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Expert assessment of the organization of comprehensive support for the prolongation of professional effective activity of a doctor 专家对延长医生专业有效活动的综合支持组织工作的评估
Pub Date : 2024-07-03 DOI: 10.17816/dd627052
A. Vorobeva, M. Yakushin
BACKGROUND: Medical workers are one of the professions that significantly strengthen the country’s economy [1, 2]. The development and implementation of health-saving technologies to prolong the effective professional life of medical workers of older age groups will preserve them as a labor resource of the country, which will exclude economic losses of the state. The results of a sociological survey of doctors providing medical care in the polyclinic segment of Moscow and the Moscow region were used to assess the professional competencies of specialists [3]. An organizational technology was then formed based on these findings, which was subsequently proposed for expert assessment. AIM: The aim of this study was to ascertain the significance of organizational technology measures for the professional longevity of doctors in older age groups. MATERIALS AND METHODS: The study employed a multi-methodological approach, integrating sociological, statistical, and expert evaluation techniques. A total of 50 experts were invited to rank the activities comprising the integrated technology in terms of their perceived importance for achieving the desired outcome, namely, the support of effective professional longevity of doctors in the event of the implementation of such technology. The experts were specialists in the field of health care and public health, including chief physicians and heads of departments of urban polyclinics in Moscow and the Moscow region, who were accredited in the specialty 03.02.03. They had experience of management in the field of health care ranging from one to 29 years. RESULTS: All experts concur that a medical organization should implement measures to prevent the deterioration of doctors due to aging. The necessity to test doctors over the age of 50 for cognitive disorders and dementia was confirmed by 90% of experts. Additionally, 60% of experts agreed that doctors over the age of 50 require a less demanding work schedule, including a reduction in intellectual workload and an extension of rest periods. At the same time, 20% of experts approve of the transition to a lighter work regime on an individual basis after testing, 10% agreed only with the prolongation of rest, and 10% gave a negative answer. In the opinion of 90% of experts, the widespread introduction of medical information systems (and training in working with them) will help to support the effective professional longevity of doctors of older age groups. A mere 40% of experts concurred that the transfer of senior physicians to monoprofile appointments would assist in prolonging their effective professional longevity. The majority of experts (80%) recommend regular cognitive training for doctors of advanced age, while 10% believe it is only necessary in specific cases and 10% are opposed to the idea. Only 70% of experts in the medical field implement organizational measures to maintain effective professional longevity, while the remaining 30% employ single measures.
背景:医务工作者是显著增强国家经济实力的职业之一[1, 2]。开发和实施保健技术以延长老年医务工作者的有效职业寿命,将保护他们作为国家的劳动力资源,从而避免国家的经济损失。对莫斯科和莫斯科地区综合医院提供医疗服务的医生进行社会学调查的结果被用来评估专家的专业能力[3]。然后根据这些结果形成了一种组织技术,随后提出了专家评估建议。目的:本研究旨在确定组织技术措施对老年组医生职业寿命的意义。材料与方法:本研究采用了多种方法,整合了社会学、统计学和专家评估技术。共邀请了 50 位专家,根据他们对实现预期结果(即在实施综合技术的情况下,支持医生有效延长职业寿命)的重要性的认识,对综合技术的各项活动进行排序。专家们都是医疗保健和公共卫生领域的专家,包括莫斯科和莫斯科州城市综合医院的主任医师和科室主任,他们都获得了 03.02.03 专业认证。他们在医疗保健领域的管理经验从 1 年到 29 年不等。结果:所有专家一致认为,医疗机构应采取措施防止医生因年龄增长而退化。90%的专家确认有必要对 50 岁以上的医生进行认知障碍和痴呆症测试。此外,60%的专家同意 50 岁以上的医生需要减轻工作强度,包括减少脑力劳动和延长休息时间。同时,20% 的专家同意在测试后根据个人情况过渡到较轻松的工作制度,10% 的专家只同意延长休息时间,10% 的专家给出了否定的答案。90% 的专家认为,广泛采用医疗信息系统(并对如何使用这些系统进行培训)将有助 于支持老年医生有效地延长职业寿命。仅有 40%的专家同意,将高龄医生转为单病种任命将有助于延长他们的有效职业寿命。大多数专家(80%)建议对高龄医生进行定期认知培训,10%的专家认为只有在特殊情况下才有必要,10%的专家表示反对。只有 70% 的医学领域专家采取组织措施来保持有效的职业寿命,而其余 30% 的专家则采取单一措施。治疗学习技术[5]得到了所有专家的积极评价。专家们提出的措施清单包括:在工作时间的午休之外引入 "暂停时间"、工业体操、由心理学家为医生提供心理援助以及举办计算机扫盲学校。结论:医疗保健和公共卫生领域的专家已经确认,有必要引入组织技术来延长医疗能力。不过,应根据专家意见对拟议技术进行调整。
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引用次数: 0
Non-contrast quantitative study of brain perfusion changes in multiple sclerosis 多发性硬化症脑灌注变化的非对比定量研究
Pub Date : 2024-07-03 DOI: 10.17816/dd625953
V. V. Popov, Yulia A. Stankevich, L. M. Vasilkiv, A. Tulupov
