, predictive value, likelihood ratio, and odds ratio of the defining characteristics of the diagnosis. Of the characteristics, 82.22% presented the diagnosis. The defining characteristics "Expresses the desire to enhance congruency of expectations with desires" and "Expresses the desire to enhance problem solving to meet goals" increased the chance of having the diagnosis by eleven and five, respectively. The characteristics, "Expresses desire to enhance congruency of expectations with desires" and "Expresses desire to enhance problem solving to meet goals" had good accuracy measures.

Evaluating the predictive accuracy and the clinical benefit of a nomogram aimed to predict survival in node-positive prostate cancer patients: External validation on a multi-institutional database.

Science.gov (United States)

Bianchi, Lorenzo; Schiavina, Riccardo; Borghesi, Marco; Bianchi, Federico Mineo; Briganti, Alberto; Carini, Marco; Terrone, Carlo; Mottrie, Alex; Gacci, Mauro; Gontero, Paolo; Imbimbo, Ciro; Marchioro, Giansilvio; Milanese, Giulio; Mirone, Vincenzo; Montorsi, Francesco; Morgia, Giuseppe; Novara, Giacomo; Porreca, Angelo; Volpe, Alessandro; Brunocilla, Eugenio

2018-04-06

To assess the predictive accuracy and the clinical value of a recent nomogram predicting cancer-specific mortality-free survival after surgery in pN1 prostate cancer patients through an external validation. We evaluated 518 prostate cancer patients treated with radical prostatectomy and pelvic lymph node dissection with evidence of nodal metastases at final pathology, at 10 tertiary centers. External validation was carried out using regression coefficients of the previously published nomogram. The performance characteristics of the model were assessed by quantifying predictive accuracy, according to the area under the curve in the receiver operating characteristic curve and model calibration. Furthermore, we systematically analyzed the specificity, sensitivity, positive predictive value and negative predictive value for each nomogram-derived probability cut-off. Finally, we implemented decision curve analysis, in order to quantify the nomogram's clinical value in routine practice. External validation showed inferior predictive accuracy as referred to in the internal validation (65.8% vs 83.3%, respectively). The discrimination (area under the curve) of the multivariable model was 66.7% (95% CI 60.1-73.0%) by testing with receiver operating characteristic curve analysis. The calibration plot showed an overestimation throughout the range of predicted cancer-specific mortality-free survival rates probabilities. However, in decision curve analysis, the nomogram's use showed a net benefit when compared with the scenarios of treating all patients or none. In an external setting, the nomogram showed inferior predictive accuracy and suboptimal calibration characteristics as compared to that reported in the original population. However, decision curve analysis showed a clinical net benefit, suggesting a clinical implication to correctly manage pN1 prostate cancer patients after surgery. © 2018 The Japanese Urological Association.