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Antal datortomografiundersökningar har ökat under flera år i Sverige tack vare tekniska utvecklingar och ökad tillgänglighet på sjukvård. Södertälje sjukhus röntgenavdelningen är i behov av att byta ut en utdaterad datortomograf (eng: Computed tomography, CT) och avdelningen för medicinsk teknik har föreslagit ett inköp av en CT med fotonräknande-detektor. Bilddata framställdes genom en fantomstudie för att påvisa förhållandet mellanstråldosparametern CTDIvol och kontrast-brus-förhållandet (CNR) hos CT-systemen: SOMATOM Drive och NAEOTOM Alpha. Den genererade datan påvisade att det finns en väsentlig skillnad i CNR-CTDIvol-förhållandet mellan SOMATOM Drive och NAEOTOM Alpha. Resultaten tydliggör att NAEOTOM Alpha kan producera bilder med betydligt mindre brus vid lägre stråldoser. Ett inköp av en fotonräknande detektor CT skulle kunna rättfärdigas utifrån bildkvalitéförbättringen som systemet kan erbjuda. / The number of computed tomography (CT) scans has increased during the past years in Sweden due to technical advancements and increased availability of healthcare. The x-ray department at Södertälje hospital is in need of replacing an outdated computed tomography and the departmentof clinical engineering has proposed a purchase of a photon-counting detector CT. Image data was produced through a phantom study to demonstrate the relationship between the parameter CTDIvol radiation dose and the contrast-to-noise ratio (CNR) of the CT systems: SOMATOM Drive and NAEOTOM Alpha. The generated data demonstrated that there is a substantial difference in the CNR-CTDIvol relationship between SOMATOM Drive and NAEOTOM Alpha. The results entail that NAEOTOM Alpha can produce images with considerably less noise at lower radiation doses. The purchase of a photon-counting CT could be justified by the improved image quality it can offer.

This review examines the factors that can influence an investigation into the unexpected death of a child before considering if using imaging techniques could be of benefit. Method A systematic search strategy was adopted to search databases using keywords, these results were then subjected to inclusion and exclusion criteria to filter and refine the evidence base further. Discussion More research is published on the use of MRI in comparison with other modalities. There is evidence in the case of MRI in particular that its use could be of benefit in identifying and ruling out potential causes of death in children. Conclusion More research is needed on the use of CT but the routine use of MRI in child death investigation could now be considered. Ethical considerations appear to be a barrier to research in this area and discussions as to how such considerations can be overcome is necessary.

Denna uppsats presenterar resultaten av en kvalitativ undersökning som syftar till att ge en djupare förståelse för användningen av AI inom radiologi, dess framtida påverkan på yrket och hur det används idag. Genom att genomföra tre intervjuer med personer som arbetar inom radiologi, har datainsamlingen fokuserat på att identifiera de positiva och negativa aspekterna av AI i radiologi, samt dess potentiella konsekvenser på yrket. Resultaten visar på en allmän acceptans för AI inom radiologi och dess förmåga att förbättra diagnostiska processer och effektivisera arbetet. Samtidigt finns det en viss oro för att AI kan ersätta människor och minska behovet av mänskliga bedömningar. Denna uppsats ger en grundläggande förståelse för hur AI används inom radiologi och dess möjliga framtida konsekvenser. / This essay presents the results of a qualitative study aimed at gaining a deeper understanding of the use of artificial intelligence (AI) in radiology, its potential impact on the profession and how it’s used today. By conducting three interviews with individuals working in radiology, data collection focused on identifying the positive and negative aspects of AI in radiology, as well as its potential consequences on the profession. The results show a general acceptance of AI in radiology and its ability to improve diagnostic processes and streamline work. At the same time, there is a certain concern that AI may replace humans and reduce the need for human judgments. This report provides a basic understanding of how AI is used in radiology and its possible future consequences.