BACKGROUND: Non-contrast magnetic resonance perfusion can identify areas of cerebral perfusion changes in patients with multiple sclerosis, even in the absence of focal lesions [1]. This technique offers several advantages, including non-invasiveness [2] and a short data collection time, which allows for repeated examinations and dynamic monitoring without contrast loading on the patient. The use of contrast-free magnetic resonance perfusion in patients with multiple sclerosis may prove to be a valuable diagnostic, management, and evaluation tool for the disease course. Nevertheless, the quantitative assessment of perfusion in multiple sclerosis remains a relatively understudied area in clinical practice [3]. The application of the developed algorithm for postprocessing of non-contrast MR perfusion data allows for the assessment of specific areas of interest and the estimation of absolute perfusion values in milliliters per 100 grams per minute. AIM: The study aims to develop an algorithm and investigate cerebral perfusion changes by non-contrast magnetic resonance perfusion in patients with multiple sclerosis compared with controls. MATERIALS AND METHODS: The study population comprises patients with multiple sclerosis (n=15) and a control group (n=15). The methodology employed in this study is magnetic resonance imaging on a 3.0T Philips Ingenia machine, using the basic study protocol (T1- and T2-weighted images, FLAIR, DIR, and CE_T1) and supplemented with pseudo-continuous arterial spin labeling (pCASL). The statistical analysis employed nonparametric methods. RESULTS: The quantitative processing of non-contrast perfusion data presents significant challenges. To address this, an algorithm was developed, which incorporates the use of the following software: Radiant, MatLAB, FSL (BASIL), MriCroGL, PyCharm. The perfusion in a group of conditionally healthy volunteers, without consideration of liquor-containing spaces and cerebral vessels, was isolated and co-registered with the atlas of T1-weighted images. The average perfusion was found to be 52.8±1.32 mL/(100 g×min), which is consistent with the findings of leading studies worldwide and reflects the efficacy and quality of the algorithm [4, 5]. Furthermore, within the context of the study, values for the demyelination focus [9.7 ± 5.4 mL/(100 g×min)] and for the visually intact white matter of the cerebral hemispheres [46.1 ± 1.7 mL/(100 g×min)] were obtained in the group of patients with multiple sclerosis. Moreover, a diffuse decrease in perfusion indices in visually intact regions of the cerebral hemispheres relative to the control group was revealed. This finding is also widely reported in the scientific literature [6]. CONCLUSIONS: The application of the developed algorithm for the analysis of pseudo-continuous arterial spin labeling in patients with multiple sclerosis allows for the assessment of perfusion in both the focus of demyelination and in the visually intact white matter of t
背景:非对比磁共振灌注可确定多发性硬化症患者的脑灌注变化区域,即使没有病灶[1]。这种技术有几个优点,包括无创[2]和数据采集时间短,因此可以在患者无造影剂负荷的情况下进行重复检查和动态监测。在多发性硬化症患者中使用无造影剂磁共振灌注可能会被证明是诊断、管理和评估病程的重要工具。然而,在临床实践中,多发性硬化症灌注的定量评估仍是一个研究相对不足的领域[3]。应用所开发的算法对非对比 MR 灌注数据进行后处理,可以评估特定的关注区域,并估算出以毫升/100 克/分钟为单位的绝对灌注值。目的:本研究旨在开发一种算法,并通过非对比磁共振灌注研究多发性硬化症患者与对照组相比的脑灌注变化。材料与方法:研究对象包括多发性硬化症患者(15 人)和对照组(15 人)。本研究采用的方法是在 3.0T 飞利浦 Ingenia 机器上进行磁共振成像,使用基本研究方案(T1 和 T2 加权图像、FLAIR、DIR 和 CE_T1),并辅以伪连续动脉自旋标记(pCASL)。统计分析采用了非参数方法。结果:非对比灌注数据的定量处理面临巨大挑战。为了解决这个问题,我们开发了一种算法,并结合使用了以下软件:Radiant、MatLAB、FSL (BASIL)、MriCroGL 和 PyCharm。在不考虑含酒精空间和脑血管的情况下,分离出一组条件健康志愿者的血流灌注,并与 T1 加权图像图集共同注册。结果发现,平均灌注量为 52.8±1.32 mL/(100 g×min),这与全球领先研究的结果一致,反映了该算法的有效性和质量[4, 5]。此外,在本研究中,多发性硬化症患者组的脱髓鞘病灶值[9.7 ± 5.4 mL/(100 g×min)]和大脑半球视觉完整白质值[46.1 ± 1.7 mL/(100 g×min)]均有所提高。此外,与对照组相比,大脑半球视觉完整区域的灌注指数呈弥漫性下降。这一发现在科学文献中也有广泛报道[6]。结论:应用所开发的算法对多发性硬化症患者进行假连续动脉自旋标记分析,可以评估脱髓鞘病灶和大脑半球视觉完整白质的灌注情况。研究表明,与对照组的结果相比,大脑半球视觉完整区域的灌注指数呈弥漫性下降(平均下降 13%)。这一观察结果表明,使用假连续动脉自旋标记法可以在其他常规序列对病灶进行临床和形态学验证之前怀疑病灶的出现。
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引用次数: 0
Diagnosis of pulmonary embolism in patients with viral pneumonia using multislice spiral computed tomographic angiography 利用多层螺旋计算机断层扫描血管造影术诊断病毒性肺炎患者的肺栓塞
Pub Date : 2024-07-03 DOI: 10.17816/dd626886
Ekaterina P. Kalinina, I. B. Belova
BACKGROUND: Viral pneumonia represents a significant and potentially life-threatening complication of coronavirus infection. It can result in a range of adverse outcomes, including pulmonary embolism. However, the prevalence of pulmonary embolism in these patients remains poorly understood. Multispiral computed tomographic angiography offers a valuable tool for studying the unique characteristics of radiation diagnostics in this disease and identifying specific signs of this complication. AIM: The aim of this study is to improve the diagnosis of pulmonary embolism in patients with SARS-CoV-2 virus-induced pneumonia using multispiral computed tomographic angiography. MATERIALS AND METHODS: A retrospective review of medical records and multispiral computed tomographic angiography data from 200 patients with viral pneumonia (COVID-19) who were treated between May 25, 2021, and October 15, 2021, for suspected pulmonary embolism based on laboratory findings was conducted. RESULTS: Of the total number of patients (58.5% female, 41.5% male), the majority were aged between 60 and 69 years. Pulmonary embolism was confirmed in 42 patients, which constituted 21% of the total number. This group included 36% males and 62% females. When the localization of thromboemboli was assessed, it was found that 64.3% of cases had a peripheral localization, 24% of cases had thromboemboli at the level of lobular branches, 7.1% of cases had thromboemboli in the main arteries and pulmonary trunk, and 4.6% of cases had thromboemboli in the pulmonary trunk. In the assessment of pulmonary perfusion disorders, the majority of patients exhibited a degree of severity classified as I (78.6%), with a smaller proportion classified as III or IV (11.9% and 9.5%, respectively). A