Op verzoek van Jelle Scheurleer: Purpose: To investigate the accuracy of dose calculation on cone beam CT (CBCT) data sets after HU-RED calibration and validation in phantom studies and clinical patients. Material and methods: Calibration of HU-RED curves for kV-CBCT were generated for three clinical protocols (H&N, thorax and pelvis) by using a Gammex RMI phantom with human tissue equivalent inserts and additional perspex blocks to account for patient scatter. Two calibration curves per clinical protocol were defined, one for the Varian Truebeam 2.0 and another for the OBI systems (Varian, Palo Ato). Differences in HU values with respect to the CT-calibration curve were evaluated for all the inserts. Four radiotherapy plans (breast, prostate, H&N and lung) were produced on an anthropomorphic phantom (Alderson) to evaluate dose differences on the kV-CBCT with the new calibration curves with respect to the CT based dose calculation. Dose differences were evaluated according to the D2%, D98% and Dmean metrics extracted from the DVHs of the plans and - evaluation (2%, 1mm) on the three planes at the isocenter for all plans. Clinical evaluation was performed on 5 patients and dose differences were evaluated as in the phantom study.
DOCUMENT
Purpose: Resuscitation quality and pace depend on effective team coordination, which can be facilitated by adequate leadership. Our primary aim was to assess the influence of trauma team leader experience on resuscitation pace. Second, we investigated the influence of injury severity on resuscitation pace. Methods: The trauma team leaders were identified (Staff trauma surgeon vs Fellow trauma surgeon) and classified from video analysis during a 1-week period. Resuscitations were assessed for time to the treatment plan, total resuscitation time, and procedure time. Furthermore, patient and resuscitation characteristics were assessed and compared: age, gender, Injury Severity Score, Glasgow Coma Scale < 9, and the number (and duration) of surgical procedures during initial resuscitation. Correlations between total resuscitation time, Injury Severity Score, and time to treatment plan were calculated. Results: After adjustment for the time needed for procedures, the time to treatment plan and total resuscitation time was significantly shorter in resuscitations led by a Staff trauma surgeon compared to a Fellow trauma surgeon (median 648 s (IQR 472-813) vs 852 s (IQR 694-1256); p 0.01 resp. median 1280 s (IQR 979-1494) vs 1535 s (IQR 1247-1864), p 0.04). Surgical procedures were only performed during resuscitations led by Staff trauma surgeons (4 thorax drains, 1 endotracheal intubation, 1 closed fracture reduction). Moreover, a significant negative correlation (r: - 0.698, p < 0.01) between Injury Severity Score and resuscitation time was found. Conclusion: Experienced trauma team leaders may positively influence the pace of the resuscitation. Moreover, we found that the resuscitation pace increases when the patient is more severely injured.
LINK
In 2014 heeft Hogeschool Inholland samen met het RIVM voor het Ministerie van Volksgezondheid, Welzijn en Sport een pilotproject uitgevoerd. In dit project hebben studenten Medische Beeldvormende en Radiotherapeutische Technieken dosismetingen uitgevoerd bij 8 ziekenhuizen en deze getoetst aan de Diagnostische Referentieniveaus (DRN’s). In alle gevallen bleken de toetsingswaarden lager dan het DRN en in de meeste gevallen ook lager dan de streefwaarde. De verschillen in doses tussen de ziekenhuizen waren maximaal een factor 2-3. Opvallend genoeg werden in een enkel geval soortgelijke verschillen binnen 1 ziekenhuis aangetroffen. In 2015 wordt dit project uitgebreid en gaan de Fontys Hogeschool en de Hanzehogeschool meedoen.
DOCUMENT
Daily wheelchair ambulation is seen as a risk factor for shoulder problems, which are prevalent in manual wheelchair users. To examine the long-term effect of shoulder load from daily wheelchair ambulation on shoulder problems, quantification is required in real-life settings. In this study, we describe and validate a comprehensive and unobtrusive methodology to derive clinically relevant wheelchair mobility metrics (WCMMs) from inertial measurement systems (IMUs) placed on the wheelchair frame and wheel in real-life settings. The set of WCMMs includes distance covered by the wheelchair, linear velocity of the wheelchair, number and duration of pushes, number and magnitude of turns and inclination of the wheelchair when on a slope. Data are collected from ten able-bodied participants, trained in wheelchair-related activities, who followed a 40 min course over the campus. The IMU-derived WCMMs are validated against accepted reference methods such as Smartwheel and video analysis. Intraclass correlation (ICC) is applied to test the reliability of the IMU method. IMU-derived push duration appeared to be less comparable with Smartwheel estimates, as it measures the effect of all energy applied to the wheelchair (including thorax and upper extremity movements), whereas the Smartwheel only measures forces and torques applied by the hand at the rim. All other WCMMs can be reliably estimated from real-life IMU data, with small errors and high ICCs, which opens the way to further examine real-life behavior in wheelchair ambulation with respect to shoulder loading. Moreover, WCMMs can be applied to other applications, including health tracking for individual interest or in therapy settings.
