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National radiotherapy dosimetry audit in the UK – A vision and roadmap 英国全国放射治疗剂量测量审计--愿景和路线图
Pub Date : 2024-09-25 DOI: 10.1016/j.ipemt.2024.100032
Sarah Misson , Antony L Palmer , Patricia Diez , Mohammed Hussein , Catharine H Clark
Radiotherapy dosimetry audit is an important element in the overall quality assurance of radiotherapy delivery and has become established as best practice prior to implementation of new equipment, techniques or clinical trials.
The Institute of Physics and Engineering in Medicine (IPEM) Interdepartmental Dosimetry Audit group (IDA) facilitates regional audits across the UK through a network of 8 regional chairs. This is a well-established and successful network utilising local staff resources and dosimetry equipment from each region to conduct audits for new radiotherapy equipment, techniques and annual reference audits. All dosimeters used are traceable to the National Physical Laboratory's (NPL) primary standard.
NPL and the National Radiotherapy Trials Quality Assurance Group (RTTQA) perform audits for new techniques and clinical trials in the UK. The IPEM IDA, NPL and RTTQA have a joint vision of a national audit network so that comprehensive audits can be offered to all UK centres and bring together all UK dosimetry audit data within a centralised database to facilitate coordinated national audits. This will also allow centres to access and review their data for anonymous benchmarking against other UK centres to support quality improvement.
Increasing the frequency and complexity of national audits to reflect current clinical practice is often inhibited by the cost of purchasing appropriate equipment. IPEM have now funded two phantoms that will enable national audits of gynae brachytherapy and head and neck external beam treatments through 2024–25.
The aim of this Position Paper is to provide an update on the activities of the IPEM IDA and present the future vision and roadmap for the three UK dosimetry audit groups.
放射治疗剂量测定审核是保证放射治疗整体质量的重要因素,已成为实施新设备、新技术或临床试验前的最佳做法。英国医学物理与工程研究所(IPEM)部门间剂量测定审核小组(IDA)通过由 8 个地区主席组成的网络,促进英国各地的地区审核工作。这是一个成熟而成功的网络,利用各地区的当地人力资源和剂量测定设备,对新的放射治疗设备、技术和年度参考审核进行审核。NPL 和国家放射治疗试验质量保证小组 (RTTQA) 对英国的新技术和临床试验进行审核。IPEM IDA、NPL 和 RTTQA 的共同愿景是建立一个国家审核网络,以便为英国所有中心提供全面审核,并将英国所有剂量测定审核数据集中到一个中央数据库中,以促进协调的国家审核。这也将使各中心能够访问和审查其数据,与英国其他中心进行匿名基准比较,以支持质量改进。增加国家审核的频率和复杂性以反映当前的临床实践,往往会受到购买适当设备的成本的限制。IPEM 现已资助了两台模型,这两台模型将在 2024-25 年间对妇科近距离放射治疗和头颈部体外射束治疗进行全国性审核。
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引用次数: 0
A review of the clinical value of mechanical ventilators and extracorporeal membrane oxygenation (ECMO) equipment 机械呼吸机和体外膜氧合(ECMO)设备的临床价值回顾
Pub Date : 2024-08-15 DOI: 10.1016/j.ipemt.2024.100031
David Stell , Dr Man Ting Kwong , Robert Megwa , Dr Tom Bashford , Dr. Emmanuel Akinluyi , Prof. P. John Clarkson
Acute healthcare providers operate large, diverse medical equipment inventories. Resources for managing these inventories is frequently scarce so must be prioritised such that maximum benefit is conferred per unit of expenditure.
This review identifies publications which have discussed the clinical value conferred by mechanical ventilation (MV) and by extra corporeal membrane oxygenation (ECMO). Respectively, mechanical ventilators and ECMO units are necessary to deliver these therapies. Systematic searches for publications which discuss the clinical value conferred by MV and by ECMO were conducted.
The identified articles included reviews, prospective studies, retrospective studies, and models. Most presented findings in terms of the cost-effectiveness ratio. The patient populations studied, and analytical methods used varied widely. The clinical value conferred by MV varied with dependencies on several factors including the age- and disease- profile of the patient population. It was not possible to infer these dependencies from the literature which exists for ECMO.
More relevant literature existed for MV, the more mature technology, than did for ECMO. The ECMO literature also tended to be more recent and included more modelling studies and fewer prospective studies. The data extracted could inform estimates of the clinical value likely to be delivered by mechanical ventilators operated by a specific institution. Estimates for ECMO are likely to carry greater uncertainty than those for MV.
急诊医疗机构拥有大量不同的医疗设备库存。用于管理这些库存的资源往往非常稀缺,因此必须确定优先次序,使每单位支出产生最大效益。本综述确定了讨论机械通气(MV)和体外膜肺氧合(ECMO)临床价值的出版物。机械通气和体外膜肺氧合分别是提供这些疗法所必需的设备。我们对讨论机械通气和体外膜肺氧合临床价值的出版物进行了系统性检索,发现的文章包括综述、前瞻性研究、回顾性研究和模型。大多数文章以成本效益比的形式介绍了研究结果。研究的患者群体和使用的分析方法差别很大。MV 带来的临床价值因多种因素而异,包括患者的年龄和疾病状况。与 ECMO 相比,MV 的相关文献更多,因为它是一种更成熟的技术。与 ECMO 相比,MV 技术更为成熟,相关文献也更多。ECMO 的文献往往更新近,包括更多的模型研究和较少的前瞻性研究。所提取的数据可为估算特定机构运行的机械通气设备可能提供的临床价值提供参考。ECMO 的估计值可能比 MV 的估计值具有更大的不确定性。
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引用次数: 0
The use of solar film elements on a neonate manikin surface to estimate the received output power of neonatal phototherapy lamp systems 利用新生儿人体模型表面的太阳膜元件估算新生儿光疗灯系统的接收输出功率
Pub Date : 2024-06-01 DOI: 10.1016/j.ipemt.2024.100029
D.M. Clarkson , P. Satodia

