A comparison of endoscopy versus pathology sizing of colorectal adenomas and potential implications for surveillance colonoscopy

Background and AimsTo compare endoscopy and pathology sizing in a large population-based series of colorectal adenomas and to evaluate the implications for patient stratification into surveillance colonoscopy.MethodsEndoscopy and pathology sizes available from intact adenomas removed at colonoscopies performed as part of the Northern Ireland Bowel Cancer Screening Programme, from 2010 to 2015, were included in this study. Chi-squared tests were applied to compare size categories in relation to clinicopathological parameters and colonoscopy surveillance strata according to current American Gastroenterology Association and British Society of Gastroenterology guidelines.ResultsA total of 2521 adenomas from 1467 individuals were included. There was a trend toward larger endoscopy than pathology sizing in 4 of the 5 study centers, but overall sizing concordance was good. Significantly greater clustering with sizing to the nearest 5 mm was evident in endoscopy versus pathology sizing (30% vs 19%, p<0.001), which may result in lower accuracy. Applying a 10-mm cut-off relevant to guidelines on risk stratification, 7.3% of all adenomas and 28.3% of those 8 to 12 mm in size had discordant endoscopy and pathology size categorization. Depending upon which guidelines are applied, 4.8% to 9.1% of individuals had differing risk stratification for surveillance recommendations, with the use of pathology sizing resulting in marginally fewer recommended surveillance colonoscopies.ConclusionsChoice of pathology or endoscopy approaches to determine adenoma size will potentially influence surveillance colonoscopy follow-up in 4.8% to 9.1% of individuals. Pathology sizing appears more accurate than endoscopy sizing, and preferential use of pathology size would result in a small, but clinically important, decreased burden on surveillance colonoscopy demand. Careful endoscopy sizing is required for adenomas removed piecemeal.

Fibre laser joining of highly dissimilar materials: Commercially pure Ti and PET hybrid joint for medical device applications

Laser transmission joining (LTJ) is growing in importance, and has the potential to become a niche technique for the fabrication of hybrid plastic-metal joints for medical device applications. The possibility of directly joining plastics to metals by LTJ has been demonstrated by a number of recent studies. However, a reliable and quantitative method for defining the contact area between the plastic and metal, facilitating calculation of the mechanical shear stress of the hybrid joints, is still lacking. A new method, based on image analysis using ImageJ, is proposed here to quantify the contact area at the joint interface. The effect of discolouration on the mechanical performance of the hybrid joints is also reported for the first time. Biocompatible polyethylene terephthalate (PET) and commercially pure titanium (Ti) were selected as materials for laser joining using a 200 W CW fibre laser system. The effect of laser power, scanning speed and stand-off distance between the nozzle tip and top surface of the plastic were studied and analysed by Taguchi L9 orthogonal array and ANOVA respectively. The surface morphology, structure and elemental composition on the PET and Ti surfaces after shearing/peeling apart were characterized by SEM, EDX, XRD and XPS.

Laser-fabricated PET-Ti Hybrid Joints for Medical Device Applications

Currently, micro-joining of plastic parts to metal parts in medical devices is achieved by using medical adhesives, For example, pacemakers, defibrillators and neurological stimulators are designed using silicone adhesive to seal the joint between the polyurethane connector module and the titanium can [1]. Nevertheless, the use of adhesive is problematic because it requires a long time to cure and has high tendency to produce leachable products which might be harmful to the human body. An alternative for directly joining plastics to metal without adhesive is therefore required. Laser transmission joining (LTJ) is growing in importance, and has the potential to gain the niche in micro-fabrication of plastics-metal hybrid joints for medical device applications. The possibility of directly joining plastics to metal by LTJ technique have been demonstrated by a number of studies in recent literature [2]. The widely-accepted understanding of LTJ between plastics and metal is that generation and rapid expansion of micro-bubbles at the plastics-metal interface exert high local pressure to press the melted plastics towards the metal surface features during the laser processing [2]. This subsequently creates the plastics-metal hybrid joint by the mechanisms of mechanical interlocking as well as chemical and physical bonds between the plastics and metal surfaces. Although the micro-bubbles can help promote the mechanical interlocking effect to increase the joint strength, the creation of bubble is a random and complex process depending on the complicated interactions between the laser intensity, thermal degradation properties of plastics, surface temperature and topographical features of metal. In an ideal situation, it is desirable to create the hybrid plastics-metal joint without bubbles. However, the mechanical performance of the hybrid plastics-metal joint without bubbles is still unknown, and systematic comparison between the hybrid joints with and without bubbles is lacking in literature. This becomes the objective of this study. In this work, the laser process parameters were carefully chosen from a preliminary study, such that different hybrid joints: with and without bubbles can be produced and compared. Biocompatible PET and commercially pure Ti were selected as materials for laser joining.

