京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18866号 / 医博第3977号 / 新制||医||1008(附属図書館) / 31817 / 京都大学大学院医学研究科医学専攻 / (主査)教授 戸井 雅和, 教授 平岡 眞寛, 教授 三森 経世 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

At the School of Technology and Health (STH) on KTH, a micro- CT is beeing build. The micro-CT-system need to be aligned in order to function correctly. The purpose of this bachelor thesis was to create an application that, from the micro-CT images, could calculate all the necessary parameters to make the alignment pos- sible. During the projekt, LabView-code for aligning a micro-CT system has been modified to being compatible with the micro-CT at the School of Technology and Health (STH) on KTH. The code has also partly been translated into the open-source and platform independent programming language Java. Due to delays in building the micro-CT at STH, neither the LabView- or Javacode could be validated with it. However, successful attempts have been made with images from another micro-CT and on simulated images of a phantom in a micro-CT.

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We investigate the difference between surface matching and target matching for pelvic radiation image guidance. The uniqueness of our study is that all patients have multiple CT-on-rails (CTOR) scans to compare to corresponding AlignRT images. Ten patients receiving pelvic radiation were enrolled in this study. Two simulation CT scans were performed in supine and prone positions for each patient. Body surface contours were generated in treatment planning system and exported to AlignRT to serve as reference images. During treatment day, the patient was aligned to treatment isocenter with room lasers, and then scanned with both CTOR and AlignRT. Image-guidance shifts were calculated for both modalities by comparison to the simulation CT and the differences between them were analyzed for both supine and prone positions, respectively. These procedures were performed for each patient once per week for five weeks. The difference of patient displacement between AlignRT and CTOR was analyzed. For supine position, five patients had an average difference of displacement between AlignRT and CTOR along any direction (vertical, longitudinal, and lateral) greater than 0.5 cm, and one patient greater than 1 cm. Four patients had a maximum difference greater than 1 cm. For prone position, seven patients had an average difference greater than 0.5 cm, and three patients greater than 1 cm. Nine patients had a maximum difference greater than 1 cm. The difference of displacement between AlignRT and CTOR was greater for the prone position than for the supine position. For the patients studied here, surface matching does not appear to be an advisable image-guidance approach for pelvic radiation therapy for patients with either supine or prone position. There appears to be a potential for large alignment discrepancies (up to 2.25 cm) between surface matching and target matching.

Maria Graham is known as a travel writer, but she also translated works from French and German into English, wrote on history, painting, stories for children, and kept personal journals. My thesis centres on her travel journals and memoirs, published and unpublished. Graham is one of the first female travel writers to acquire fame as a writer shortly after publication, or to provoke controversy; in the cases of Brazil and Chile she actually is the first woman to write about those emerging states. She is outstanding as well for the authority of her narrative voice, her disregard of restrictions imposed on women’s text during her time, her complex approach to gender issues and for the changes experienced by her narrating persona. She begins by constructing a well informed but detached observer who reports her visit to India and the first visit to Brazil in a cold and distant voice, but who later allows another voice to filter through her text, an event that turns the narrator into a mere shadow in parts of the journal on Chile. It is in this journal that Graham begins to build up a contradictory persona who can be superior, ironic, and scathing when describing other women, but who can portray herself as a helpless heroine in a traditional romance when her script so demands it. In the second visit to Brazil this complex narrator becomes warmly eulogising of the country and its ruler, but this attitude does not last. The position is reversed in the third journal, which has elements of a spy thriller at times. The last chapter concerns the journals written in and about Europe regardless of chronology; they illustrate one of the main postulates of the thesis: that Graham evolved as narrator from detached observer to heroine up to the journals written at the end of her life, which become explorations into the narrator’s inner self.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Computer tomography (CT) is commonly used to evaluate suspected acute appendicitis; however, ionizing radiation limits its use in children. This study assesses 3T magnetic resonance imaging (MRI) as an imaging modality in the evaluation of suspected acute appendicitis in the pediatric population. This study is a retrospective review of prospectively‐collected data from 155 pediatric subjects who underwent MRI and 197 pediatric subjects who underwent CT for suspected acute appendicitis. Sensitivity, specificity, appendix visualization rate, positive appendicitis rate, and alternative diagnosis rate are determined. Sensitivity and specificity of MRI are 100% and 98%, 99% and 97% for CT (p = 0.61 and 0.53), respectively. Appendix visualization rate is 77% for MRI, 90% for CT (p = 0.0002), positive appendicitis rate is 25% for MRI, 34% for CT (p = 0.175), and alternative diagnosis rate is 3% for MRI, 3% for CT (p = 0.175). This study supports 3T MRI as a comparable modality to CT in the evaluation of suspected acute appendicitis in the pediatric population. Although MRI visualizes the appendix at a lower rate than CT, our protocol maintains 100% sensitivity with no false negatives. Our appendix visualization rate with 3T MRI (77%) is an improvement from published data from both 1.5T and 3T MRI systems. The exam time differential is clinically insignificant and use of MRI spares the patient the ionizing radiation and intravenous contrast of CT.

