Optimization of image quality and dose for Varian aS500 electronic portal imaging devices (EPIDs)

This study was carried out to investigate whether the electronic portal imaging (EPI) acquisition process could be optimized, and as a result tolerance and action levels be set for the PIPSPro QC-3V phantom image quality assessment. The aim of the optimization process was to reduce the dose delivered to the patient while maintaining a clinically acceptable image quality. This is of interest when images are acquired in addition to the planned patient treatment, rather than images being acquired using the treatment field during a patient's treatment. A series of phantoms were used to assess image quality for different acquisition settings relative to the baseline values obtained following acceptance testing. Eight Varian aS500 EPID systems on four matched Varian 600C/D linacs and four matched Varian 2100C/D linacs were compared for consistency of performance and images were acquired at the four main orthogonal gantry angles. Images were acquired using a 6 MV beam operating at 100 MU min(-1) and the low-dose acquisition mode. Doses used in the comparison were measured using a Farmer ionization chamber placed at d(max) in solid water. The results demonstrated that the number of reset frames did not have any influence on the image contrast, but the number of frame averages did. The expected increase in noise with corresponding decrease in contrast was also observed when reducing the number of frame averages. The optimal settings for the low-dose acquisition mode with respect to image quality and dose were found to be one reset frame and three frame averages. All patients at the Northern Ireland Cancer Centre are now imaged using one reset frame and three frame averages in the 6 MV 100 MU min(-1) low-dose acquisition mode. Routine EPID QC contrast tolerance (+/-10) and action (+/-20) levels using the PIPSPro phantom based around expected values of 190 (Varian 600C/D) and 225 (Varian 2100C/D) have been introduced. The dose at dmax from electronic portal imaging has been reduced by approximately 28%, and while the image quality has been reduced, the images produced are still clinically acceptable.

Risk assessment of patient handling with ambulance stretcher systems (ramp/(winch), easi-loader, tail-lift) using biomechanical failure criteria

The research aims to carry out a detailed analysis of the loads applied by the ambulance workers when loading/unloading ambulance stretchers. The forces required of the ambulance workers for each system are measured using a load cell in a force handle arrangement. The process of loading and unloading is video recorded for all the systems to register the posture of the ambulance workers in different stages of the process. The postures and forces exerted by the ambulance workers are analyzed using biomechanical assessment software to examine if the work loads at any stage of the process are harmful. Kinetic analysis of each stretcher loading system is performed. Comparison of the kinetic analysis and measurements shows very close agreement for most of the cases. The force analysis results are evaluated against derived failure criteria. The evaluation is extended to a biomechanical failure analysis of the ambulance worker's lower back using 3DSSPP software developed at the Centre for Ergonomics at the University of Michigan. The critical tasks of each ambulance worker during the loading and unloading operations for each system are identified. Design recommendations are made to reduce the forces exerted based on loading requirements from the kinetic analysis. © 2006 IPEM.

Evaluation of cement stresses in finite element analyses of cemented orthopaedic implants

Stress analysis of the cement fixation of orthopaedic implants to bone is frequently? carried out using finite element analysis. However, the stress distribution in the cement laver is usually intricate, and it is difficult to report it in a way that facilitates comparison of implants for pre-clinical testing. To study this problem, and make recommendations for stress reporting, a finite element analysis of a hip prosthesis implanted into a synthetic composite femur is developed. Three cases are analyzed: a fully bonded implant, a debonded implant, and a debonded implant where the cement is removed distal to the stein tip. In addition to peak stresses, and contour and vector plots, a stressed volume and probability-of-failure analysis is reported. It is predicted that the peak stress is highest for the debonded stem, and that removal of the distal cement more than halves this peak stress. This would suggest that omission of the distal cement is good for polished prostheses (as practiced for the Exeter design). However; if the percentage of cement stressed above a certain threshold (say 3 MPa) is considered, then the removal of distal cement is shown to be disadvantageous because a higher volume of cement is stressed to above the threshold. Vector plots clearly demonstrate the different load transfer for bonded and debonded prostheses: A bonded stein generates maximum tensile stresses in the longitudinal direction, whereas a debonded stem generates most tensile stresses in the hoop direction, except near the tip where tensile longitudinal stresses occur due to subsidence of the stein. Removal of the cement distal to the tip allows greater subsidence but alleviates these large stresses at the tip, albeit at the expense of increased hoop stresses throughout the mantle. It is concluded that a thorough analysis of cemented implants should not report peak stress, which can be misleading, but rather stressed volume, and that vector plots should be reported if a precise analysis of the load transfer mechanism is required.

Cantilever steel post damaged by wind

An analysis for the cause of fracture failure of a cantilever steel sign post damaged by wind has been carried out. An unusual cause of failure has been identified, which is the subject of this paper. Microscopy and microanalysis of the fracture surface showed that the failure was due to pre-existing cracks, from the fabrication of the post. This conclusion was reached after detecting and analysing a galvanised layer on the fracture surfaces.

The experience of individuals with renal failure participating in home haemodialysis: An interpretative phenomenological analysis.

This study explored the experience of individuals with renal failure undertaking home haemodialysis (HHD). Semi-structured interviews were conducted with six participants who were active HHD users in a UK region. Participants’ accounts were transcribed verbatim and analysed using an interpretative phenomenological approach. Three main themes were identified: (1) embracing treatment and lifestyle freedom and flexibility; (2) re-establishing a sense of self and preferred self-identity; and (3) integrating aspects of active engagement and aspects of supported, life-sustaining dependence. A ‘good fit’ between the HHD user (an independent, self-determined health participant) and the healthcare provision (personalized, enabling) is proposed.