The work described was undertaken to develop a means to estimate the delivered power over the exposed body surface of a neonate receiving phototherapy. Previous work of the group had involved the use of discrete photodiodes distributed over a newborn manikin surface. It was considered that improved accuracy of sensing over curved surfaces would be provided with the use of flexible solar cell elements. A group of products based on amorphous silicon was identified as potentially suitable and a range of its properties investigated. These included the wavelength sensitivity, the relative sensitivity of similar elements and the cosine response of elements. It was identified that with selection of elements of matched sensitivity, specific element types were appropriate for intended use. A total of 44 discrete solar cell elements of three separate sizes was used to cover the previously used manikin surface and a dedicated interface circuit was designed and constructed. A handheld calibrated spectroradiometer provided a means to relate incident irradiance values within specific wavelength bands to corresponding optical power over the manikin surface. Initial use of the system is described together with future potential developments in relation to clinical applications and testing standards for neonatal phototherapy devices.

所述工作旨在开发一种方法,用于估算接受光疗的新生儿暴露体表的输出功率。该小组以前的工作涉及使用分布在新生儿人体模型表面的离散光电二极管。他们认为,使用柔性太阳能电池元件可以提高对曲面的感应精度。一组基于非晶硅的产品被认为可能适用,并对其一系列特性进行了调查。这些特性包括波长灵敏度、类似元件的相对灵敏度和元件的余弦响应。结果表明,只要选择灵敏度相匹配的元件,特定类型的元件就适合预期用途。共使用了 44 个三种不同尺寸的分立太阳能电池元件来覆盖以前使用过的人体模型表面,并设计和建造了一个专用接口电路。手持式校准光谱辐射计可将特定波长段内的入射辐照度值与人体模型表面上的相应光功率联系起来。本文介绍了该系统的初步使用情况,以及未来在临床应用和新生儿光疗设备测试标准方面的潜在发展。
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引用次数: 0
Experimental measurement of dosimetric parameters relevant to radioactive needlestick injury 放射性针刺伤相关剂量参数的实验测量
Pub Date : 2024-06-01 DOI: 10.1016/j.ipemt.2024.100028
Niamh Banks , Luke Collett , Farnoosh Zananiri

Nuclear medicine healthcare workers are exposed to the risk of radioactive needlestick injury. To quantify the severity of this risk, the activity deposited into the skin and the injury depth have been experimentally measured for input into skin dosimetry program VARSKIN+. Agar test objects were pierced by hand with a needle containing Tc-99m Hydroxymethylene Diphosphonate (HMDP). The deposited activity was measured by contamination monitor and converted into deposited volume. Injury depth was measured with a ruler by piercing the test objects with visible dye.