Medical information extraction in European Portuguese

The electronic storage of medical patient data is becoming a daily experience in most of the practices and hospitals worldwide. However, much of the data available is in free-form text, a convenient way of expressing concepts and events, but especially challenging if one wants to perform automatic searches, summarization or statistical analysis. Information Extraction can relieve some of these problems by offering a semantically informed interpretation and abstraction of the texts. MedInX, the Medical Information eXtraction system presented in this document, is the first information extraction system developed to process textual clinical discharge records written in Portuguese. The main goal of the system is to improve access to the information locked up in unstructured text, and, consequently, the efficiency of the health care process, by allowing faster and reliable access to quality information on health, for both patient and health professionals. MedInX components are based on Natural Language Processing principles, and provide several mechanisms to read, process and utilize external resources, such as terminologies and ontologies, in the process of automatic mapping of free text reports onto a structured representation. However, the flexible and scalable architecture of the system, also allowed its application to the task of Named Entity Recognition on a shared evaluation contest focused on Portuguese general domain free-form texts. The evaluation of the system on a set of authentic hospital discharge letters indicates that the system performs with 95% F-measure, on the task of entity recognition, and 95% precision on the task of relation extraction. Example applications, demonstrating the use of MedInX capabilities in real applications in the hospital setting, are also presented in this document. These applications were designed to answer common clinical problems related with the automatic coding of diagnoses and other health-related conditions described in the documents, according to the international classification systems ICD-9-CM and ICF. The automatic review of the content and completeness of the documents is an example of another developed application, denominated MedInX Clinical Audit system.

Portuguese georesources suitability for medical hydrology applications

In Portugal, there is an old tradition in using clayey materials for therapeutic purposes. They are applied in pelotherapy, at several beaches of the Atlantic coast in the form of clay-sea water mixtures (peloids) to treat skin and rheumatic diseases. During many generations, peloids have been applied without scienti c studies that prove their therapeutic validity. In the last decade, the Portuguese scienti c community has become increasingly more interested in assessing the properties that make clayey materials suitable for therapeutic purposes. The abundance of clayey formations and the established practices of medical hydrology in our country turned this interest into a new perspective of application. The studied materials include di erent clays (in age and origin) mainly collected from well-known Mesozoic-Cenozoic formations, in some cases outcropping at beaches where empirical applications occur. This thesis focus in the study of silt-clay fraction (< 63 m).To determine their suitability for therapy, compositional, physicochemical, technological, thermal and rheological properties were assessed. Conventional techniques (XRD, XRF and Sedigraph) were used to assess compositional features of silt-clay fraction. Electron microscopy (SEM, VPSEM, HREM) was used to study the micromorphology and composition of clay fraction (< 2 m). Physicochemical properties (cation exchange and speci c surface) were assessed using the Ammonium Acetate and BET methods. Technological properties (plasticity and abrasivity indices) were assessed using the Atterberg limits and Einlehner abrasion tests. Thermal properties (speci c heat and cooling kinetics) were estimated by DSC analysis and cooling tests. Pharmacotechnical tests (compressibility index, sediment volume and Brook eld viscosity) were used to assess the powder owability as well as the physical stability and viscosity of clay-water dispersions. We selected as suitable Portuguese clays for health applications the samples A-Pe, A-Be2, A-Sd, J-Fr , M-To, C-Lu1, C-Lu2, Pl-Ba, M-Ga and J-Ab because they represent safe materials, with an adequate composition, good technological, physicochemical and thermal properties for application, also presenting an adequate rheology when dispersed in water. Their most relevant characteristics are the high clay minerals content, abundant smectite, illite and kaolinite, and safe hazardous concentrations. They also showed moderate capacity to exchange Ca 2+, high plasticity, low abrasivity, high speci c heat and slow cooling kinetics. They evidenced fair powder owability and good potential to formulate viscous dispersions when stabilized. Because the majority of the assessed characteristics are in accordance with those presented by clays applied in European spas for pelotherapy, we considered this group of clays also suitable for medical hydrology treatments in Portuguese spas.

