Assessment of patient dose in digital systems

The assessment of patient dose has gained increased attention, still being an issue of concern that arises from the use of digital systems. The development of digital technology offers the possibility for a reduction of radiation dose around 50% without loss in image quality when compared to a conventional screen–film system. Digital systems give an equivalent or superior diagnostic performance and also several other advantages, but the risk of overexposure with no adverse effect on image quality could be present. This chapter refers to the management of patient dose and provides an explanation of dose-related concepts. In this chapter, exposure influence in dose and image representation and the effects of radiation exposure are also discussed.

Desvio de posicionamento em radioterapia para patologias de cabeça e pescoço e próstata: revisão de literatura

Introdução – Numa era em que os tratamentos de Radioterapia Externa (RTE) exigem cada vez mais precisão, a utilização de imagem médica permitirá medir, quantificar e avaliar o impacto do erro provocado pela execução do tratamento ou pelos movimentos dos órgãos. Objetivo – Analisar os dados existentes na literatura acerca de desvios de posicionamento (DP) em patologias de cabeça e pescoço (CP) e próstata, medidos com Cone Beam Computed Tomography (CBCT) ou Electronic Portal Image Device (EPID). Metodologia – Para esta revisão da literatura foram pesquisados artigos recorrendo às bases de dados MEDLINE/PubMed e b-on. Foram incluídos artigos que reportassem DP em patologias CP e próstata medidos através de CBCT e EPID. Seguidamente foram aplicados critérios de validação, que permitiram a seleção dos estudos. Resultados – Após a análise de 35 artigos foram incluídos 13 estudos e validados 9 estudos. Para tumores CP, a média (μ) dos DP encontra-se entre 0,0 e 1,2mm, com um desvio padrão (σ) máximo de 1,3mm. Para patologias de próstata observa-se μDP compreendido entre 0,0 e 7,1mm, com σ máximo de 7,5mm. Discussão/Conclusão – Os DP em patologias CP são atribuídos, maioritariamente, aos efeitos secundários da RTE, como mucosite e dor, que afetam a deglutição e conduzem ao emagrecimento, contribuindo para a instabilidade da posição do doente durante o tratamento, aumentando as incertezas de posicionamento. Os movimentos da próstata devem-se principalmente às variações de preenchimento vesical, retal e gás intestinal. O desconhecimento dos DP afeta negativamente a precisão da RTE. É importante detetá-los e quantificá-los para calcular margens adequadas e a magnitude dos erros, aumentando a precisão da administração de RTE, incluindo o aumento da segurança do doente. - ABSTRACT - Background and Purpose – In an era where precision is an increasing necessity in external radiotherapy (RT), modern medical imaging techniques provide means for measuring, quantifying and evaluating the impact of treatment execution and movement error. The aim of this paper is to review the current literature on the quantification of setup deviations (SD) in patients with head and neck (H&N) or prostate tumors, using Cone Beam Computed Tomography (CBCT) or Electronic Portal Image Device (EPID). Methods – According to the study protocol, MEDLINE/PubMed and b-on databases were searched for trials, which were analyzed using selection criteria based on the quality of the articles. Results – After assessment of 35 papers, 13 studies were included in this analysis and nine were authenticated (6 for prostate and 3 for H&N tumors). The SD in the treatment of H&N cancer patients is in the interval of 0.1 to 1.2mm, whereas in prostate cancer this interval is 0.0 to 7.1mm. Discussion – The reproducibility of patient positioning is the biggest barrier for higher precision in RT, which is affected by geometrical uncertainty, positioning errors and inter or intra-fraction organ movement. There are random and systematic errors associated to patient positioning, introduced since the treatment planning phase or through physiological organ movement. Conclusion – The H&N SD are mostly assigned to the Radiotherapy adverse effects, like mucositis and pain, which affect swallowing and decrease secretions, contributing for the instability of patient positioning during RT treatment and increasing positioning uncertainties. Prostate motion is mainly related to the variation in bladder and rectal filling. Ignoring SD affects negatively the accuracy of RT. Therefore, detection and quantification of SD is crucial in order to calculate appropriate margins, the magnitude of error and to improve accuracy in RTE and patient safety.