The median volume deposited into test objects without gloves was 100 ± 50 nl (standard error) (interquartile range (IQR): 50–320 nl). Through one glove, this was reduced to 50 ± 20 nl (IQR: 30 - 140 nl), however, the difference was not significant (p > 0.1). The volume deposited through two gloves was highly variable due to the increased force required to puncture. The median injury depth was 4.0 ± 0.4 mm (standard error).

Decontamination efficacy was investigated by rinsing alone, with hand soap and by application of decontamination agent RadiacWash. All decontamination methods were found to significantly decrease the activity deposited (p < 0.001). Test objects rinsed for 60 s had a mean reduction of 42 % ± 6 % (95 % confidence interval). There was no significant difference observed between decontamination methods. This may be due to differences in absorption time between the sample groups.

Skin dose estimates have been calculated in VARSKIN+ using the results of the experiment. For injuries without gloves, involving 1011 MBq/ml of Tc-99m HMDP, a skin dose of 11 ± 5 mSv (propagated standard error) was calculated. Immediate decontamination under running water is recommended to reduce the dose. Further research is encouraged to investigate the protection offered by gloves.

核医学医护人员面临放射性针刺伤害的风险。为了量化这种风险的严重程度,我们通过实验测量了沉积到皮肤中的放射性活度和损伤深度,并将其输入皮肤剂量测定程序 VARSKIN+。用含有 Tc-99m 羟甲基二膦酸盐 (HMDP) 的针头手工刺穿琼脂测试物体。用污染监测仪测量沉积活性,并将其转换为沉积体积。在不戴手套的情况下,沉积到测试物体中的体积中位数为 100 ± 50 毫微升(标准误差)(四分位距(IQR):50-320 毫微升)。戴上一只手套后,沉积量减少到 50 ± 20 毫升(IQR:30 - 140 毫升),但差异并不显著(p > 0.1)。由于穿刺所需的力量增加,通过两只手套的沉积量变化很大。中位损伤深度为 4.0 ± 0.4 毫米(标准误差)。所有去污方法都能显著降低沉积的活性(p < 0.001)。冲洗 60 秒的测试对象平均减少了 42 % ± 6 %(95 % 置信区间)。去污方法之间没有明显差异。VARSKIN+ 根据实验结果计算出了皮肤剂量估计值。对于不戴手套的伤害,涉及 1011 MBq/ml 的 Tc-99m HMDP,计算出的皮肤剂量为 11 ± 5 mSv(传播标准误差)。建议立即在流水下进行消毒,以降低剂量。鼓励进一步研究手套提供的保护。
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引用次数: 0
Role of Coriolis flow measurement technology in validation of model of syringe driver performance 科里奥利流量测量技术在验证注射器驱动器性能模型中的作用
Pub Date : 2024-04-12 DOI: 10.1016/j.ipemt.2024.100027
D.M. Clarkson , M. Tshangini

The development of a flow/pressure measurement system in association with Bronkhorst High-Tech B.V. incorporating a Coriolis flow transducer, provided an opportunity to observe the flow/pressure dynamics of syringe drivers. A model of flow/pressure performance of syringe drivers was established where key variable factors included the compliance of the connected system and the associated line resistance. It was identified that the flow/pressure dynamics observed with the flow measurement system incorporating the Coriolis transducer matched that of the model. In this consideration the dominant compliance contribution related to that of the syringe. The model operates by considering the notional volume change in the residual fluid volume in the syringe with inflow from stepper motor action and outflow in the interval between sequential pulses. While many of the observations in the literature of syringe driver function are qualitative, the model allows a more precise prediction of associated device performance.

与布琅轲锶特高科技公司合作开发的流量/压力测量系统采用了科里奥利流量传感器,为观察注射器驱动器的流量/压力动态提供了机会。建立了注射器驱动器的流量/压力性能模型,其中关键的可变因素包括连接系统的顺应性和相关的线路电阻。结果表明,使用科里奥利传感器的流量测量系统观察到的流量/压力动态与模型相符。在这种情况下,主要的顺应性与注射器的顺应性有关。该模型的运行考虑了注射器中残留流体体积的名义体积变化,步进电机作用产生流入,连续脉冲之间的间隔产生流出。虽然文献中对注射器驱动器功能的许多观察都是定性的,但该模型可以更精确地预测相关设备的性能。
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引用次数: 0
Photoplethysmogram-based heart rate and blood pressure estimation with hypertension classification 基于照相血压计的心率和血压估算与高血压分类
Pub Date : 2024-03-01 DOI: 10.1016/j.ipemt.2024.100024
Aditta Chowdhury , Diba Das , Abdelrahman B.M. Eldaly , Ray C.C. Cheung , Mehdi Hasan Chowdhury