Hole-type gaseous detectors for medical imaging and HEP experiments

This work presents the results on the development of a high pressure Xe gaseous detector envisaging medical imaging. The detector uses two VUV photosensors operating face-to-face, based on the CsI-MHSP with position discrimination capability. The known effect of the charge gain decrease with the gas pressure is compensated with a light gain using the electroluminescence process. Studies of signal amplitude, energy and position resolution are presented. On the second part, gaseous detectors based on THGEM where studied in order to fulfill the requirements of present and future high energy physics experiments. The work is focused on the application of THGEM in RICH detectors elements: a triple THGEM detector using CsI photocathodes in Ne mixtures was suggested. The ion backflow to the photocathode remains a concern and a limitation; to minimize it, the application of a new hole-structure, THCOBRA, was suggested. Preliminary results foresee good perspectives for the successful application of THCOBRA in ion back-flow suppression. This work contains several methods and measurements of the CsI photocathodes behaviour in radiation gaseous detectors. A long discussion on its issues and possible solutions are presented.

Rastreio do cancro da mama no concelho de Aveiro: do estudo dos fatores determinantes da adesão às propostas educativas emergentes

O cancro da mama feminino pela sua magnitude merece uma especial atenção ao nível das políticas de saúde. Emerge, pois uma visão abrangente que, por um lado, deve atentar para o encargo que esta representa para qualquer sistema de saúde, pelos custos que acarreta, como também, para a qualidade de vida das mulheres portadoras da mesma. Desta forma, a Liga Portuguesa Contra o Cancro (LPCC) tem desenvolvido, em colaboração com as Administrações Regionais de Saúde (ARS), o Programa de Rastreio do Cancro da Mama (PRCM), o qual apresenta, no Concelho de Aveiro, taxas de adesão na ordem dos 50%, ainda distantes dos 70%, objetivo recomendado pelas guidelines da Comissão Europeia. A não adesão tem sido considerada como um dos principais problemas do sistema de saúde, tanto pelas repercussões ao nível de ganhos em saúde, como também na qualidade de vida e na satisfação dos pacientes com os cuidados de saúde, constituindo-se como um fenómeno multifatorial e multidimensional. É neste sentido que o presente trabalho se propõe identificar os fatores, de cariz individual e do meio envolvente, determinantes da adesão ao PRCM, numa amostra de mulheres residentes no Concelho de Aveiro, com idades compreendidas entre os 45 e os 69 anos e, a partir dos resultados emergentes, propor estratégias de educação em saúde. Como procedimentos metodológicos e, numa primeira fase, entre outubro 2009 e maio 2010 foi aplicado um survey, o qual foi complementado com notas de campo dos entrevistadores a uma amostra não aleatória de 805 mulheres, em dois contextos distintos: no centro de saúde às aderentes à mamografia e, no domicílio, às não aderentes. Numa segunda fase, realizamos duas sessões de Focus Group (FG), num total de 12 elementos, um grupo heterogéneo com enfermeiros, médicos e utentes, e um outro grupo homogéneo, apenas com profissionais de saúde. O tratamento dos dados do survey foi efetuado através de procedimentos estatísticos, com utilização do SPSS® versão 17 e realizadas análises bivariadas (qui-quadrado) e multivariadas (discriminação de função e árvore de decisão através do algoritmo Chi-squared Automatic Interaction Detector) com o intuito de determinar as diferenças entre os grupos e predizer as variáveis exógenas. No que diz respeito a indicadores sociodemográficos, os resultados mostram que aderem mais, as mulheres com idades <50 anos e ≥ 56 anos, as que vivem em localidades urbanas, as trabalhadoras não qualificadas e as reformadas. As que aderem menos ao PRCM têm idades compreendidas entre os 50-55 anos, vivem nas zonas periurbanas, são licenciadas, apresentam categoria profissional superior ou estão desempregadas. Em relação às restantes variáveis exógenas, aderem ao PRCM, as mulheres que apresentam um Bom Perfil de Conhecimentos (46.6%), enquanto as não aderentes apresentam um Fraco Perfil de Conhecimentos (50.6%), sendo esta relação estatisticamente significativa (X2= 10.260; p=0.006).Cerca de 59% das mulheres aderentes realiza o seu rastreio de forma concordante com as orientações programáticas presentes no PRCM, comparativamente com 41.1% das mulheres que não o faz, verificando-se uma relação de dependência bastante significativa entre as variáveis Perfil de Comportamentos e adesão(X2= 348.193; p=0.000). Apesar de não existir dependência estatisticamente significativa entre