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Objetivo: O desenvolvimento da tecnologia em diagnóstico odontológico por imagem através dos Tomógrafos Computadorizados por Feixe Cônico, tornou possível e acessível a avaliação cefalométrica através de reconstruções volumétricas do crânio. Parâmetros baseados em evidências científicas são necessários para implementar o seu uso. Alguns parâmetros utilizados na cefalometria convencional (bidimensional) deverão ser esquecidos, outros deverão ser adaptados, outros, ainda, deverão ser criados. Propomos aqui a criação de um Cefalostato Virtual para orientação do crânio em TC, com a utilização de pontos intracranianos, que são mais estáveis. Também propomos a criação do ponto TS e da linha TS-Pg em substituição ao ponto S e ao eixo Y de crescimento de Downs, respectivamente. Além disso, propomos a linha Ba-Op como referência para casos de assimetria faciais onde não é possível a utilização do plano Horizontal de Frankfurt, em casos, por exemplo, de síndromes que afetem os pontos de referências mais externos. Métodos: 49 crânios pertencentes ao do Museu de Anatomia UNIFESP, foram escaneados em um tomógrafo computadorizado por feixe cônico (TCFC), na clínica ISOOrthographic, São Paulo. As pontuações foram realizadas em dois momentos, com espaçamento de uma semana. Foram calculadas estatisticamente medidas-resumo (média, quartis, mínimo, máximo e desvio padrão). Foram calculadas também as correlações intraclasse e correlações de Pearson entre o Eixo Y (S-Gn) e linha entre os pontos TS e Pg. Resultados: Apesar de se observar uma baixa reprodutibilidade nas coordenadas, para os pontos CE, Pg e Gn, foi observada alta correlação entre as medidas angulares em questão. Para descrever a inclinação do Eixo Y em função da inclinação da Linha TS e Pg adotou-se um modelo de regressão linear simples descrito pela equação abaixo: Ang Sö- Gn = 0,989 Ang TS Pgi i Conclusões: o uso do Cefalostato Virtual na orientação de Crânios em Tomografia Computadorizada é factível e favorece a reprodução do posicionamento craniano; apesar da baixa reprodutibilidade intra observador dos pontos CE, Pg e Gn, novos critérios tridimensionais na definição destes pontos poderiam aumentar a precisão na sua localização; a alta reprodutibilidade intra observador para os pontos Op, TS e N, sugere que os critérios anatômicos próprios das estruturas estudadas favorecem a sua determinação; o ponto TS apresentou maior reprodutibilidade do que o ponto S, embora esta diferença não tenha sido estatisticamente significante, podendo-se substituir o ponto S pelo TS em estudos futuros; existe alta correlação entre a linha entre os pontos TS e Pg e o Eixo Y; a avaliação do comportamento da inclinação da linha orbitomeática (HF) com relação à linha Básio-Opístio sugere que na presença de alterações cranianas este relacionamento propicie auxílio no diagnóstico das alterações craniofaciais. / Objective: The development of new technology in dental diagnosis by cone beam CT (CBCT) image, made possible and accessible the realization of cephalometric evaluation through volumetric reconstructions of the skull. Scientific parameters with evidence-based are needed to implement its use. Some parameters used in conventional cephalometry (2D) maybe need to be forgotten, others should be adapted, and others still to be created. In this research we propose to create a Virtual Cephalostat orientation of the skull in CT, with the intracranial landmarks, because they are more stable. We propose the creation of landmark TS (Tubercle Sella) and the TS-Pg line to replace the landmark S (Sella) and the Y-axis of growth (Downs), respectively. Furthermore, we propose to use the Basion-Opistion line as a reference for cases of craniofacial asymmetry where is not possible to use the Frankfurt horizontal plane, as in some cases of syndromes that affects the most external landmarks. Methods: 49 skulls of Anatomy Museum of UNIFESP Federal University of São Paulo, were scanned in a CBCT. The analyses were performed in 2 stages, within 1-week space. Statistics measurements were calculated (mean, quartiles, minimum, maximum and standard deviation). We also calculated the intraclass correlations (ICC) and the Pearson correlations between the Y axis (S-Gn) and the line between landmarks TS-Pg. Results: Even if there is a low reproducibility in the coordinates for landmarks EC (Ethmoidal Crest), Pg and Gn it was observed a high correlation between the angular measures in question. To describe the inclination of the Y axis according to the slope of the line adopted TS and Pg a simple linear regression model is used, showed by the equation bellow: Ang Sö- Gn = 0,989 Ang TS Pgi i Conclusions: The use of the Virtual Cephalostat in orientation of skulls using CBCT is feasible and facilitates the reproduction of the skull position, despite the low intra observer reproducibility of landmarks EC, Pg and Gn, new 3D criteria in the definition of these landmarks could increase the precision in its location. The high intra observer reproducibility at the landmarks Op, N and TS, suggests that the anatomical criteria themselves promote their reliability; The TS landmark showed a higher reproducibility than the S landmark, even though the difference was not statistically significant, and it should be replaced by the landmark TS in future studies. There is a high correlation between the TS - Pg line and Y-axis. The relationship between the slope of the HF plane and Ba -Op line suggests that in the presence of the alteration of morphology in craniofacial structure, this relationship offer help in the diagnosis of craniofacial changes.