DOCUMENT
Samenvatting: In het kader van een afstudeerproject zijn data van 33 kinderen verzameld die een X-abdomen onderzoek ondergingen in het Wilhelmina Kinderziekenhuis. Uit deze data zijn curves afgeleid van Dosis Oppervlakte Product (DOP) ten opzichte van het lichaamsgewicht om te dienen als Diagnostisch ReferentieNiveau (DRN). De spreiding in de data leidt echter tot onzekerheid over de beste DRN-curve. Die curve is bovendien slechts gebaseerd op de data van één ziekenhuis en is daarmee hooguit bruikbaar als lokaal DRN. Door deze studie te herhalen in andere ziekenhuizen en meer data te verzamelen zou een nationale DRN-curve afgeleid kunnen worden. Zo’n curve zou de toetsing van doses aan DRN’s voor kinderen vergemakkelijken.
DOCUMENT
In 2015 hebben studenten Medische Beeldvormende en Radiotherapeutische Technieken (MBRT) van Hogeschool Inholland, de Hanzehogeschool en de Fontys Paramedische Hogeschool dosismetingen uitgevoerd bij 21 ziekenhuizen en deze getoetst aan de Diagnostische Referentieniveaus (DRN’s) en vergeleken met de streefwaarden. Het project werd uitgevoerd in opdracht van het RIVM en gefinancierd door het Ministerie van Volksgezondheid, Welzijn en Sport. Uit de toetsingen blijkt dat de DRN’s voor de röntgenopnamen bij volwassenen (X thorax, X bekken, CAG en mammografie) zelden worden overschreden en dat de streefwaarden vaak worden gehaald. Sterker nog, de 75-percentielwaarden van de gevonden waarden geven aanleiding sommige DRN’s te verlagen tot de streefwaarde. Bij de CT verrichtingen komen iets vaker overschrijdingen van streefwaarden en DRN’s voor, m.n. bij CT pulmonale angiografie (CTPA) en CT abdomen.
DOCUMENT
Diagnostic reference levels (DRLs) for medical x-ray procedures are being implemented currently in the Netherlands. By order of the Dutch Healthcare Inspectorate, a survey has been conducted among 20 Dutch hospitals to investigate the level of implementation of the Dutch DRLs in current radiological practice. It turns out that hospitals are either well underway in implementing the DRLs or have already done so. However, the DRLs have usually not yet been incorporated in the QAsystem of the department nor in the treatment protocols. It was shown that the amount of radiation used, as far as it was indicated by the hospitals, usually remains below the DRLs. A procedure for comparing dose levels to the DRLs has been prescribed but is not Always followed in practice. This is especially difficult in the case of children, as most general hospitals receive few children. Health Phys. 108(4):462–464; 2015
DOCUMENT
Samenvatting Achtergrond: Een integrale behandeling inclusief zelfmanagement bij chronisch obstructieve longziekte (COPD) leidt tot betere klinische resultaten. eHealth kan zorgen voor meer betrokkenheid bij patiënten waardoor ze in staat zijn een gezondere levensstijl aan te nemen en vast te houden. Desondanks is er geen eenduidig bewijs van de impact van eHealth op de kwaliteit van leven (quality of life (QoL)). Doel: Het primaire doel van de e-Vita COPD-studie was om te onderzoeken wat de effecten zijn van het gebruik van eeneHealth-platform voor patiënten op de verschillende domeinen van ziektespecifieke kwaliteit van leven van COPD-patiënten (CCQ). Methoden: We hebben de impact beoordeeld van het gebruik van een eHealth-platform op de klinische COPD-vragenlijst (CCQ). Deze vragenlijst omvatte subschalen van symptomen, functionele en mentale toestand. Een design met onderbroken tijdreeksen (interrupted time series (ITS)) is gebruikt om CCQ-gegevens op verschillende tijdstippen te verzamelen. Er is gebruik gemaakt van multilevel lineaire regressieanalyse om de CCQ-trends vóór en na de interventie te vergelijken. Resultaten: Van de 742 uitgenodigde COPD-patiënten hebben er 244 het document voor ‘informed consent’ ondertekend. In de analyses hebben we uitsluitend patiënten opgenomen die daadwerkelijk gebruik hebben gemaakt van het eHealthplatform (n=123). De afname van CCQ-symptomen was 0,20% vóór de interventie en 0,27% na de interventie; dit was een statistisch significant