statistical analysis of the incidence of pulmonary embolism in patients with varying degrees of pneumonia severity revealed that in over half of the cases, the condition was confirmed in patients with minimal pulmonary parenchyma lesions. Specifically, 22 (52.4%) patients exhibited this pattern. The second part accounted for 16.6% of cases with critical severity of pneumonia, 16.7% with moderate severity, 11.9% with significant severity, and only 2.4% of cases with regression of inflammatory infiltration. Among patients with pulmonary embolism, pneumonia was in the advanced stage in 35.7% of cases, the peak stage in 33.3%, the incomplete stage in 21.4%, the early stage in 7.2%, and the resolution stage in 2.4%. However, when comparing the severity and stage of pneumonia in patients with confirmed and unconfirmed pulmonary embolism, no statistically significant differences between these parameters were found (p 0.05). CONCLUSIONS: Among patients with suspected pulmonary embolism and viral pneumonia, 21% had a confirmed diagnosis. Of these, 64.3% had a peripheral localization of thromboemboli, 78.6% had grade I impairment of pulmonary perfusion, and most cases were in the advanced (35.7%) and peak (33.3%) st
背景:病毒性肺炎是冠状病毒感染的一种严重并发症,有可能危及生命。它可导致一系列不良后果,包括肺栓塞。然而,人们对这些患者肺栓塞的发病率仍然知之甚少。多螺旋计算机断层扫描血管造影术提供了一种宝贵的工具,可用于研究这种疾病辐射诊断的独特特征,并确定这种并发症的具体征兆。目的:本研究旨在利用多螺旋计算机断层扫描血管造影术改进对 SARS-CoV-2 病毒诱发肺炎患者肺栓塞的诊断。材料与方法:对 2021 年 5 月 25 日至 2021 年 10 月 15 日期间接受治疗的 200 例病毒性肺炎(COVID-19)患者的病历和多螺旋计算机断层扫描血管造影数据进行了回顾性审查,根据实验室结果对疑似肺栓塞进行了诊断。结果:在所有患者中(58.5% 为女性,41.5% 为男性),大多数患者的年龄在 60 岁至 69 岁之间。42名患者确诊为肺栓塞,占总人数的21%。其中男性占 36%,女性占 62%。在对血栓栓子的定位进行评估时发现,64.3%的病例定位在外周,24%的病例血栓栓子位于肺叶分支,7.1%的病例血栓栓子位于主动脉和肺动脉干,4.6%的病例血栓栓子位于肺动脉干。在肺灌注障碍的评估中,大多数患者的严重程度为 I 级(78.6%),III 级或 IV 级的比例较小(分别为 11.9% 和 9.5%)。对不同肺炎严重程度患者的肺栓塞发生率进行统计分析后发现,在超过一半的病例中,肺实质病变极小的患者被确诊为肺栓塞。具体来说,有 22 例(52.4%)患者表现出这种模式。第二部分中,16.6%的病例为肺炎临界严重程度,16.7%为中度严重程度,11.9%为重度严重程度,只有 2.4%的病例炎症浸润消退。在肺栓塞患者中,35.7%的病例处于肺炎晚期,33.3%的病例处于肺炎高峰期,21.4%的病例处于肺炎未完全期,7.2%的病例处于肺炎早期,2.4%的病例处于肺炎缓解期。然而,在比较确诊和未确诊肺栓塞患者的肺炎严重程度和阶段时,发现这些参数之间没有统计学意义上的显著差异(P 0.05)。结论:在疑似肺栓塞和病毒性肺炎患者中,21%的患者得到确诊。其中,64.3%的患者血栓栓塞部位在外周,78.6%的患者肺灌注出现一级损伤,大多数病例处于肺炎晚期(35.7%)和高峰期(33.3%)。肺栓塞的发生率、病毒性肺炎的严重程度和阶段之间没有相关性。
{"title":"Diagnosis of pulmonary embolism in patients with viral pneumonia using multislice spiral computed tomographic angiography","authors":"Ekaterina P. Kalinina, I. B. Belova","doi":"10.17816/dd626886","DOIUrl":"https://doi.org/10.17816/dd626886","url":null,"abstract":"BACKGROUND: Viral pneumonia represents a significant and potentially life-threatening complication of coronavirus infection. It can result in a range of adverse outcomes, including pulmonary embolism. However, the prevalence of pulmonary embolism in these patients remains poorly understood. Multispiral computed tomographic angiography offers a valuable tool for studying the unique characteristics of radiation diagnostics in this disease and identifying specific signs of this complication. \u0000AIM: The aim of this study is to improve the diagnosis of pulmonary embolism in patients with SARS-CoV-2 virus-induced pneumonia using multispiral computed tomographic angiography. \u0000MATERIALS AND METHODS: A retrospective review of medical records and multispiral computed tomographic angiography data from 200 patients with viral pneumonia (COVID-19) who were treated between May 25, 2021, and October 15, 2021, for suspected pulmonary embolism based on laboratory findings was conducted. \u0000RESULTS: Of the total number of patients (58.5% female, 41.5% male), the majority were aged between 60 and 69 years. Pulmonary embolism was confirmed in 42 patients, which constituted 21% of the total number. This group included 36% males and 62% females. When the localization of thromboemboli was assessed, it was found that 64.3% of cases had a peripheral localization, 24% of cases had thromboemboli at the level of lobular branches, 7.1% of cases had thromboemboli in the main arteries and pulmonary trunk, and 4.6% of cases had thromboemboli in the pulmonary trunk. In the assessment of pulmonary perfusion disorders, the majority of patients exhibited a degree of severity classified as I (78.6%), with a smaller proportion classified as III or IV (11.9% and 9.5%, respectively). A statistical analysis of the incidence of pulmonary embolism in patients with varying degrees of pneumonia severity revealed that in over half of the cases, the condition was confirmed in patients with minimal pulmonary parenchyma lesions. Specifically, 22 (52.4%) patients exhibited this pattern. The second part accounted for 16.6% of cases with critical severity of pneumonia, 16.7% with moderate severity, 11.9% with significant severity, and only 2.4% of cases with regression of inflammatory infiltration. Among patients with pulmonary embolism, pneumonia was in the advanced stage in 35.7% of cases, the peak stage in 33.3%, the incomplete stage in 21.4%, the early stage in 7.2%, and the resolution stage in 2.4%. However, when comparing the severity and stage of pneumonia in patients with confirmed and unconfirmed pulmonary embolism, no statistically significant differences between these parameters were found (p 0.05). \u0000CONCLUSIONS: Among patients with suspected pulmonary embolism and viral pneumonia, 21% had a confirmed diagnosis. Of these, 64.3% had a peripheral localization of thromboemboli, 78.6% had grade I impairment of pulmonary perfusion, and most cases were in the advanced (35.7%) and peak (33.3%) st","PeriodicalId":34831,"journal":{"name":"Digital Diagnostics","volume":" 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141680675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Diagnosis of diabetic polyneuropathy in type 2 diabetes mellitus: focus on changes in peripheral nerves according to ultrasonic research method 2 型糖尿病多发性神经病变的诊断:根据超声波研究方法关注周围神经的变化