A photoplethysmogram (PPG) is an optically-derived signal that records the variation in blood volume within the microvasculature. Certain cardiovascular diseases (CVDs) are symptomatic of damaged blood vessels and problems in blood flow, including hypertension. While software implementations for heart rate and blood pressure estimation exist, point-of-care systems demand hardware-based implementations for real-time estimations to be useful for CVD detection. In this study, digital field programmable gate array (FPGA) based systems are developed for heart rate and blood pressure estimation from PPG signals by means of linear regression. In addition to the blood pressure estimation system, we present a prototype hypertension level detection system that achieves 92.42% accuracy while consuming 0.364 W of power. The Mean Absolute Error (MAE) ± Standard Deviation (SD) for heart rate estimation is 3.17 ± 2.79 beat per minute. The corresponding results for systolic and diastolic blood-pressure estimation are 4.75 ± 2.78 and 3.34 ± 2.60, respectively. The prototype can be further extended to wearable devices and medical equipment in the future.

光敏血流图(PPG)是一种光学衍生信号,可记录微血管内的血容量变化。某些心血管疾病(CVD)的症状是血管受损和血流问题,包括高血压。虽然已有用于心率和血压估算的软件实现方法,但护理点系统需要基于硬件的实现方法来进行实时估算,以便用于 CVD 检测。本研究开发了基于数字现场可编程门阵列(FPGA)的系统,通过线性回归的方法从 PPG 信号估算心率和血压。除了血压估算系统外,我们还展示了一个高血压水平检测系统原型,其准确率达到 92.42%,而功耗仅为 0.364 W。心率估计的平均绝对误差(MAE)± 标准偏差(SD)为每分钟 3.17±2.79 次。相应的收缩压和舒张压估计结果分别为 4.75 ± 2.78 和 3.34 ± 2.60。未来,该原型可进一步扩展到可穿戴设备和医疗设备。
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引用次数: 0
Realistic phantoms for quantitative MR: the need and a proposal (the B1 sleeve) 定量 MR 的真实模型:需求与建议(B1 套筒)
Pub Date : 2024-03-01 DOI: 10.1016/j.ipemt.2024.100026
Paul S Tofts

Quantitative MR (qMR) has offered direct access to in-vivo biology and physiology for over three decades, yet it has failed to translate into the clinic. Why is this? The development of suitable phantoms is a key stage in the evolution of qMR, and here a systematic categorisation is proposed. Currently there is much attention paid to creating simple head phantoms containing materials with metrologically traceable values of MR quantities. However these are usually unrealistic; many of the disrupting phenomena present in clinical imaging are absent. Good performance with a simple traceable phantom is a necessary but not sufficient requirement for the establishment of good in-vivo measurement performance. There is therefore a premium on developing realistic phantoms. A proposal made for a more realistic body phantom that includes RF B1 imperfections. It consists of lossy annuli placed around a standard head phantom. Other confounding phenomena could be identified, possibly built into an appropriate annulus around a simple head phantom, to form realistic phantoms; these would enable validation of qMR methods and translation to the clinic. The concept is probably applicable to other quantitative diagnostic imaging modalities.

三十多年来,定量磁共振(qMR)为人们提供了直接了解体内生物学和生理学的途径,但却未能应用于临床。这是为什么呢?开发合适的模型是 qMR 发展的关键阶段,这里提出了一个系统分类。目前,人们非常关注制作简单的头部模型,其中包含的材料具有可计量溯源的磁共振量值。然而,这些模型通常是不现实的;临床成像中存在的许多干扰现象都不存在。简单可溯源模型的良好性能是建立良好体内测量性能的必要条件,但并非充分条件。因此,开发逼真的模型非常重要。我们提出了一个包含射频 B1 缺陷的更逼真人体模型的建议。它由放置在标准头部模型周围的有损环组成。可以确定其他干扰现象,并在简单的头部模型周围设置适当的环面,以形成逼真的模型;这将有助于验证 qMR 方法并将其应用于临床。这一概念可能适用于其他定量诊断成像模式。
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引用次数: 0
Towards clinical translation of 7 Tesla MRI in the human brain 实现 7 特斯拉核磁共振成像在人脑中的临床转化
Pub Date : 2024-03-01 DOI: 10.1016/j.ipemt.2024.100025
Graeme A. Keith , Rosemary A. Woodward , Tracey Hopkins , Sarah Allwood-Spiers , Jon Trinder , Keith W. Muir , David A. Porter , Natasha E. Fullerton

Clinical translation of 7 tesla (T) MRI of the brain promises high image quality and potentially improved clinical diagnosis for patients compared to current standard lower field-strength MRI at 1.5 and 3T.