Die Lebendspende von Leberlappen wird in der Zukunft gerade vor dem Hintergrund des stets weiter steigenden Bedarfs und des sich dazu diskrepant entwickelnden Mangels an Leichenorganen zur Transplantation eine zunehmend wichtige Rolle einnehmen, um Patienten im Endstadium einer Lebererkrankung kurativ zu versorgen. Umso mehr spielen Überlegungen zur Gewährleistung insbesondere der Sicherheit für einen gesunden Lebendspender eine Rolle, ohne Risiken für ihn eliminieren zu können. In diese Überlegungen gehen Weiterentwicklungen der Möglichkeiten für die spezielle Evaluation der Leber eines potenziellen Spenders anhand bildgebender Verfahren ein. Hier nehmen Methoden zur präoperativen Abschätzung der Gewichts- und Volumenverhältnisse einer potenziellen Spenderleber und ihrer Lappen einen besonderen Stellenwert ein, da bei entsprechend ungünstigen Voraussetzungen ein gesunder Mensch aus Gründen der Sicherheit für eine Lebendspende nicht in Frage kommt. Die vorliegende Arbeit zeigt anhand einer prospektiven Studie unterschiedliche Methoden der präoperativen CT-gestützten Volumetrie zur Evaluation von Lebern und ihrer beiden Lappen von potenziellen Lebendspendern auf. Dabei wurde ein neu entwickeltes Volumetrieverfahren klinisch erprobt und mit einem etablierten Verfahren verglichen. Als Referenzgrößen wurden erstmalig gleichermaßen intraoperativ gemessene Gewichte und Volumina der transplantieren rechten Leberlappen herangezogen. Hinsichtlich der auf CT-gestützter Volumetrie basierenden, präoperativen Abschätzung von intraoperativ zu erwartendem Gewicht und Volumen von rechten Leberlappen im Rahmen einer Lebendspende erwies sich das etablierte Verfahren bezüglich des Gewichts dem neu entwickelten Verfahren geringgradig überlegen, während das neu entwickelte Verfahren bezüglich des Volumens gegenüber dem etablierten Verfahren geringgradig besser abschnitt. Darüber hinaus resultierte aus den intraoperativ erhobenen Daten die Erkenntnis, dass die physikalische Dichte von gesundem Lebergewebe bei einer relativ hohen interindividuellen Streuung im Mittel um knapp 12% höher liegt als zumeist angenommen. In Zukunft werden Fortschritte technischer Verfahren sehr genaue virtuelle Trennungen von Lebern in ihre beiden Lappen ermöglichen. Gleichzeitig werden chirurgische Resektionstechniken verfeinert. Sowohl der virtuelle als auch der reale Ansatz haben den Anspruch, die avaskuläre und somit ideale Resektionsfläche zwischen beiden Leberlappen aufzusuchen, um gleichzeitig präoperativ exakte Gewichts- und Volumenabschätzungen zu ermöglichen und intraoperativ Risiken zu minimieren. Welchem dieser beiden Ansätze die stärkste Annäherung an diesen Anspruch oder dessen Vollendung zuerst gelingt, wird sich als Referenzmethode behaupten, an der sich der unterlegene Ansatz wird messen lassen müssen. / The increasing need of cadaveric liver grafts and the scarcity of living related liver transplants (LRLT) will play a critical role in the future treatment of patients suffering from end stage liver disease. Various considerations, including especially a safe outcome for the donor, are essential. However, risks can not be eliminated. These considerations can be influenced in the evaluation of a potential living donor. Accurate methods, including imaging modalities, for the preoperative estimation of the potential donor liver’s weight and volume are essential as an adverse condition would preclude a living donation for safety reasons. This thesis presents different methods of preoperative CT-based volumetric analyses for the evaluation the liver and both its lobes in potential living donors. A newly developed method of volumetric analysis was clinically tested and compared with an established method. Intraoperatively measured weights and volumes of transplanted right hepatic lobes were used as reference values. With regards to the weight, the established method proved to be mildly superior, while the newer method was slightly more accurate for volume. Additionally, it was discovered that the mean density of healthy liver tissue is approximately 12 percent higher than generally assumed but with a relatively high individual variation. Progress in technical methods will render possible very exact virtual divisions of the liver in both of its lobes. Both the virtual and surgical approach have a claim for finding the appropriate avascular and consequently ideal resection plane in order to minimize risks intraoperatively.