Pub Date : 2024-07-03 DOI: 10.17816/dd626159
Zoya V. Karaseva, A. S. Ametov, Victoria G. Saltykova, E. Pashkova, Larisa V. Kuznetsova, Ksenia G. Yudina
BACKGROUND: Diabetic polyneuropathy remains a significant and urgent problem in the context of diabetes mellitus, affecting more than a quarter of patients with type 2 diabetes mellitus. Currently, the method of peripheral nerve examination using ultrasound is gaining worldwide popularity. In the Russian Federation, however, it remains widely used only in some medical institutions. The ultrasound method employs the indicator “nerve cross-sectional area” to diagnose this complication, exhibiting a high degree of sensitivity (93%) in comparison to magnetic resonance imaging data (67%). Foreign and Russian studies [3, 4] confirm the observed increase in the cross-sectional area of the nerve in patients with diabetes mellitus. AIM: The study aimed to assess the diagnostic value of the ultrasound method of peripheral nerve examination in the detection of diabetic polyneuropathy in patients with type 2 diabetes mellitus. MATERIALS AND METHODS: The Philips Epiq 7 ultrasonic diagnostic device (USA) with a linear transducer, operating at a frequency of 4–18 MHz, was used. The comparison group consisted of 30 volunteers. The main group comprised 25 patients with type 2 diabetes mellitus and confirmed diabetic polyneuropathy, as determined by electroneuromyography and physical examination methods. The median cross-sectional area of the sciatic and common peroneal nerves in patients with type 2 diabetes mellitus and healthy volunteers was calculated. The criterion for a difference in area values was calculated using the Mann-Whitney test. RESULTS: The cross-sectional area thresholds were determined based on the 95th percentile of a cohort of healthy volunteers. In patients with type 2 diabetes mellitus, the following median nerve cross-sectional area values were found: for the sciatic nerve, 0.579 cm2 (at the gluteal crease) and 0.553 cm2 (2 cm proximal to the bifurcation); for the common peroneal nerve, 0.11 cm2 (1 cm distal to the bifurcation of the sciatic nerve) and 0.08 cm2 (at the level of the head of the fibula). In healthy volunteers, the values were as follows: for the sciatic nerve, 0.46 cm2 (at the gluteal crease) and 0.37 cm2 (2 cm proximal to the bifurcation); for the common peroneal nerve, 0.08 cm2 (1 cm distal to the bifurcation of the sciatic nerve) and 0.06 cm2 (at the level of the head of the fibula). A significant difference was found between the control and target groups using the Mann-Whitney test (p 0.01). CONCLUSIONS: In patients with type 2 diabetes mellitus and diabetic polyneuropathy, a significant increase in the cross-sectional area of the nerves of the lower extremities (sciatic and peroneal nerves) was revealed, which allows for the use of ultrasound as an additional method for the instrumental diagnosis of diabetic polyneuropathy. However, due to the small sample size, further study is required to confirm these findings.
背景:糖尿病多发性神经病变仍然是糖尿病的一个重要而紧迫的问题,超过四分之一的 2 型糖尿病患者会受到影响。目前,使用超声波进行周围神经检查的方法在全世界越来越受欢迎。但在俄罗斯联邦,这种方法仍只在一些医疗机构广泛使用。超声波方法采用 "神经横截面积 "指标来诊断这种并发症,与磁共振成像数据(67%)相比,具有很高的灵敏度(93%)。国外和俄罗斯的研究[3, 4]证实,糖尿病患者的神经横截面积有所增加。目的:本研究旨在评估超声周围神经检查法在检测 2 型糖尿病患者糖尿病多发性神经病变方面的诊断价值。材料与方法:使用飞利浦 Epiq 7 超声波诊断仪(美国),其线性换能器的工作频率为 4-18 兆赫。对比组由 30 名志愿者组成。主研究组由 25 名 2 型糖尿病患者组成,并通过电神经肌电图和体格检查方法确诊为糖尿病多发性神经病变。计算了 2 型糖尿病患者和健康志愿者坐骨神经和腓总神经的中位横截面积。使用曼-惠特尼检验计算面积值差异的标准。结果:横截面积阈值是根据健康志愿者队列的第 95 百分位数确定的。2 型糖尿病患者的正中神经横截面积值如下:坐骨神经为 0.579 平方厘米(臀部皱襞处)和 0.553 平方厘米(分叉处近端 2 厘米处);腓总神经为 0.11 平方厘米(坐骨神经分叉处远端 1 厘米处)和 0.08 平方厘米(腓骨头水平处)。健康志愿者的数值如下:坐骨神经 0.46 cm2(臀部皱襞处)和 0.37 cm2(分叉处近端 2 cm);腓总神经 0.08 cm2(坐骨神经分叉处远端 1 cm)和 0.06 cm2(腓骨头水平)。使用 Mann-Whitney 检验发现,对照组和目标组之间存在明显差异(P 0.01)。结论:在 2 型糖尿病合并糖尿病多发性神经病变的患者中,下肢神经(坐骨神经和腓肠神经)的横截面积显著增加,这使得超声波成为糖尿病多发性神经病变器质性诊断的一种补充方法。不过,由于样本量较小,还需要进一步研究来证实这些发现。
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引用次数: 0
Emission textural features I-131 of differentiated thyroid cancer tissue 分化型甲状腺癌组织的 I-131 发射纹理特征
Pub Date : 2024-07-03 DOI: 10.17816/dd626496
Mikhail S. Maltsev, A. A. Trukhin, A. V. Manaev, M. V. Reinberg