Semiconductor Device as Optical Demultiplexer for Short Range Optical Communications

In this paper we present results on the use of a multilayered a-SiC:H heterostructure as a wavelength-division demultiplexing device for the visible light spectrum. The proposed device is composed of two stacked p-i-n photodiodes with intrinsic absorber regions adjusted to short and long wavelength absorption and carrier collection. An optoelectronic characterisation of the device was performed in the visible spectrum. Demonstration of the device functionality for WDM applications was done with three different input channels covering the long, the medium and the short wavelengths in the visible range. The recovery of the input channels is explained using the photocurrent spectral dependence on the applied voltage. An electrical model of the WDM device is proposed and supported by the solution of the respective circuit equations. Short range optical communications constitute the major application field, however other applications are also foreseen.

Exposure to dust in poultry: the importance of task differences for detailed exposure assessment

Dust is a complex mixture of particles of organic and inorganic origin and different gases absorbed in aerosol droplets. In a poultry unit include dried faecal matter and urine, skin flakes, ammonia, carbon dioxide, pollens, feed and litter particles, feathers, grain mites, fungi spores, bacteria, viruses and their constituents. Dust particles vary in size and differentiation between particle size fractions is important in health studies in order to quantify penetration within the respiratory system. A descriptive study was developed in order to assess exposure to particles in a poultry unit during different operations, namely routine examination and floor turn over. Direct-reading equipment was used (Lighthouse, model 3016 IAQ). Particle measurement was performed in 5 different sizes (PM0.5; PM1.0; PM2.5; PM5.0; PM10). The chemical composition of poultry litter was also determined by neutron activation analysis. Normally, the litter of poultry pavilions is turned over weekly and it was during this operation that the higher exposure of particles was observed. In all the tasks considered PM5.0 and PM10.0 were the sizes with higher concentrations values. PM10 is what turns out to have higher values and PM0.5 the lowest values. The chemical element with the highest concentration was Mg (5.7E6 mg.kg-1), followed by K (1.5E4 mg.kg-1), Ca (4.8E3 mg.kg-1), Na (1.7E3 mg.kg-1), Fe (2.1E2 mg.kg-1) and Zn (4.2E1 mg.kg-1). This high presence of particles in the respirable range (<5–7μm) means that poultry dust particles can penetrate into the gas exchange region of the lung. Larger particles (PM10) present a range of concentrations from 5.3E5 and 3.0E6 mg/m3.

A novel flow cytometric protocol for assessment of yeast cell adhesion

Microbial adhesion is a field of recognized relevance and, as such, an impressive array of tools has been developed to understand its molecular mechanisms and ultimately for its quantification. Some of the major limitations found within these methodologies concern the incubation time, the small number of cells analyzed, and the operator's subjectivity. To overcome these aspects, we have developed a quantitative method to measure yeast cells' adhesion through flow cytometry. In this methodology, a suspension of yeast cells is mixed with green fluorescent polystyrene microspheres (uncoated or coated with host proteins). Within 2 h, an adhesion profile is obtained based on two parameters: percentage and cells-microsphere population's distribution pattern. This flow cytometry protocol represents a useful tool to quantify yeast adhesion to different substrata in a large scale, providing manifold data in a speedy and informative manner.

Fungi, MVOCs and dust exposure assessment in poultry production

Agricultural workers especially poultry farmers, are at increased risk of occupational respiratory diseases. In poultry production besides fungi microbial volatile organic compounds (MVOCs) are also present due to compounds released during fungal metabolism. Dust is also one of the risk factors present in animal housing and is comprised by poultry residues, fungi and feathers. A study was developed aiming to assess occupational exposure to fungi, MVOCs and dust in seven poultry units located in Portugal.

Optoelectronic Digital Capture Device Based on Si/C Multilayer Heterostructures

Combined tunable WDM converters based on SiC multilayer photonic active filters are analyzed. The operation combines the properties of active long-pass and short-pass wavelength filter sections into a capacitive active band-pass filter. The sensor element is a multilayered heterostructure produced by PE-CVD. The configuration includes two stacked SiC p-i-n structures sandwiched between two transparent contacts. Transfer function characteristics are studied both theoretically and experimentally. Results show that optical bias activated photonic device combines the demultiplexing operation with the simultaneous photodetection and self amplification of an optical signal acting the device as an integrated photonic filter in the visible range. Depending on the wavelength of the external background and irradiation side, the device acts either as a short- or a long-pass band filter or as a band-stop filter. The output waveform presents a nonlinear amplitude-dependent response to the wavelengths of the input channels. A numerical simulation and two building-blocks active circuit is presented and gives insight into the physics of the device.