Objetivo: O desenvolvimento da tecnologia em diagnóstico odontológico por imagem através dos Tomógrafos Computadorizados por Feixe Cônico, tornou possível e acessível a avaliação cefalométrica através de reconstruções volumétricas do crânio. Parâmetros baseados em evidências científicas são necessários para implementar o seu uso. Alguns parâmetros utilizados na cefalometria convencional (bidimensional) deverão ser esquecidos, outros deverão ser adaptados, outros, ainda, deverão ser criados. Propomos aqui a criação de um Cefalostato Virtual para orientação do crânio em TC, com a utilização de pontos intracranianos, que são mais estáveis. Também propomos a criação do ponto TS e da linha TS-Pg em substituição ao ponto S e ao eixo Y de crescimento de Downs, respectivamente. Além disso, propomos a linha Ba-Op como referência para casos de assimetria faciais onde não é possível a utilização do plano Horizontal de Frankfurt, em casos, por exemplo, de síndromes que afetem os pontos de referências mais externos. Métodos: 49 crânios pertencentes ao do Museu de Anatomia UNIFESP, foram escaneados em um tomógrafo computadorizado por feixe cônico (TCFC), na clínica ISOOrthographic, São Paulo. As pontuações foram realizadas em dois momentos, com espaçamento de uma semana. Foram calculadas estatisticamente medidas-resumo (média, quartis, mínimo, máximo e desvio padrão). Foram calculadas também as correlações intraclasse e correlações de Pearson entre o Eixo Y (S-Gn) e linha entre os pontos TS e Pg. Resultados: Apesar de se observar uma baixa reprodutibilidade nas coordenadas, para os pontos CE, Pg e Gn, foi observada alta correlação entre as medidas angulares em questão. Para descrever a inclinação do Eixo Y em função da inclinação da Linha TS e Pg adotou-se um modelo de regressão linear simples descrito pela equação abaixo: Ang Sö- Gn = 0,989 Ang TS Pgi i Conclusões: o uso do Cefalostato Virtual na orientação de Crânios em Tomografia Computadorizada é factível e favorece a reprodução do posicionamento craniano; apesar da baixa reprodutibilidade intra observador dos pontos CE, Pg e Gn, novos critérios tridimensionais na definição destes pontos poderiam aumentar a precisão na sua localização; a alta reprodutibilidade intra observador para os pontos Op, TS e N, sugere que os critérios anatômicos próprios das estruturas estudadas favorecem a sua determinação; o ponto TS apresentou maior reprodutibilidade do que o ponto S, embora esta diferença não tenha sido estatisticamente significante, podendo-se substituir o ponto S pelo TS em estudos futuros; existe alta correlação entre a linha entre os pontos TS e Pg e o Eixo Y; a avaliação do comportamento da inclinação da linha orbitomeática (HF) com relação à linha Básio-Opístio sugere que na presença de alterações cranianas este relacionamento propicie auxílio no diagnóstico das alterações craniofaciais. / Objective: The development of new technology in dental diagnosis by cone beam CT (CBCT) image, made possible and accessible the realization of cephalometric evaluation through volumetric reconstructions of the skull. Scientific parameters with evidence-based are needed to implement its use. Some parameters used in conventional cephalometry (2D) maybe need to be forgotten, others should be adapted, and others still to be created. In this research we propose to create a Virtual Cephalostat orientation of the skull in CT, with the intracranial landmarks, because they are more stable. We propose the creation of landmark TS (Tubercle Sella) and the TS-Pg line to replace the landmark S (Sella) and the Y-axis