BACKGROUND: The management of differentiated thyroid cancer includes single-photon emission tomography combined with X-ray computed tomography after radioiodine therapy. Despite a good response to surgery and radioiodine therapy, recurrence is noted in some cases, leading to an unfavorable prognosis in 8% of cases [1]. A preliminary analysis of the distribution of I-131 in residual thyroid tissues and foci of metastasis allows for the estimation of the probability of differentiated cancer recurrence. Currently, there is no method that is simultaneously effective and easy to perform for predicting the recurrence of differentiated thyroid cancer. AIM: The aim of the study was to develop a technique for extracting and computing textural features of the I-131 accumulation region using a single-photon emission tomography system corresponding to differentiated thyroid cancer tissue. MATERIALS AND METHODS: A retrospective analysis of single-photon emission tomography combined with X-ray computed tomography of the neck and thorax of 23 patients was conducted. Regions of interest, including foci of I-131 accumulation in the primary tumor bed, regional and distant metastases, were delineated in Xeleris 4DR software. The obtained mask with the original image was processed in a program written with the help of the Matlab package, which localizes the foci. The textural features of foci are calculated based on the obtained spatial adjacency matrix. This matrix shows how often pixels with certain gray scale brightness values occur in an image. Therefore, the features based on the spatial adjacency matrix reflect the frequency distribution of different pixel neighborhoods in a given context. RESULTS: An algorithm for constructing three-dimensional matrices of a radiation source surrounded by tissue of differentiated thyroid cancer was developed. The textural features of three-dimensional matrices were investigated. It was demonstrated that there are tendencies for differences in texture features corresponding to the ordering of pixel values and image contrast. The values of the obtained features obey the lognormal distribution. CONCLUSIONS: An algorithm for extracting textural features of I-131 accumulation foci allows post-therapy single-photon emission tomography images combined with X-ray computed tomography to be analyzed for the likelihood of recurrence of differentiated thyroid cancer.
背景:分化型甲状腺癌的治疗包括放射碘治疗后的单光子发射断层扫描和 X 射线计算机断层扫描。尽管手术和放射性碘治疗反应良好,但仍有一些病例出现复发,导致8%的病例预后不良[1]。对残留甲状腺组织和转移灶中的I-131分布进行初步分析,可以估计分化癌复发的概率。目前,预测分化型甲状腺癌复发还没有一种既有效又简便的方法。目的:本研究旨在开发一种技术,利用单光子发射断层成像系统提取和计算分化型甲状腺癌组织相应的 I-131 累积区的纹理特征。材料与方法:研究人员对 23 名患者的颈部和胸部单光子发射断层扫描结合 X 射线计算机断层扫描进行了回顾性分析。在 Xeleris 4DR 软件中划定了感兴趣的区域,包括原发肿瘤床、区域和远处转移灶的 I-131 聚集灶。利用 Matlab 软件包编写的程序对获得的掩膜和原始图像进行处理,从而确定病灶的位置。病灶的纹理特征是根据获得的空间邻接矩阵计算出来的。该矩阵显示了具有特定灰度亮度值的像素在图像中出现的频率。因此,基于空间邻接矩阵的特征反映了不同像素邻域在给定上下文中的频率分布。结果:开发出了一种构建分化型甲状腺癌组织周围辐射源三维矩阵的算法。研究了三维矩阵的纹理特征。结果表明,与像素值排序和图像对比度相对应的纹理特征存在差异趋势。获得的特征值服从对数正态分布。结论通过一种提取 I-131 积聚灶纹理特征的算法,可以结合 X 射线计算机断层扫描对治疗后的单光子发射断层扫描图像进行分析,以确定分化型甲状腺癌复发的可能性。
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引用次数: 0
Anthropomorphic abdominal aortic phantoms for computed tomography angiography 用于计算机断层扫描血管造影的拟人化腹主动脉模型
Pub Date : 2024-07-03 DOI: 10.17816/dd626820
Anastasia V. Guseva, M. Kodenko
BACKGROUND: Anthropomorphic vascular test objects are an important tool for improving computed tomography angiography studies, as they allow avoiding the impact of radiation exposure on the patient. The presented work is a continuation of the research in the field of development and implementation of the system of pulse blood flow simulation of vessels for computed tomography angiography studies. Based on the results of successful validation of the experimental test bench using simplified test objects [1], the work on creation of anthropomorphic test objects of the abdominal aorta imitating normal and aneurysmatically dilated vessels was initiated and carried out. AIM: Creation of anthropomorphic test objects of the abdominal aorta from materials that simultaneously mimic the biomechanical and X-ray properties of the real vessel. MATERIALS AND METHODS: Publicly available computed tomography data of patients were selected to create anthropomorphic test objects [2]. 3D Slicer software was used to segment studies containing normal and aneurysmatically dilated abdominal aortic lumen. The models obtained during segmentation were processed using Autodesk Meshmixer computer-aided design system. Model preparation for printing was performed using Polygon X computer-aided design system. The models were printed from water-soluble plastic using Picaso X PRO 3D printer. The resulting model was used as the basis for creating a test object using the smearing method. In order to ensure uniform thickness of the vessel wall, a structure, which is a rotating frame with adjustable speed, was developed. A combination of silicone matrix and reinforcing threads was used as a tissueimitating material with the required X-ray and biomechanical properties [3]. RESULTS: Anthropomorphic test objects were made for cases of normal and aneurysmatically dilated abdominal aortic lumen in 1:3 and 1:1 scale. A technological process of material application was developed, which made it possible to obtain a uniform layer of material over the entire volume of the model. CONCLUSION: The results are intended for the development of computed tomography angiographyusing anthropomorphic test objects that allow taking into account the individual characteristics of the patient. Further development of the project involves testing of the obtained test objects within the framework of computed tomography angiography research using a device simulating pulse blood flow.