A probabilistic modelling scheme for analysis of long-term failure of cemented femoral joint replacements

Reliable prediction of long-term medical device performance using computer simulation requires consideration of variability in surgical procedure, as well as patient-specific factors. However, even deterministic simulation of long-term failure processes for such devices is time and resource consuming so that including variability can lead to excessive time to achieve useful predictions. This study investigates the use of an accelerated probabilistic framework for predicting the likely performance envelope of a device and applies it to femoral prosthesis loosening in cemented hip arthroplasty.
A creep and fatigue damage failure model for bone cement, in conjunction with an interfacial fatigue model for the implant–cement interface, was used to simulate loosening of a prosthesis within a cement mantle. A deterministic set of trial simulations was used to account for variability of a set of surgical and patient factors, and a response surface method was used to perform and accelerate a Monte Carlo simulation to achieve an estimate of the likely range of prosthesis loosening. The proposed framework was used to conceptually investigate the influence of prosthesis selection and surgical placement on prosthesis migration.
Results demonstrate that the response surface method is capable of dramatically reducing the time to achieve convergence in mean and variance of predicted response variables. A critical requirement for realistic predictions is the size and quality of the initial training dataset used to generate the response surface and further work is required to determine the recommendations for a minimum number of initial trials. Results of this conceptual application predicted that loosening was sensitive to the implant size and femoral width. Furthermore, different rankings of implant performance were predicted when only individual simulations (e.g. an average condition) were used to rank implants, compared with when stochastic simulations were used. In conclusion, the proposed framework provides a viable approach to predicting realistic ranges of loosening behaviour for orthopaedic implants in reduced timeframes compared with conventional Monte Carlo simulations.

Numerical analysis of intralaminar failure mechanisms in composite structures, Part I: FE implementation

This paper presents a three-dimensional continuum damage mechanics-based material model which was implemented in an implicit finite element code to simulate the progressive intralaminar degradation of fibre reinforced laminates. The damage model is based on ply failure mechanisms and uses seven damage variables assigned to tensile, compressive and shear damage at a ply level. Non-linear behaviour and irreversibility were taken into account and modelled. Some issues on the numerical implementation of the damage model are discussed and solutions proposed. Applications of the methodology are presented in Part II

Numerical analysis of intralaminar failure mechanisms in composite structures, Part II: Applications

A three-dimensional continuum damage mechanics-based material model was implemented in an implicit Finite Element code to simulate the progressive intralaminar degradation of fibre reinforced laminates based on ply failure mechanisms. This paper presents some structural applications of the progressive failure model implemented. The focus is on the non-linear response of the shear failure mode and its interaction with other failure modes. Structural applications of the damage model show that the proposed model is able to reproduce failure loads and patterns observed experimentally.

Micro-mechanical analysis of bonding failure in a particle-filled composite

Composites with a weak interface between the filler and matrix which are susceptible to interfacial crack formation are studied. A finite-element model is developed to predict the stres/strain behavior of particulate composites with an interfacial crack. This condition can be distinguished as a partially bonded inclusion. Another case arises when there is no bonding between the inclusion and the matrix. In this latter case the slip boundary condition is imposed on the section of the interface which remains closed. The states of stress and displacement fields are obtained for both cases. The location of any further deformation through crazing or shear band formation is identified as the crack tip. A completely unbonded inclusion with partial slip at a section of the interface reduces the concentration of the stress at the crack tip. Whereas this might lead to slightly higher strength, it decreases the load-transfer efficiency and stiffness of this type of composite. © 2002 Elsevier Science Ltd. All rights reserved.

Prediction of failure and fracture mechanisms of polymeric composites using finite element analysis. Part 1:Particulate filled composites

Micro-mechanical analysis of polymeric composites provides a powerful means for the quantitative assessment of their bulk behavior. In this paper we describe a robust finite element model (FEM) for the micro-structural modeling of the behavior of particulate filled polymer composites under external loads. The developed model is applied to simulate stress distribution in polymer composites containing particulate fillers. Quantitative information about the magnitude and location of maximum stress concentrations obtained from these simulations is used to predict the dominant failure and crack growth mechanisms in these composites. The model predictions are compared with the available experimental data and also with the values found using other methods reported in the literature. These comparisons show the range of the validity of the developed model and its predictive potential.

Prediction of failure and fracture mechanisms of polymeric composites using finite element analysis. Part 2:Fiber reinforced composites

A robust finite element scheme for the micro-mechanical modeling of the behavior of fiber reinforced polymeric composites under external loads is developed. The developed model is used to simulate stress distribution throughout the composite domain and to identify the locations where maximum stress concentrations occur. This information is used as a guide to predict dominant failure and crack growth mechanisms in fiber reinforced composites. The differences between continuous fibers, which are susceptible to unidirectional transverse fracture, and short fibers have been demonstrated. To assess the validity and range of applicability of the developed scheme, numerical results obtained by the model are compared with the available experimental data and also with the values found using other methods reported in the literature. These comparisons show that the present finite element scheme can generate meaningful results in the analysis of fiber reinforced composites.