of growth (Downs), respectively. Furthermore, we propose to use the Basion-Opistion line as a reference for cases of craniofacial asymmetry where is not possible to use the Frankfurt horizontal plane, as in some cases of syndromes that affects the most external landmarks. Methods: 49 skulls of Anatomy Museum of UNIFESP Federal University of São Paulo, were scanned in a CBCT. The analyses were performed in 2 stages, within 1-week space. Statistics measurements were calculated (mean, quartiles, minimum, maximum and standard deviation). We also calculated the intraclass correlations (ICC) and the Pearson correlations between the Y axis (S-Gn) and the line between landmarks TS-Pg. Results: Even if there is a low reproducibility in the coordinates for landmarks EC (Ethmoidal Crest), Pg and Gn it was observed a high correlation between the angular measures in question. To describe the inclination of the Y axis according to the slope of the line adopted TS and Pg a simple linear regression model is used, showed by the equation bellow: Ang Sö- Gn = 0,989 Ang TS Pgi i Conclusions: The use of the Virtual Cephalostat in orientation of skulls using CBCT is feasible and facilitates the reproduction of the skull position, despite the low intra observer reproducibility of landmarks EC, Pg and Gn, new 3D criteria in the definition of these landmarks could increase the precision in its location. The high intra observer reproducibility at the landmarks Op, N and TS, suggests that the anatomical criteria themselves promote their reliability; The TS landmark showed a higher reproducibility than the S landmark, even though the difference was not statistically significant, and it should be replaced by the landmark TS in future studies. There is a high correlation between the TS - Pg line and Y-axis. The relationship between the slope of the HF plane and Ba -Op line suggests that in the presence of the alteration of morphology in craniofacial structure, this relationship offer help in the diagnosis of craniofacial changes.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Σκοπός της παρούσας διδακτορικής διατριβής είναι η ανάπτυξη αλγορίθμων επεξεργασίας ιατρικής εικόνας για την ενσωμάτωση τους σε ιατρικές εφαρμογές ακτινοθεραπευτικού ενδιαφέροντος. Οι αλγόριθμοι αυτοί στηρίζονται στην αρχή λειτουργίας των χαρτών αυτο-οργάνωσης Kohonen και αξιοποιούν την πληροφορία που περιέχεται σε περιοχές των εικόνων γύρω από σημεία ενδιαφέροντος, ώστε να εντοπίσουν αυτόματα, με ακρίβεια και αξιοπιστία, αντιστοιχίες μεταξύ των εικόνων. Πιο συγκεκριμένα, ένας επαναληπτικός αλγόριθμος προτείνεται για την αυτόματη εύρεση αντίστοιχων σημείων σε ιατρικές εικόνες δύο διαστάσεων. Ο προτεινόμενος αλγόριθμος προϋποθέτει την εύρεση σημείων ενδιαφέροντος μόνο στη μια από τις δύο εικόνες και εντοπίζει τα αντίστοιχα σημεία στη δεύτερη εικόνα μέσα από μια επαναληπτική διαδικασία, η οποία προσομοιάζει τη φάση εκπαίδευσης του νευρωνικού δικτύου. Με βάση τα ζεύγη των αντίστοιχων σημείων, υπολογίζονται στη συνέχεια οι παράμετροι ενός μετασχηματισμού, κατάλληλου για να περιγράψει τη σχέση μεταξύ των δεδομένων εικόνων. Ο αλγόριθμος ευθυγράμμισης εφαρμόζεται σε δεδομένες εικόνες ηλεκτρονικής πυλαίας απεικόνισης (Electronic Portal Images), που λαμβάνονται πριν από κάθε συνεδρία της ακτινοθεραπείας, για τον υπολογισμό του σφάλματος τοποθέτησης του ασθενούς. Το ζήτημα της επαλήθευσης της θέσης του ασθενούς στην ακτινοθεραπεία αντιμετωπίζεται επίσης με τη βοήθεια μιας αυτόματης μεθόδου εύρεσης αντίστοιχων σημείων σε τρισδιάστατα δεδομένα, η οποία εφαρμόζεται για την ευθυγράμμιση της αξονικής