背景:拟人化血管测试对象是改进计算机断层扫描血管成像研究的重要工具,因为它们可以避免辐射对病人的影响。本文介绍的工作是计算机断层扫描血管成像研究中血管脉冲血流模拟系统开发和实施领域研究的继续。在使用简化测试对象成功验证实验测试台的结果[1]的基础上,开始并实施了仿造正常血管和动脉瘤扩张血管的腹主动脉拟人测试对象的创建工作。目的:用能同时模拟真实血管的生物力学和 X 射线特性的材料制作腹主动脉拟人化测试物体。材料和方法:选择公开的患者计算机断层扫描数据来创建拟人测试对象[2]。使用 3D Slicer 软件对包含正常和动脉瘤扩张腹主动脉管腔的研究进行分割。分割过程中获得的模型使用 Autodesk Meshmixer 计算机辅助设计系统进行处理。打印模型的准备工作使用 Polygon X 计算机辅助设计系统进行。使用 Picaso X PRO 三维打印机用水溶性塑料打印模型。生成的模型被用作使用涂抹法创建测试对象的基础。为了确保血管壁的厚度均匀一致,我们开发了一种结构,即一个速度可调的旋转框架。硅酮基质和加强线的组合被用作组织模拟材料,具有所需的 X 射线和生物力学特性[3]。结果:以 1:3 和 1:1 的比例为正常和动脉瘤扩张的腹主动脉管腔制作了拟人化的测试对象。开发了一种材料应用技术流程,从而可以在模型的整个体积上获得均匀的材料层。结论:该成果旨在利用拟人化测试对象开发计算机断层扫描血管成像技术,从而考虑到病人的个体特征。该项目的进一步发展包括在计算机断层扫描血管成像研究框架内使用模拟脉搏血流的设备对获得的测试对象进行测试。
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引用次数: 0
“Live surgery” as a modern and visual way of training medical specialists "现场手术 "是培训医学专家的一种现代化和可视化方式
Pub Date : 2024-07-03 DOI: 10.17816/dd627090
Alexander A. Fedortsov, I. Moshurov, O. V. Manukovskaya, S. M. Povarkov
BACKGROUND: The teaching of surgical skills is a complex and time-consuming process. From the time when surgery became the primary method of curing patients of diseases to the present day, the transfer of knowledge through direct participation in surgical interventions remains relevant. However, technically complex interventions, as well as those that carry a high risk of error, cannot always be allowed to be performed as a learning process. In such cases, the term “live surgery” becomes particularly relevant, as it refers to a demonstration surgery conducted in real time and broadcast on screens in a lecture-dialogue format [1]. This format is particularly valuable in the training of oncologists, whose patients initially face a number of intra- and postoperative surgical risks. AIM: The aim of this study is to demonstrate the efficacy of live surgery as an effective tool for teaching surgical skills to physicians. MATERIALS AND METHODS: A descriptive synthesis of the literature data was conducted to justify the need to implement live surgery in the process of training physician specialists. In the course of writing the paper, studies reflecting various aspects of the process of training physicians in surgical skills using telecommunication technologies were analyzed. RESULTS: In all the studies analyzed, the authors agree that the use of telecommunication technologies that facilitate live surgery sessions for the transfer of knowledge regarding operative techniques to specialists has educational value and presents an opportunity to present a list of practical skills necessary for surgical intervention in a visual and step-by-step manner [1–8]. C. T. Huerta et al. posit that live surgery broadcasts have a greater educational effect than similar manipulations presented by video recordings [2]. A significant number of authors engaged in the study of the potential applications of live surgery have sought to ascertain the safety of this procedure for the patient. The majority of these studies have demonstrated that live broadcasts do not result in an increased incidence of intra- and postoperative complications [1, 3–5], yet a few researchers have identified potential risks, which, when properly mitigated, can be effectively managed through the implementation of a set of rules for live surgery [6, 7]. Furthermore, it is important to obtain the patient’s consent to live surgical treatment prior to the event [7]. CONCLUSIONS: To summarize the above, live surgery can be considered an effective method for training medical specialists in surgical skills. Its use should become regular and technically practiced. At the same time, in order to avoid any potential harm to the patient's health, it is necessary to adhere to the clear rules of live surgery, having previously obtained the patient's informed consent to participate in this event.
背景:外科手术技能的传授是一个复杂而耗时的过程。从外科手术成为治疗病人疾病的主要方法至今,通过直接参与外科手术干预来传授知识仍然具有现实意义。然而,技术复杂的介入手术以及那些出错风险较高的手术不能总是作为学习过程来进行。在这种情况下,"现场手术 "一词就变得尤为重要,因为它指的是以讲座-对话的形式在屏幕上实时播放的示范手术[1]。这种形式对肿瘤医生的培训尤其有价值,因为肿瘤医生的病人最初会面临术中和术后的一些手术风险。目的:本研究旨在证明直播手术作为向医生传授手术技能的有效工具的有效性。材料与方法:我们对文献资料进行了描述性综合,以证明在培训专科医生的过程中实施现场手术的必要性。在撰写论文的过程中,分析了反映利用远程通信技术培训医生手术技能过程的各个方面的研究。结果:在所分析的所有研究中,作者都认为使用远程通信技术促进现场手术课程,向专科医生传授手术技术知识具有教育价值,并提供了一个机会,以直观和循序渐进的方式展示手术干预所需的实用技能列表[1-8]。C. T. Huerta 等人认为,手术直播比通过视频录制的类似操作具有更大的教育效果[2]。许多从事实况手术潜在应用研究的学者试图确定这种手术对病人的安全性。这些研究大多表明,直播不会导致术中和术后并发症的发生率增加[1, 3-5],但也有少数研究人员发现了潜在的风险,这些风险如果得到适当缓解,可以通过实施一套直播手术的规则得到有效控制[6, 7]。此外,在手术前征得患者对直播手术治疗的同意也很重要[7]。结论:综上所述,真人手术可被视为培训医学专家外科技能的有效方法。这种方法应经常使用,并在技术上加以实践。同时,为了避免对患者的健康造成任何潜在伤害,有必要在事先征得患者的知情同意后,遵守现场手术的明确规则。
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引用次数: 0
Medical phantom of the knee joint for computed tomography studies 用于计算机断层扫描研究的膝关节医学模型
Pub Date : 2024-07-03 DOI: 10.17816/dd627089
Ekaterina D. Belyakova, Anastasia A. Nasibullina, Julia V. Bulgakova, Olga Vlasova, Veronika V. Grebennikova, O. Omelyanskaya, A. Petraikin, D. Leonov