William Shenstone was a polymath. He wrote letters, essays, composed poetry, painted water-colours, played musical instruments and indulged in architectural design, but above all he created a landscape garden at The Leasowes in the West Midlands that became a celebrated place to visit in the eighteenth century. Shenstone worked during the early days of the English landscape garden movement, and while others created grounds with political and/or historical themes he fashioned a garden in a 'naturesque' style. He created a version, called a ferme ornée that was a distinctive form of English garden at the time. This thesis is the first detailed study of The Leasowes and presents a re-evaluation of his garden. Though many people have written about the landscape in the past, few have had the opportunity to look at it from a multidisciplinary perspective which marries an exploration of archival and literary material with landscape studies and archaeological evidence. The study evaluates why and how Shenstone created his garden. It explores his cultural networks and influences and what he did to make it distinctive. It looks at the planting regime and the verse and poetry that illuminated the garden. Finally, it discovers other gardeners who were influenced by his work before and after his death.

In spite of burgeoning of new technologies in the field of maxillofacial surgery, such as novel methods for osteosynthesis, bone substitution and bone regeneration, the reconstruction of the craniofacial skeleton (CFS) remains a challenge. Complications and failure in existing technologies and treatments for the CFS may be attributed in part to an incomplete understanding of the biomechanical environment in which these technologies are expected to perform. Characterizing the morphology and biomechanical behaviour of this complex and unique structure is important to understanding its global response to mechanical demands. This thesis aims to characterize the biomechanical behaviour of thin bone regions and sutures in the CFS. We investigated the impact of image degradation in CT scans on the ability to develop accurate specimen-specific FE models. Image degradation resulted in large increases in cortical thickness and decreases in scan intensity, which corresponded to significant changes in maximum principal strains in the FE models. A new semi-automated connectivity technique was developed to quantify the degree of fusion in sutures and revealed varying degrees of connectivity and interdigitation depending on the suture location. Morphological features characterized using this technique were incorporated into idealized suture FE models and analysed under multiple loading directions. The idealized FE models revealed that the impact of the number of interdigitations on the strain energy absorption in the suture/bone complex is dependent on the loading direction (inversely related under pressure and directly related under perpendicular and pressure loading); similar behaviour was seen in a μCT based specimen-specific FE model. Three-point bending tests on bone samples containing sutures revealed a positive correlation between the number of interdigitations and bending strength. Finally, experimental testing of full cadaveric heads demonstrated inter-specimen consistency in strain magnitude and direction under muscle loading in spite of morphological differences. Overall, these findings provide new insight into the complex morphology of the CFS, limitations of current clinical imaging and the biomechanical behaviour of thin bone structures and their articulations. This work forms a solid foundation for future development of image analysis, modeling and experimental investigations focused on characterizing the global behaviour of the CFS.

In spite of burgeoning of new technologies in the field of maxillofacial surgery, such as novel methods for osteosynthesis, bone substitution and bone regeneration, the reconstruction of the craniofacial skeleton (CFS) remains a challenge. Complications and failure in existing technologies and treatments for the CFS may be attributed in part to an incomplete understanding of the biomechanical environment in which these technologies are expected to perform. Characterizing the morphology and biomechanical behaviour of this complex and unique structure is important to understanding its global response to mechanical demands. This thesis aims to characterize the biomechanical behaviour of thin bone regions and sutures in the CFS. We investigated the impact of image degradation in CT scans on the ability to develop accurate specimen-specific FE models. Image degradation resulted in large increases in cortical thickness and decreases in scan intensity, which corresponded to significant changes in maximum principal strains in the FE models. A new semi-automated connectivity technique was developed to quantify the degree of fusion in sutures and revealed varying degrees of connectivity and interdigitation depending on the suture location. Morphological features characterized using this technique were incorporated into idealized suture FE models and analysed under multiple loading directions. The idealized FE models revealed that the impact of the number of interdigitations on the strain energy absorption in the suture/bone complex is dependent on the loading direction (inversely related under pressure and directly related under perpendicular and pressure loading); similar behaviour was seen in a μCT based specimen-specific FE model. Three-point bending tests on bone samples containing sutures revealed a positive correlation between the number of interdigitations and bending strength. Finally, experimental testing of full cadaveric heads demonstrated inter-specimen consistency in strain magnitude and direction under muscle loading in spite of morphological differences. Overall, these findings provide new insight into the complex morphology of the CFS, limitations of current clinical imaging and the biomechanical behaviour of thin bone structures and their articulations. This work forms a solid foundation for future development of image analysis, modeling and experimental investigations focused on characterizing the global behaviour of the CFS.