Performance evaluation of detectors for digital radiography

To date the hospital radiological workflow is completing a transition from analog to digital technology. Since the X-rays digital detection technologies have become mature, hospitals are trading on the natural devices turnover to replace the conventional screen film devices with digital ones. The transition process is complex and involves not just the equipment replacement but also new arrangements for image transmission, display (and reporting) and storage. This work is focused on 2D digital detector’s characterization with a concern to specific clinical application; the systems features linked to the image quality are analyzed to assess the clinical performances, the conversion efficiency, and the minimum dose necessary to get an acceptable image. The first section overviews the digital detector technologies focusing on the recent and promising technological developments. The second section contains a description of the characterization methods considered in this thesis categorized in physical, psychophysical and clinical; theory, models and procedures are described as well. The third section contains a set of characterizations performed on new equipments that appears to be some of the most advanced technologies available to date. The fourth section deals with some procedures and schemes employed for quality assurance programs.

Temporary teams learning and performance: the case of 3D printing technology in orthopaedic surgery

This dissertation contributes to the scholarly debate on temporary teams by exploring team interactions and boundaries.The fundamental challenge in temporary teams originates from temporary participation in the teams. First, as participants join the team for a short period of time, there is not enough time to build trust, share understanding, and have effective interactions. Consequently, team outputs and practices built on team interactions become vulnerable. Secondly, as team participants move on and off the teams, teams’ boundaries become blurred over time. It leads to uncertainty among team participants and leaders about who is/is not identified as a team member causing collective disagreement within the team. Focusing on the above mentioned challenges, we conducted this research in healthcare organisations since the use of temporary teams in healthcare and hospital setting is prevalent. In particular, we focused on orthopaedic teams that provide personalised treatments for patients using 3D printing technology. Qualitative and quantitative data were collected using interviews, observations, questionnaires and archival data at Rizzoli Orthopaedic Institute, Bologna, Italy. This study provides the following research outputs. The first is a conceptual study that explores temporary teams’ literature using bibliometric analysis and systematic literature review to highlight research gaps. The second paper qualitatively studies temporary relationships within the teams by collecting data using group interviews and observations. The results highlighted the role of short-term dyadic relationships as a ground to share and transfer knowledge at the team level. Moreover, hierarchical structure of the teams facilitates knowledge sharing by supporting dyadic relationships within and beyond the team meetings. The third paper investigates impact of blurred boundaries on temporary teams’ performance. Using quantitative data collected through questionnaires and archival data, we concluded that boundary blurring in terms of fluidity, overlap and dispersion differently impacts team performance at high and low levels of task complexity.

Trattamento transcatetere e chirurgico della stenosi valvolare aortica severa in Hesperia Hospital Modena nella seconda decade del ventunesimo secolo

Scopo Confrontare il trattamento transcatetere (TAVI) balloon-expandable con il trattamento chirurgico di sostituzione valvolare aortica (AVR) della stenosi valvolare aortica severa (SVAS) nella pratica clinica real world. Materiali e metodi Nel decennio 2010-2020, 1486 pazienti con SVAS isolata sono stati sottoposti a AVR (n=1049) o TAVI balloon-expandable (n=437) presso Hesperia Hospital Modena. Sono stati analizzati la Mortality nell’intera popolazione e gli episodi di ricovero cardiovascolare nei 5 anni precedenti e durante il follow-up nella popolazione residente in Emilia Romagna (n=1196) al momento della procedura (AVR n=879, TAVI balloon-expandable n=317). Risultati La popolazione TAVI è risultata mediamente più anziana di quella AVR (età media 82.2 vs. 72.7 anni) e maggiormente gravata da comorbidità. L’In-hospital mortality è stata del 1.4% nella AVR e 2.1% nella TAVI (pNS). La sopravvivenza a 5 anni è stata del 85.74% nella AVR e del 59.45% nella TAVI, con la TAVI come fattore predittivo di All-cause mortality (HR 1.44 95%CI 1.14-1.82). La riospedalizzazione per Heart Failure a 5 anni è stata del 20.6% per AVR e 51.3% per TAVI, con dialisi preoperatoria (HR 5.67 95%CI 3.06-10.49) come principale fattore predittivo. Il tasso di All Stroke a 5 anni è stato del 3.7% nella AVR e del 7.5% nella TAVI, con fibrillazione atriale preoperatoria come principale fattore predittivo (HR 1.91 95%CI 1.06-3.45). Il tasso di angioplastica coronarica percutanea (PCI) a 5 anni è stato del 3.1% sia nella AVR che nella TAVI, con previous PCI come principale fattore predittivo (HR 4.86 95%CI 2.57-9.21). L’impianto di pacemaker a 30 giorni è stato del 2.9% nella AVR e 3.4% nella TAVI (pNS). Conclusioni Nella pratica clinica real-world 2010-2020 di un centro cardiochirurgico a medio volume, la TAVI balloon-expandable ha mostrato una eccellente performance a 30 giorni in confronto con la AVR, che invece ha evidenziato una migliore performance durante follow-up.