Relatório de estágio de natureza profissional em PET/CT: Clinical Imaging Sciences Centre, Sussex

Mestrado em Medicina Nuclear - Ramo de especialização: Tomografia por Emissão de Positrões

10 kVp rule – An anthropomorphic pelvis phantom imaging study using a CR system: impact on image quality and effective dose using AEC and manual mode

Background - Pelvis and hip radiography are consistently found to be amongst the highest contributors to the collective effective dose (E) in all ten DOSE DATAMED countries in Europe, representing 2.8 to 9.4% of total collective dose (S) in the TOP 20 exams list. The level of image quality should provide all the diagnostic information in order not to jeopardise the diagnosis, but being able to provide the needed clinical information with the minimum dose. A recent study suggests further research to determine whether the “10 kVp rule” would have value for a range of examinations using Computed Radiography (CR) systems. As a “rule of thumb” increasing the kVp by 10 whilst halving the mAs is suggested to give a similar perceptual image quality when compared to the original exposure factors. Aims - In light of the 10kVp rule, this study aims to investigate the influence of tube potential (kVp) variation in relation to perceptual image quality and E for pelvis imaging using automatic exposure control (AEC) and non-AEC in a Computed Radiography (CR) system. Research questions - Does the 10kVp rule works for the pelvis in relation to image quality in a CR system? Does the image quality differs when the AEC is used instead of manual mode using the 10kVp rule and how this impacts on E?

OPTIMAX 2014 - Radiation dose and image quality optimisation in medical imaging

Medical imaging is a powerful diagnostic tool. Consequently, the number of medical images taken has increased vastly over the past few decades. The most common medical imaging techniques use X-radiation as the primary investigative tool. The main limitation of using X-radiation is associated with the risk of developing cancers. Alongside this, technology has advanced and more centres now use CT scanners; these can incur significant radiation burdens compared with traditional X-ray imaging systems. The net effect is that the population radiation burden is rising steadily. Risk arising from X-radiation for diagnostic medical purposes needs minimising and one way to achieve this is through reducing radiation dose whilst optimising image quality. All ages are affected by risk from X-radiation however the increasing population age highlights the elderly as a new group that may require consideration. Of greatest concern are paediatric patients: firstly they are more sensitive to radiation; secondly their younger age means that the potential detriment to this group is greater. Containment of radiation exposure falls to a number of professionals within medical fields, from those who request imaging to those who produce the image. These staff are supported in their radiation protection role by engineers, physicists and technicians. It is important to realise that radiation protection is currently a major European focus of interest and minimum competence levels in radiation protection for radiographers have been defined through the integrated activities of the EU consortium called MEDRAPET. The outcomes of this project have been used by the European Federation of Radiographer Societies to describe the European Qualifications Framework levels for radiographers in radiation protection. Though variations exist between European countries radiographers and nuclear medicine technologists are normally the professional groups who are responsible for exposing screening populations and patients to X-radiation. As part of their training they learn fundamental principles of radiation protection and theoretical and practical approaches to dose minimisation. However dose minimisation is complex – it is not simply about reducing X-radiation without taking into account major contextual factors. These factors relate to the real world of clinical imaging and include the need to measure clinical image quality and lesion visibility when applying X-radiation dose reduction strategies. This requires the use of validated psychological and physics techniques to measure clinical image quality and lesion perceptibility.

An evaluation of SAFIRE’s potential to reduce the dose received by paediatric patients undergoing CT: a narrative review

Introduction: The purpose of this review is to gather and analyse current research publications to evaluate Sinogram-Affirmed Iterative Reconstruction (SAFIRE). The aim of this review is to investigate whether this algorithm is capable of reducing the dose delivered during CT imaging while maintaining image quality. Recent research shows that children have a greater risk per unit dose due to increased radiosensitivity and longer life expectancies, which means it is particularly important to reduce the radiation dose received by children. Discussion: Recent publications suggest that SAFIRE is capable of reducing image noise in CT images, thereby enabling the potential to reduce dose. Some publications suggest a decrease in dose, by up to 64% compared to filtered back projection, can be accomplished without a change in image quality. However, literature suggests that using a higher SAFIRE strength may alter the image texture, creating an overly ‘smoothed’ image that lacks contrast. Some literature reports SAFIRE gives decreased low contrast detectability as well as spatial resolution. Publications tend to agree that SAFIRE strength three is optimal for an acceptable level of visual image quality, but more research is required. The importance of creating a balance between dose reduction and image quality is stressed. In this literature review most of the publications were completed using adults or phantoms, and a distinct lack of literature for paediatric patients is noted. Conclusion: It is necessary to find an optimal way to balance dose reduction and image quality. More research relating to SAFIRE and paediatric patients is required to fully investigate dose reduction potential in this population, for a range of different SAFIRE strengths.