verschil (P=0,027). De daling van CCQ-mentale toestand was 0,97% vóór de interventie en na de interventie was er sprake van een stijging van 0,017%; dit verschil was statistisch significant (P=0,01). Er werd geen significant verschil vastgesteld in het verloop van CCQ (P=0,12) en CCQ-functionele toestand (P=0,11) vóór en na de interventie. Conclusie: Het e-Vita eHealth-platform had een gunstig effect op de CCQ-symptomen van COPD-patiënten, maar niet op de functionele status. De CCQ-mentale toestand bleef stabiel na de interventie, maar dit was een verslechtering in vergelijking met de verbeterende situatie voorafgaand aan de start van het eHealth-platform. Deze studie laat dus zien dat patiënten na de introductie van het COPD-platform minder symptomen ervaarden, maar dat hun mentale toestand tegelijkertijd licht verslechterde. Zorgprofessionals moeten zich ervan bewust zijn dat, ondanks de verbetering van symptomen, er een lichte toename van angst en depressie kan optreden na invoering van een eHealth-interventie.
DOCUMENT
The thoracic and peritoneal cavities are lined by serous membranes and are home of the serosal immune system. This immune system fuses innate and adaptive immunity, to maintain local homeostasis and repair local tissue damage, and to cooperate closely with the mucosal immune system. Innate lymphoid cells (ILCs) are found abundantly in the thoracic and peritoneal cavities, and they are crucial in first defense against pathogenic viruses and bacteria. Nanomaterials (NMs) can enter the cavities intentionally for medical purposes, or unintentionally following environmental exposure; subsequent serosal inflammation and cancer (mesothelioma) has gained significant interest. However, reports on adverse effects of NMon ILCs and other components of the serosal immune systemare scarce or even lacking. As ILCs are crucial in the first defense against pathogenic viruses and bacteria, it is possible that serosal exposure to NMmay lead to a reduced resistance against pathogens. Additionally, affected serosal lymphoid tissues and cells may disturb adipose tissue homeostasis. This review aims to provide insight into key effects of NMon the serosal immune system.
DOCUMENT
Literature highlights the need for research on changes in lumbar movement patterns, as potential mechanisms underlying the persistence of low-back pain. Variability and local dynamic stability are frequently used to characterize movement patterns. In view of a lack of information on reliability of these measures, we determined their within- and between-session reliability in repeated seated reaching. Thirty-six participants (21 healthy, 15 LBP) executed three trials of repeated seated reaching on two days. An optical motion capture system recorded positions of cluster markers, located on the spinous processes of S1 and T8. Movement patterns were characterized by the spatial variability (meanSD) of the lumbar Euler angles: flexion–extension, lateral bending, axial rotation, temporal variability (CyclSD) and local dynamic stability (LDE). Reliability was evaluated using intraclass correlation coefficients (ICC), coefficients of variation (CV) and Bland-Altman plots. Sufficient reliability was defined as an ICC ≥ 0.5 and a CV < 20%. To determine the effect of number of repetitions on reliability, analyses were performed for the first 10, 20, 30, and 40 repetitions of each time series. MeanSD, CyclSD, and the LDE had moderate within-session reliability; meanSD: ICC = 0.60–0.73 (CV = 14–17%); CyclSD: ICC = 0.68 (CV = 17%); LDE: ICC = 0.62 (CV = 5%). Between-session reliability was somewhat lower; meanSD: ICC = 0.44–0.73 (CV = 17–19%); CyclSD: ICC = 0.45–0.56 (CV = 19–22%); LDE: ICC = 0.25–0.54 (CV = 5–6%). MeanSD, CyclSD and the LDE are sufficiently reliable to assess lumbar movement patterns in single-session experiments, and at best sufficiently reliable in multi-session experiments. Within-session, a plateau in reliability appears to be reached at 40 repetitions for meanSD (flexion–extension), meanSD (axial-rotation) and CyclSD.
MULTIFILE