as Motivações e a adesão ao PRCM (X2= 0.199; p=0.656), se analisarmos particularmente, os motivos de adesão, algumas inquiridas demonstram preocupação, tanto na deteção precoce da doença, como na hereditariedade. Por outro lado, os motivos de não adesão, também denotam aspetos de nível pessoal como o desleixo com a saúde, o desconhecimento e o esquecimento da marcação. As mulheres que revelam Boa Acessibilidade aos Cuidados de Saúde Primários e um Bom Atendimento dos Prestadores de Cuidados aderem mais ao PRCM, comparativamente com as inquiridas que relatam Fraca Acessibilidade e Atendimento, não aderindo. A partir dos resultados da análise multivariada podemos inferir que as variáveis exógenas estudadas possuem um poder discriminante significativo, sendo que, o Perfil de Comportamentos é a variável que apresenta maior grau de diferenciação entre os grupos das aderentes e não aderentes. Como variáveis explicativas resultantes da árvore de decisão CHAID, permaneceram, o Perfil de Comportamentos (concordantes e não concordantes com as guidelines), os grupos etários (<50 anos, 50-55anos e ≥56anos) e o Atendimento dos prestadores de cuidados de saúde. As mulheres mais novas (<50 anos) com Perfil de comportamentos «concordantes» com as guidelines são as que aderem mais, comparativamente com os outros grupos etários. Por outro lado, as não aderentes necessitam de um «bom» atendimento dos prestadores de cuidados para se tornarem aderentes ao PRCM. Tanto as notas de campo, como a discussão dos FG foram sujeitas a análise de conteúdo segundo as categorias em estudo obtidas na primeira fase e os relatos mostram a importância de fatores de ordem individual e do meio envolvente. No que se refere a aspetos psicossociais, destaca-se a importância das crenças e como fatores ambientais menos facilitadores para a adesão apontam a falta de transportes, a falta de tempo das pessoas e a oferta de recursos, principalmente se existirem radiologistas privados como alternativa ao PRCM. Tal como na primeira fase do estudo, uma das motivações para a adesão é a recomendação dos profissionais de saúde para o PRCM, bem como a marcação de consultas pela enfermeira, que pode ser uma oportunidade de contacto para a sensibilização. Os hábitos de vigilância de saúde, a perceção positiva acerca dos programas de saúde no geral, o acesso à informação pertinente sobre o PRCM e a operacionalização deste no terreno parecem ser fatores determinantes segundo a opinião dos elementos dos FG. O tipo e a regularidade no atendimento por parte dos profissionais de saúde, a relação entre profissional de saúde/paciente, a personalização das intervenções educativas, a divulgação que estes fazem do PRCM junto das suas pacientes, bem como, a organização do modelos de cuidados de saúde das unidades de saúde e a forma como os profissionais se envolvem e tomam a responsabilização por um programa desta natureza são fatores condicionantes da adesão. Se atendermos aos resultados deste estudo, verificamos um envolvimento de fatores que integram múltiplos níveis de intervenção, sendo um desafio para as equipas de saúde que pretendam intervir no âmbito do programa de rastreio do cancro da mama. Com efeito, os resultados também apontam para a combinação de múltiplas estratégias que são transversais a vários programas de promoção da saúde, assumindo, desta forma, uma perspetiva multidimensional e dinâmica que visa, essencialmente, a construção social da saúde e do bem-estar (i.e. responsabilização do cidadão pela sua própria saúde e o seu empowerment).

Diversifying medical imaging of breast lesions

Dissertação de mestrado, Engenharia Informática, Faculdade de Ciências e Tecnologia, Universidade do Algarve, 2015

3D Reconstruction of Medical Images from Slices Automatically Landmarked with Growing Neural Models

In this study, we utilise a novel approach to segment out the ventricular system in a series of high resolution T1-weighted MR images. We present a brain ventricles fast reconstruction method. The method is based on the processing of brain sections and establishing a fixed number of landmarks onto those sections to reconstruct the ventricles 3D surface. Automated landmark extraction is accomplished through the use of the self-organising network, the growing neural gas (GNG), which is able to topographically map the low dimensionality of the network to the high dimensionality of the contour manifold without requiring a priori knowledge of the input space structure. Moreover, our GNG landmark method is tolerant to noise and eliminates outliers. Our method accelerates the classical surface reconstruction and filtering processes. The proposed method offers higher accuracy compared to methods with similar efficiency as Voxel Grid.