Climatology of the Iberia coastal low-level wind jet: weather research forecasting model high-resolution results

Coastal low-level jets (CLLJ) are a low-tropospheric wind feature driven by the pressure gradient produced by a sharp contrast between high temperatures over land and lower temperatures over the sea. This contrast between the cold ocean and the warm land in the summer is intensified by the impact of the coastal parallel winds on the ocean generating upwelling currents, sharpening the temperature gradient close to the coast and giving rise to strong baroclinic structures at the coast. During summertime, the Iberian Peninsula is often under the effect of the Azores High and of a thermal low pressure system inland, leading to a seasonal wind, in the west coast, called the Nortada (northerly wind). This study presents a regional climatology of the CLLJ off the west coast of the Iberian Peninsula, based on a 9km resolution downscaling dataset, produced using the Weather Research and Forecasting (WRF) mesoscale model, forced by 19 years of ERA-Interim reanalysis (1989-2007). The simulation results show that the jet hourly frequency of occurrence in the summer is above 30% and decreases to about 10% during spring and autumn. The monthly frequencies of occurrence can reach higher values, around 40% in summer months, and reveal large inter-annual variability in all three seasons. In the summer, at a daily base, the CLLJ is present in almost 70% of the days. The CLLJ wind direction is mostly from north-northeasterly and occurs more persistently in three areas where the interaction of the jet flow with local capes and headlands is more pronounced. The coastal jets in this area occur at heights between 300 and 400 m, and its speed has a mean around 15 m/s, reaching maximum speeds of 25 m/s.

Failure on clinical image quality criteria in digital mammography: how can radiographers do better?

Purpose: To assess image quality using PGMI (perfect, good, moderate, inadequate) scale in digital mammography examinations acquired in DR systems. Identify the main failures and propose corrective actions. Evaluate the most typical breast density. Methods and Materials: Clinical image quality criteria were evaluated considering mammograms acquired in 13 DR systems and classified according to PGMI scale using the criteria described in European Commission guidelines for radiographers. The breast density was assessed according to ACR recommendations. The data were collected on the acquisition system monitor to reproduce the daily practice of the radiographer. Results: The image quality criteria were evaluated in 3044 images. The criteria were fully achieved in 41% of the images that were classified as P (perfect), 31 % of the images were classified as M (moderate), 20% G (good) and 9% I (inadequate). The main cause of inadequate image quality was absence of all breast tissue in the image, skin folders in the pectoral muscle and in the infra-mammary angle. The higher number of failures occurred in MLO projections (809 out of 1022). The most represented (36%) breast type was type 2 (25-50% glandular tissue). Conclusion: Incorrect radiographic technique was frequently detected suggesting potential training needs and poor communication between the team members (radiographer and radiologists). Further correlations are necessary to identify the main causes for the failures, namely specific education and training in digital mammography and workload.

Visual functional analysis in medical imaging

Aims of study: 1) Describe the importance of human visual system on lesion detection in medical imaging perception research; 2) Discuss the relevance of research in medical imaging addressing visual function analysis; 3) Identify visual function tests which could be conducted on observers prior to participation in medical imaging perception research.

Occupational stress and coping resources in physiotherapists: a survey of physiotherapists in three general hospitals

Objectives - To identify occupational stressors and coping resources in a group of physiotherapists, and to analyse interactions between subjective levels of stress, efficacy in stress resolution and coping resources used by these professionals. Design - A sample of 55 physiotherapists working in three general hospitals in Portugal completed the Coping Resources Inventory for Stress, the Occupational Stressors Inventory and two subjective scales for stress and stress resolution. Main results - Most physiotherapists perceived that they were moderately stressed (19/55, 35%) or stressed (20/55, 36%) due to work, and reported that their efficacy in stress resolution was moderate (25/54, 46%) or efficient (23/54, 42%). Issues related to lack of professional autonomy, lack of organisation in the hierarchical command chain, lack of professional and social recognition, disorganisation in task distribution and interpersonal conflicts with superiors were identified as the main sources of stress. The most frequently used coping resources were social support, stress monitoring, physical health and structuring. Perceived efficacy in stress resolution was inversely related to perceived level of occupational stress (r = −0.61, P < 0.01). Significant correlations were found between several coping resources and the perceived level of stress and efficacy in stress resolution. Associations between problem solving, cognitive restructuring and stress monitoring and both low levels of perceived stress and high levels of perceived efficacy were particularly strong. Implications for practice - The importance of identifying stressors and coping resources related to physiotherapists’ occupational stress, and the need for the development of specific training programmes to cope with stress are supported.