Assessment of saccharide fractionation by ultrafiltration and nanofiltration

This paper addresses the investigation of the fractionation of saccharide mixtures and saccharide mixtures with calcium using ultrafiltration (UF) and nanofiltration (NF). A set of cellulose acetate membranes covered a wide range of molecular weight cut-off (MWCO) ranging from 250 to 46,000 Da and the total feed concentration of saccharides mixtures varied from 1550 to 4700 ppm with the ratio of the two saccharides-solutes (glucose to raffinose) being kept constant at the value of 1.8. The evolution pattern of the saccharide concentration ratio in the UF/NF permeate streams displayed a dependence on the membrane MWCO, on the total sugar concentration and on the presence of calcium ions. For the highest total sugar content, the membranes with MWCO from 2000 to 7000 Da showed saccharide fractionation capability that was enhanced in the presence of calcium. The Steric Pore Flow Model was used to predict individual solute permeation behaviours and to assess the deviations to steric hindered transport of the solutes in multi-component saccharide solutions. (C) 2008 Elsevier B.V. All rights reserved.

Cork industry wastewater characterization assessment of the biodegradability, reuse and of the relationship between BOD, COD and tannins with TOC

Cork processing involves a boiling step to make the cork softer, which consumes a high volume of water and generates a wastewater with a high organic content, rich in tannins. An assessment of the final wastewater characteristics and of the boiling water composition along the boiling process was performed. The parameters studied were pH, color, total organic carbon (TOC), chemical and biochemical oxygen demands (COD, BOD5, BOD20), total suspended solids (TSS), total phenols and tannins (TP, TT). It was observed that the water solutes extraction power is significantly reduced for higher quantities of cork processed. Valid relationships between parameters were established not only envisaging wastewater characterization but also to provide an important tool for wastewater monitoring and for process control/optimization. Boiling water biodegradability presented decreasing values with the increase of cork processed and for the final wastewater its value is always lower than 0.5, indicating that these wastewaters are very difficult to treat by biological processes. The biodegradability was associated with the increase of tannin content that can rise up to 0.7 g/L. These compounds can be used by other industries when concentrated and the clarified wastewater can be reused, which is a potential asset in this wastewater treatment.

Detection of FRET signals with a wavelength sensitive device based on a-SiC:H

Glucose sensing is an issue with great interest in medical and biological applications. One possible approach to glucose detection takes advantage of measuring changes in fluorescence resonance energy transfer (FRET) between a fluorescent donor and an acceptor within a protein which undergoes glucose-induced changes in conformation. This demands the detection of fluorescent signals in the visible spectrum. In this paper we analyzed the emission spectrum obtained from fluorescent labels attached to a protein which changes its conformation in the presence of glucose using a commercial spectrofluorometer. Different glucose nanosensors were used to measure the output spectra with fluorescent signals located at the cyan and yellow bands of the spectrum. A new device is presented based on multilayered a-SiC:H heterostructures to detect identical transient visible signals. The transducer consists of a p-i'(a-SiC:H)-n/p-i(a-Si:H)-n heterostructure optimized for the detection of the fluorescence resonance energy transfer between fluorophores with excitation in the violet (400 nm) and emissions in the cyan (470 nm) and yellow (588 nm) range of the spectrum. Results show that the device photocurrent signal measured under reverse bias and using appropriate steady state optical bias, allows the separate detection of the cyan and yellow fluorescence signals. (C) 2013 Elsevier B.V. All rights reserved.

Exposure and genotoxicity assessment methodologies: the case of formaldehyde occupational exposure

Formaldehyde (FA) ranks 25th in the overall U.S. chemical production, with more than 5 million tons produced each year. Given its economic importance and widespread use, many people are exposed to FA occupationally. Recently, based on the correlation with nasopharyngeal cancer in humans, the International Agency for Research on Cancer (IARC) confirmed the classification of FA as a Group I substance. Considering the epidemiological evidence of a potential association with leukemia, the IARC has concluded that FA can cause this lymphoproliferative disorder. Our group has developed a method to assess the exposure and genotoxicity effects of FA in two different occupational settings, namely FAbased resins production and pathology and anatomy laboratories. For exposure assessment we applied simultaneously two different techniques of air monitoring: NIOSH Method 2541 and Photo Ionization Detection Equipment with simultaneously video recording. Genotoxicity effects were measured by cytokinesis-blocked micronucleus assay in peripheral blood lymphocytes and by micronucleus test in exfoliated oral cavity epithelial cells, both considered target cells. The two exposure assessment techniques show that in the two occupational settings peak exposures are still occurring. There was a statistical significant increase in the micronucleus mean of epithelial cells and peripheral lymphocytes of exposed individuals compared with controls. In conclusion, the exposure and genotoxicity effects assessment methodologies developed by us allowed to determine that these two occupational settings promote exposure to high peak FA concentrations and an increase in the micronucleus mean of exposed workers. Moreover, the developed techniques showed promising results and could be used to confirm and extend the results obtained by the analytical techniques currently available.