BACKGROUND: The knee joint is a frequently visualized anatomical region in clinical practice. Accurate interpretation of CT scans necessitates a comprehensive understanding of anatomy and a sound grasp of fundamental technical principles and imaging protocols. To safeguard the patient's well-being, it is of paramount importance to prevent erroneous studies resulting from suboptimal equipment quality, setup issues, and patient positioning. These difficulties can be circumvented by the use of phantoms to pre-adjust the equipment and the provision of training to medical staff in scanning techniques. AIM: The aim of the study was to develop a technique for creating an anthropomorphic medical phantom of the knee joint that would accurately reflect the X-ray density of the corresponding human tissues, thus enabling the use of computed tomography studies. MATERIALS AND METHODS: The knee joint phantom comprises a series of models representing the femur, tibia, fibula, patella, collateral ligaments, lateral and medial menisci, tendon of the quadriceps femoris muscle, anterior and posterior cruciate ligaments, and patellar ligament. Ligament models were 3D-printed from resin, bones were cast from silicone, soft tissues were modeled with a homogeneous structure of silicone-like materials and made by casting into silicone molds. The skin was similarly modeled. In the study, the anode voltage range of the CT scanner varied from 80 to 140 kV, and the slice thickness was equal to 1.25 mm. RESULTS: The developed anthropomorphic knee joint phantom demonstrated the X-ray density of the modeled anatomical structures, with ligaments exhibiting a range of 80–120 units on the Hausfield scale, bones exhibiting a range of 320–370 units, and soft tissues and skin exhibiting a range of 20–60 units. The use of additive technologies made it possible to achieve a high degree of similarity between the phantom forms and the knee joint. Further research may be directed towards the creation of a more complex model of bone tissue, comprising a separate cortical layer and spongy substance. CONCLUSIONS: The use of an anthropomorphic knee phantom allows for the acquisition of high-quality CT images without the need for prior scanning of patients.
背景:膝关节是临床实践中经常可视化的解剖区域。准确解读 CT 扫描需要对解剖学有全面的了解,并熟练掌握基本技术原理和成像协议。为了保障患者的健康,最重要的是防止因设备质量不佳、设置问题和患者体位造成的错误研究。使用模型预先调整设备,并对医务人员进行扫描技术培训,可以避免这些困难。目的:本研究的目的是开发一种技术,用于制作膝关节的拟人化医学模型,该模型能准确反映相应人体组织的 X 射线密度,从而使计算机断层扫描研究得以使用。材料和方法:膝关节模型由一系列模型组成,分别代表股骨、胫骨、腓骨、髌骨、副韧带、外侧和内侧半月板、股四头肌肌腱、前后交叉韧带和髌韧带。韧带模型是用树脂三维打印的,骨骼是用硅胶浇铸的,软组织是用硅胶类材料的均匀结构建模的,并通过浇铸到硅胶模具中制成。皮肤也是类似的模型。研究中,CT 扫描仪的阳极电压范围为 80 至 140 千伏,切片厚度为 1.25 毫米。结果:开发的拟人膝关节模型展示了建模解剖结构的 X 射线密度,其中韧带的 Hausfield 密度范围为 80-120 个单位,骨骼的 Hausfield 密度范围为 320-370 个单位,软组织和皮肤的 Hausfield 密度范围为 20-60 个单位。添加技术的使用使模型与膝关节之间达到高度相似成为可能。进一步研究的方向可能是创建更复杂的骨组织模型,包括独立的皮质层和海绵物质。结论:使用拟人膝关节模型可以获取高质量的 CT 图像,而无需事先对患者进行扫描。
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引用次数: 0
Review of tissue-mimicking materials for anthropomorphic modeling of arterial vessels 用于动脉血管拟人建模的组织仿真材料综述
Pub Date : 2024-07-03 DOI: 10.17816/dd626907
Dariya I. Abyzova, M. Kodenko
BACKGROUND: In computed tomographic angiography, anthropomorphic specimens made of tissue-mimicking materials are used to improve the diagnosis of pathological changes in arteries. The design of test objects requires the selection of materials with properties that correctly reproduce the biomechanical and radiographic characteristics of the arterial wall. Tissue-mimicking materials used in modern specimens do not always take into account the conditions under which the arterial wall functions in vivo [1]. In addition, the selection of materials is required to simulate pathological processes, such as changes in the thickness of the arterial wall in the area of the aneurysm, simulation of thrombus [2]. The choice of tissue-mimicking materials to create a test specimen has a significant impact on the results of studies conducted with these materials. AIM: The aim of this study is to ascertain the biomechanical and X-ray properties of tissue-mimicking materials for the anthropomorphic modeling of arterial vascular test objects. MATERIALS AND METHODS: A literature analysis was conducted to investigate the potential of tissue-mimicking materials for the creation of arterial vessel test objects. The search query included the following keywords: abdominal aorta, aneurysm, CT-angiography, tissue-mimicking material, test objects, and mechanical properties of the arterial wall. The results of the literature review were used to investigate the biomechanical characteristics of the arterial vessel wall in a healthy state and in aneurysm. The advantages and disadvantages of different types of tissue-mimicking materials were analyzed. In the course of this analysis, the requirements for biomechanical and X-ray properties of tissue-mimicking materials were formulated. A ranked list of tissue-mimicking materials for the creation of anthropomorphic test objects of arterial vessels for studies by computed tomographic angiography was prepared. RESULTS: During the course of the work, the requirements for biomechanical and X-ray properties of tissue-imitating materials for the creation of an arterial vessel test object were formulated. Further development of the topic will entail the expansion of the number of simulated pathologies and the search for universal materials suitable for the creation of multimodal test objects. CONCLUSIONS: The results obtained can be used to improve arterial vascular test objects.