τομογραφίας του σχεδιασμού της ακτινοθεραπείας και μιας αξονικής τομογραφίας επαλήθευσης, που λαμβάνεται πριν την πρώτη συνεδρία της ακτινοθεραπείας. Ο προτεινόμενος αλγόριθμος εντοπίζει αντίστοιχα σημεία ενδιαφέροντος στις δεδομένες τομογραφικές εικόνες και υπολογίζει τις παραμέτρους ενός μη γραμμικού μετασχηματισμού ευθυγράμμισης. Μετά την ευθυγράμμιση των δύο τομογραφιών, υπολογίζεται η μετατόπιση του ισοκέντρου στην τομογραφία επαλήθευσης σε σχέση με τη θέση του ισοκέντρου που προβλέπεται στην αρχική τομογραφία του σχεδιασμού. Με την ενσωμάτωση αυτής της μεθόδου ευθυγράμμισης στη διαδικασία της ακτινοθεραπείας, ικανοποιούνται δύο ανάγκες της κλινικής πρακτικής. Αφενός, η μετατόπιση του ισοκέντρου, όπως υπολογίζεται από την προτεινόμενη μέθοδο, παρέχει μια αξιόπιστη ένδειξη για τη μετατόπιση του ασθενούς που απαιτείται πριν τη χορήγηση της ακτινοβολίας. Αφετέρου, επιχειρείται η καλύτερη αξιοποίηση των πόρων του τμήματος της ακτινοθεραπείας με τη διαδικασία της εύρεσης του ισοκέντρου της ακτινοθεραπείας να λαμβάνει χώρα στην αίθουσα του αξονικού τομογράφου και να μειώνεται συνεπώς ο χρόνος που απαιτείται για την προετοιμασία του ασθενούς στον γραμμικό επιταχυντή κατά την πρώτη συνεδρία της ακτινοθεραπείας. / Aim of the present thesis is the development of image processing algorithms for radiotherapy applications. These algorithms are based on the principles of Kohonen Self Organizing Maps and exploit the information contained in image regions around distinctive points of interest, in order to determine image correspondences in an automatic, accurate and robust way. In particular, an iterative algorithm is proposed for automatic detection of point correspondences in two-dimensional medical images. The proposed algorithm requires the extraction of interest points only in one image and detects the homologous points in the second image through an iterative procedure, respective to the training phase of a neural network. Subsequently, the parameters of an appropriate registration transformation are computed to describe the mapping between the two images. The computation is based on the detected point correspondence. The proposed registration algorithm is applied to Electronic Portal Images, acquired prior to the radiotherapy treatment delivery, in order to estimate the setup error of the patient. The issue of patient position verification in radiotherapy is also addressed in the present thesis by developing an algorithm for automatic detection of point correspondences in three-dimensional medical data. The algorithm is used to register the CT data of radiotherapy planning to an additional verification CT, acquired prior to the first treatment fraction. The proposed algorithm detects corresponding points in the two CT images and computes the parameters of a non-rigid registration transformation. After the registration of the two CT images, the isocenter displacement of the verification CT is calculated with respect to the ideal isocenter position, defined in the planning CT. By integrating the proposed registration procedure in the clinical practice, two needs are met. Firstly, the isocenter displacement, calculated by the proposed method, provides a reliable indication of the patient shift, needed before the treatment delivery, for optimization of the dose delivery. Secondly, an improvement of the radiotherapy department efficiency is attempted by performing the procedure of isocenter marking in the CT scanner room and, consequently, reducing the time expenditure of the patient in the LINAC during the first radiotherapy fraction.