Optical demultiplexer based on an a-SiC:H voltage controlled device

In this paper we present results on the use of a semiconductor heterostructure based on a-SiC:H as a wavelength-division demultiplexer for the visible light spectrum. The proposed device is composed of two stacked p-i-n photodiodes with intrinsic absorber regions adjusted to short and long wavelength absorption and carrier collection. An optoelectronic characterisation of the device was performed in the visible spectrum. Demonstration of the device functionality for WDM applications was done with three different input channels covering the long, the medium and the short wavelengths in the visible range. The recovery of the input channels is explained using the photocurrent spectral dependence on the applied voltage. An electrical model of the WDM device is proposed and supported by the solution of the respective circuit equations. Short range optical communications constitute the major application field however other applications are foreseen. (C) 2010 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Direct Color Sensor, Optical Amplifier and Demux Device Integrated on a Single Monolithic SiC Photodetector

A pi'n/pin a-SiC:H voltage and optical bias controlled device is presented and its behavior as image and color sensor, optical amplifier and demux device is discussed. The design and the light source properties are correlated with the sensor output characteristics. Different readout techniques are used. When a low power monochromatic scanner readout the generated carriers the transducer recognizes a color pattern projected on it acting as a direct color and image sensor. Scan speeds up to 10(4) lines per second are achieved without degradation in the resolution. If the photocurrent generated by different monochromatic pulsed channels is readout directly, the information is demultiplexed. Results show that it is possible to decode the information from three simultaneous color channels without bit errors at bit rates per channel higher than 4000 bps. Finally, when triggered by light of appropriated wavelength, it can amplify or suppress the generated photocurrent working as an optical amplifier (C) 2009 Published by Elsevier Ltd.

Assessment of nursing students and nurses' orientation towards patient-centeredness

Background - Being patient centered is a core value for nursing. Patient centered-care has been related to patient and health provider satisfaction, better health outcomes, higher quality of care and more efficient health care delivery. Objectives - The purpose was to assess the orientation adopted by nurses and students in patient care, using The Patient-Practitioner Orientation Scale, as well as to compare the results between resident nurses and students from different academic years. Settings - Public School of Nursing and a Central Hospital, in Lisbon (Portugal). Participants - Students in the first, second and fourth year of nursing school and nurses participated in the study. Methods - For data collection, we used The Patient-Practitioner Orientation Scale (European Portuguese version), an instrument designed to measure individual preferences toward the dimension of caring a sharing in health professional-patient relationship. Students and nurses also filled out two additional questions about their perception of competence in technical and communication skills. Additional demographic information was also collected, including gender, age, academic year and length of professional experience. Results - A total of 525 students (84.7% female) and 108 nurses (77.8% female) participated in this study. In general, caring sub-scores, measuring the preference of about attending to patient emotional aspects, were higher than sharing sub-scores, measuring beliefs about giving information and perceiving patient as a member of the health team. Students were significantly more patient-centered throughout their nursing education (p<0.001). Comparing to students in the second and fourth academic years (p<0.001) nurses' scores were significantly lower both in total PPOS and in caring and sharing subscales. Conclusions - These results reinforce the idea that patient centeredness may be developed in academic context. The scores obtained highlight the importance of studies that aim to identify factors that may explain the decrease of patient centeredness in professional practice.

Complementarity of conventional and molecular methods in the assessment of fungal contamination caused by Aspergillus fumigatus complex in one Portuguese composting plant

The handling of waste and compost that occurs frequently in composting plants (compost turning, shredding, and screening) has been shown to be responsible for the release of dust and air borne microorganisms and their compounds in the air. Thermophilic fungi, such as A. fumigatus, have been reported and this kind of contamination in composting facilities has been associated with increased respiratory symptoms among compost workers. This study intended to characterize fungal contamination in a totally indoor composting plant located in Portugal. Besides conventional methods, molecular biology was also applied to overcome eventual limitations.