背景:在计算机断层扫描血管造影术中,用组织模拟材料制成的拟人化标本可用于改善动脉病理变化的诊断。设计测试对象需要选择具有能正确再现动脉壁的生物力学和放射学特性的材料。现代标本中使用的组织模拟材料并不总是考虑到动脉壁在体内发挥作用的条件[1]。此外,材料的选择还需要模拟病理过程,如动脉瘤区域动脉壁厚度的变化、血栓的模拟[2]。选择仿组织材料制作测试样本对使用这些材料进行研究的结果有重大影响。目的:本研究旨在确定用于动脉血管测试对象拟人建模的仿组织材料的生物力学和 X 射线特性。材料与方法:为研究仿组织材料在创建动脉血管测试对象方面的潜力,我们进行了文献分析。搜索关键词包括:腹主动脉、动脉瘤、CT 血管造影、组织模拟材料、测试对象和动脉壁的机械性能。文献综述的结果用于研究动脉血管壁在健康状态和动脉瘤状态下的生物力学特性。分析了不同类型组织模拟材料的优缺点。在分析过程中,对组织模拟材料的生物力学和 X 射线特性提出了要求。编制了一份组织仿真材料排名表,用于创建拟人化的动脉血管测试对象,供计算机断层扫描血管造影研究使用。结果:在工作过程中,制定了用于制作动脉血管测试对象的仿组织材料的生物力学和 X 射线特性要求。该课题的进一步发展需要扩大模拟病理的数量,并寻找适合创建多模态测试对象的通用材料。结论:所获得的结果可用于改进动脉血管测试对象。
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引用次数: 0
Artificial intelligence technologies in the activities of primary healthcare in Moscow 莫斯科初级保健活动中的人工智能技术
Pub Date : 2024-07-03 DOI: 10.17816/dd626790
E. V. Blokhina, A. S. Bezymyannyy
BACKGROUND: In recent years, the healthcare sector has emerged as a key area where artificial intelligence technologies are gaining strategic importance. In particular, the implementation of these technologies in primary healthcare has demonstrated particular relevance and importance [1–3]. AIM: The aim of the study is to characterize the stages of implementation of artificial intelligence technologies in the activities of urban polyclinics in Moscow. MATERIALS AND METHODS: Analytical, statistical, socio-hygienic, and experimental methods were used. RESULTS: The primary objective of integrating artificial intelligence into the operations of city polyclinics was to enhance the efficacy of medical data processing, mitigate the likelihood of professional missteps, and optimize the coordination of interactions between different medical professionals. The initial challenge of processing a vast quantity of information was met by the implementation of artificial intelligence in the analysis of electronic medical records. This approach resulted in the development of integrated and secure systems that facilitate the accessibility of patient data to physicians and medical staff for the purpose of quality of care analysis. In addressing the second task of using artificial intelligence technologies to provide consulting services to physicians in making a diagnosis, the work was carried out in several stages. In 2020, the top three medical decision support systems were implemented, which assist therapists in making preliminary diagnoses based on the International Classification of Diseases 10th revision (ICD-10). Since 2023, the Diagnostic Assistant system, which analyzes data from a patient’s electronic medical record and offers a second opinion on a confirmed diagnosis, has been actively used. Currently, this system includes 95 codes of ICD-10 and similar diagnoses, with plans to expand its functionality to 268 diagnoses. As a consequence of the training and implementation of the expansion, the system will be capable of covering approximately 85% of the most frequently established confirmed diagnoses. A considerable number of expert physicians were involved in the establishment and evaluation of the systems, with over 10,000 cases being handled. In December 2023, a pilot project was conducted at the City Polyclinic No. 64 (Moscow) with the involvement of almost 100 doctors of this medical institution to identify the possibility of improving the reliability of the model. According to its results, it was found that the diagnoses made by the doctor and the artificial intelligence system coincide by 89%. Despite the impressive achievements of technology, it is important to emphasize that the use of artificial intelligence is not intended to replace the doctor, but rather serves as a second opinion in the work of a specialist. CONCLUSIONS: The integration of artificial intelligence into the operations of Moscow’s polyclinics not only reduces the time re
背景:近年来,医疗保健领域已成为人工智能技术越来越具有战略重要性的关键领域。特别是,在初级医疗保健领域实施这些技术已显示出特别的相关性和重要性[1-3]。目的:本研究旨在描述莫斯科城市综合诊所活动中人工智能技术的实施阶段。材料与方法:采用了分析、统计、社会卫生学和实验方法。结果:将人工智能融入城市综合诊所运营的主要目的是提高医疗数据处理的效率,降低专业失误的可能性,优化不同医疗专业人员之间的互动协调。人工智能在电子病历分析中的应用应对了处理海量信息的初步挑战。通过这种方法,开发出了综合安全系统,方便医生和医务人员获取病人数据,进行医疗质量分析。第二项任务是利用人工智能技术为医生提供诊断咨询服务,这项工作分几个阶段进行。2020 年,实施了三大医疗决策支持系统,协助治疗师根据《国际疾病分类》第 10 次修订版(ICD-10)做出初步诊断。自 2023 年起,"诊断助手 "系统开始积极使用,该系统可分析患者电子病历中的数据,并就确诊提供第二意见。目前,该系统包括 95 个 ICD-10 和类似诊断代码,并计划将其功能扩展至 268 个诊断。经过培训和实施扩展后,该系统将能够涵盖约 85% 最常见的确诊诊断。大量专家医生参与了系统的建立和评估,处理了 10 000 多个病例。2023 年 12 月,在第 64 市综合诊所(莫斯科)开展了一个试点项目,该医疗机构的近 100 名医生参与其中,以确定提高该模型可靠性的可能性。结果发现,医生和人工智能系统的诊断结果吻合度高达 89%。尽管技术取得了令人瞩目的成就,但必须强调的是,人工智能的使用并不是为了取代医生,而是作为专家工作中的第二意见。结论:将人工智能融入莫斯科综合医院的运作不仅可以减少搜索和处理大量信息所需的时间,还有助于避免专业错误。此外,它还提高了整个莫斯科初级卫生保健的效率。
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引用次数: 0
期刊
Digital Diagnostics
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