Here we describe how physics principles underlying ultra-high field (UHF) strength MRI affect 7T image quality, and how these can be exploited to translate 7T brain imaging into clinical practice. UHF MRI profits from higher inherent signal-to-noise ratio (SNR) and a resultant increase in achievable spatial resolution or acceleration factors; increase in sensitivity to magnetic susceptibility differences and a higher amplitude of the Blood Oxygen Level Dependent (BOLD) signal; increase in longitudinal relaxation time; and increased frequency dispersion and spectral resolution in MR spectroscopy.

Examples are presented of different brain pathologies, which are better illustrated on 7T compared to lower field strength by applying sequences and imaging techniques that exploit these intrinsic strengths of 7T MRI. This includes imaging of various vascular pathologies, epilepsy and brain tumours.

与目前标准的 1.5T 和 3T 低磁场强度磁共振成像相比,7 特斯拉 (T) 脑部磁共振成像的临床应用有望获得高图像质量,并可能改善患者的临床诊断。超高频磁共振成像得益于更高的固有信噪比 (SNR),从而提高了可实现的空间分辨率或加速因子;提高了对磁感应强度差异的灵敏度和更高的血氧水平依赖 (BOLD) 信号振幅;增加了纵向弛豫时间;提高了磁共振光谱的频率弥散和光谱分辨率。其中包括各种血管病变、癫痫和脑肿瘤的成像。
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引用次数: 0
Towards a locally constructed multi-element ultrasound imaging transducer for resource poor environments 为资源贫乏环境开发本地制造的多元件超声波成像传感器。
Pub Date : 2024-02-14 DOI: 10.1016/j.ipemt.2024.100023
A.J. Wilson , R.W. Taylor , S.E. Burrows , S.M. Dixon

This paper investigates techniques and materials for making a multi-element ultrasound imaging transducer with craft-based techniques available in resource poor environments. The transducer housing can be conveniently divided into three parts: the body supporting the piezoelectric (PZT) elements and other components; the matching layer between the PZT elements and the human body; and the backing layer behind the PZT elements. Low-cost 3D printing systems based on photopolymers were found to be suitable for manufacturing the body. Finite Element Modelling (FEM) showed that the material characteristics of the backing layer and the thickness of the matching layer were much less critical than predicted by ultrasound plane wave theory and transmission line theory, respectively. The backing and matching layers are normally made from epoxy-tungsten composites that are pourable in the uncured state. However, the composite required for the backing layer was putty-like when uncured. When the tungsten was allowed to settle under gravity during curing, a 20 % by volume uncured tungsten-epoxy composite gave a 30 % by volume concentration of tungsten at the bottom when cured at 20–30 °C. These findings, when coupled with the findings from the FEM modelling, suggests that constructing a multi-element ultrasound imaging transducer using craft-based techniques is feasible.

本文研究了在资源匮乏的环境中利用手工技术制作多元件超声波成像换能器的技术和材料。换能器外壳可方便地分为三部分:支撑压电(PZT)元件和其他组件的主体;PZT元件与人体之间的匹配层;PZT元件后面的支撑层。研究发现,基于光聚合物的低成本三维打印系统适用于制造人体。有限元建模(FEM)显示,背衬层的材料特性和匹配层的厚度分别比超声平面波理论和传输线理论预测的要小得多。背层和匹配层通常由环氧-钨复合材料制成,在未固化状态下可以浇注。然而,背层所需的复合材料在未固化时呈油灰状。如果在固化过程中让钨在重力作用下沉淀,那么在 20-30 °C 的固化温度下,20%(体积)未固化的钨-环氧树脂复合材料底部的钨浓度为 30%(体积)。这些发现加上有限元建模的结果表明,利用基于工艺的技术制造多元件超声波成像传感器是可行的。
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引用次数: 0
Towards a locally constructed multi-element ultrasound imaging transducer for resource poor environments. 为资源贫乏环境开发本地制造的多元件超声波成像传感器。
Pub Date : 2024-02-01 DOI: 10.1016/j.ipemt.2024.100023
A.J. Wilson, R.W. Taylor, S.E. Burrows, S.M. Dixon
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引用次数: 0
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