Lesion detection performance in an anthropomorphic chest phantom: comparative analysis of low-dose CT data on two hybrid imaging systems

Introduction: multimodality environment; requirement for greater understanding of the imaging technologies used, the limitations of these technologies, and how to best interpret the results; dose optimization; introduction of new techniques; current practice and best practice; incidental findings, in low-dose CT images obtained as part of the hybrid imaging process, are an increasing phenomenon with advancing CT technology; resultant ethical and medico-legal dilemmas; understanding limitations of these procedures important when reporting images and recommending follow-up; free-response observer performance study was used to evaluate lesion detection in low-dose CT images obtained during attenuation correction acquisitions for myocardial perfusion imaging, on two hybrid imaging systems.

A fluorescente bicyclic Calix[4] Arene-Oxacyclophane with planar chirality: Resolution, chiroptical, properties, and absolute configuration.

A new inherently chiral calix[4]arene ICC 1 has been disclosed. The dissymmetry of 1 is generated from a chirality plane in the quinol moiety of a 1,3-bridged bicyclic calix[4]arene. ICC 1 has been resolved by enantioselective HPLC, and the chiroptical properties of both isolated antipodes (pS)-1 and (pR)-1 confirm their enantiomeric nature. The absolute configuration of the (pS)-1/(pR)-1 enantiomeric pair was established through time-dependent density functional theory (TDDFT) calculations of electronic circular dichroism (CD) spectra. (C) 2014 Elsevier Ltd. All rights reserved.

Segmentation of striatal brain structures from high resolution pet images

Dissertation presented at the Faculty of Science and Technology of the New University of Lisbon in fulfillment of the requirements for the Masters degree in Electrical Engineering and Computers

The impact of Sinogram-Affirmed Iterative Reconstruction on patient dose and image quality compared to filtered back projection: a narrative review

Objective: Summarize all relevant findings in published literature regarding the potential dose reduction related to image quality using Sinogram-Affirmed Iterative Reconstruction (SAFIRE) compared to Filtered Back Projection (FBP). Background: Computed Tomography (CT) is one of the most used radiographic modalities in clinical practice providing high spatial and contrast resolution. However it also delivers a relatively high radiation dose to the patient. Reconstructing raw-data using Iterative Reconstruction (IR) algorithms has the potential to iteratively reduce image noise while maintaining or improving image quality of low dose standard FBP reconstructions. Nevertheless, long reconstruction times made IR unpractical for clinical use until recently. Siemens Medical developed a new IR algorithm called SAFIRE, which uses up to 5 different strength levels, and poses an alternative to the conventional IR with a significant reconstruction time reduction. Methods: MEDLINE, ScienceDirect and CINAHL databases were used for gathering literature. Eleven articles were included in this review (from 2012 to July 2014). Discussion: This narrative review summarizes the results of eleven articles (using studies on both patients and phantoms) and describes SAFIRE strengths for noise reduction in low dose acquisitions while providing acceptable image quality. Conclusion: Even though the results differ slightly, the literature gathered for this review suggests that the dose in current CT protocols can be reduced at least 50% while maintaining or improving image quality. There is however a lack of literature concerning paediatric population (with increased radiation sensitivity). Further studies should also assess the impact of SAFIRE on diagnostic accuracy.

An experimental study to compare the interface pressure and experience of healthy participants when lying still for 20 minutes in a supine position on two different imaging surfaces

Introduction: Pressure ulcers are a high cost, high volume issue for health and medical care providers, affecting patients’ recovery and psychological wellbeing. The current research of support surfaces on pressure as a risk factor in the development of pressure ulcers is not relevant to the specialised, controlled environment of the radiological setting. Method: 38 healthy participants aged 19-51 were placed supine on two different imaging surfaces. The XSENSOR pressure mapping system was used to measure the interface pressure. Data was acquired over a time of 20 minutes preceded by 6 minutes settling time to reduce measurement error. Qualitative information regarding participants’ opinion on pain and comfort was recorded using a questionnaire. Data analysis was performed using SPSS 22. Results: Data was collected from 30 participants aged 19 to 51 (mean 25.77, SD 7.72), BMI from 18.7 to 33.6 (mean 24.12, SD 3.29), for two surfaces, following eight participant exclusions due to technical faults. Total average pressure, average pressure for jeopardy areas (head, sacrum & heels) and peak pressure for jeopardy areas were calculated as interface pressure in mmHg. Qualitative data showed that a significant difference in experiences of comfort and pain was found in the jeopardy areas (P<0.05) between the two surfaces. Conclusion: A significant difference is seen in average pressure between the two surfaces. Pain and comfort data also show a significant difference between the surfaces, both findings support the proposal for further investigation into the effects of radiological surfaces as a risk factor for the formation of pressure ulcers.

Time-frequency and time-scale characterisation of the beat-by-beat high-resolution electrocardiogram

Proceedings of the Sixth Portuguese Conference on Bioemedical Engineering faro, Portugal

Land use/ land cover change and its impact on soil erosion process in Begnas Tal Rupa Tal watershed using geospatial tools, Kaski district, Nepal

Dissertation submitted in partial fulfilment of the requirements for the Degree of Master of Science in Geospatial Technologies