M.Tech. (Radiography) / Satisfied patients are recognized as an important outcome measure for evaluating the quality of medical care provided in a hospital setting. A satisfied patient is more likely to comply with instructions given and cooperate with medical staff during procedures such as special radiographic examinations in the radiography department. In Malawi, studies on patient satisfaction have mostly been confined to doctor – patient interaction and other aspects of the health care service. Very little research has been conducted to explore the experiences of patients undergoing special radiographic examinations. The purpose of this study was to explore the experiences of patients undergoing special radiographic examinations at Kamuzu Central Hospital. A qualitative, contextual, explorative, descriptive approach was used to collect data from patients undergoing special radiographic examinations at Kamuzu Central Hospital in Malawi. Focus group interviews were employed to collect data from the study participants. A total number of 15 patients took part in the study. A content analysis approach was used to analyze the views of the participants. The themes that emerged from the focus group data were: Concerns about delays from reception to receiving radiography results (Radiographs and report); Patients’ experiences with regards to the quality of patient care they received and Concerns about the hospital environment and resources in the radiography department. Guidelines have been proposed to address the themes identified.

The ongoing development of storage devices and technologies for medical image management has led to a growth in the digital archiving of these images. The characteristics of medical x-rays are examined, and a number of digital coding methods are considered. An investigation of several fast cosine transform algorithms is carried out. An adaptive cosine transform coding technique is implemented which produces good quality images using bit rates lower than 0.38 bits per picture element

Lanthanide chelates are effective agents for improving contrast in MR images. Optimizing the relaxation of inner sphere water molecules is a common focus of research in this field. However, the efforts to design an optimal contrast agent have commonly over-looked the relationship of water position and water exchange kinetics. This work explores structural conformation, the impact of very fast water exchange kinetics on hydration, and differing tumbling rates for regioisomers of a number of lanthanide chelates. We have grown crystals of LnDOTMA and obtained structural data by X-ray diffraction that provide a picture of the chelate during water exchange and demonstrate that chelate conformation is associated with water position. We observe increased population of the major isomer with increased water exchange rates in variable temperature 1H NMR studies of HoDOTMA. This suggests that water position and water exchange rates are linked. We therefore recommend that accurate water exchange data be included in the application of the SBM equations when interpreting experimental data. As further support of this recommendation, we measured water exchange kinetics with 17O NMR for the rigid GdNB-DOTMA chelates. These results were used in the fitting of 1H NMRD profiles to establish tumbling parameters. Similar results were also observed in the less rigid GdNB-DOTA, establishing the first identification of regioisomers in these chelates and their biphenyl derivatives. Binding studies of GdBP-DOTA indicate that the side isomer is a more effective agent, but it is the minor species in solution. Our work herein shows that predicting efficacy of contrast agents with SBM equations requires a more complete consideration of chelate hydration (q/r6).

This study discusses reject film analyses (RFAs) before and after the implementation of a quality improvement intervention. RFAs were undertaken to investigate the effect of the introduction and use of exposure charts (ECs) on department and student reject rates of extremity radiographs. Methods: A quantitative comparative pre and post-treatment research design was used. Data was collected from the x-ray departments of two training hospitals in Windhoek, Namibia over a five month period. A retrospective RFA was conducted to determine the department and student reject rates for both departments before intervention. Emphasis was placed on exposure related reject films. ECs were compiled and introduced at Katutura State Hospital (venue B) by the researcher. The students were instructed to use these charts. At Windhoek Central Hospital (venue A) no ECs were used. A prospective RFA was conducted to establish department and student reject rates at both hospitals after the intervention at venue B. Results: During the retrospective phase the department reject rate for venue A was 21 percent while the student reject rate was 23 percent. At venue B 24 percent and 26 percent were scored respectively. Students at venue A produced rejected radiographs due to overexposure (49 percent) and underexposure (23 percent), whilst 37 percent was recorded for both causes at venue B. At venue A, 35 percent of films were rejected due to incorrect mAs selection, at venue B the figure was 42 percent. Undiagnostic radiographs due to inaccurate kV selection comprised 62 percent for venue A and 59 percent for venue B. During the prospective phase the department reject rate for venue A was 20 percent and that of the students was 19 percent. For venue B 12 percent and 11 percent were scored respectively. At venue A radiographs rejected due to over and underexposure were 43 percent and 33 percent respectively while those at venue B were 33 percent and 34 percent. Incorrect mAs selection caused 33 percent of discarded films at venue A and 38 percent at venue B. The figures for inaccurate kV selection were 68 percent and 62 percent for venues A and B. Conclusions: The introduction and use of ECs lowered the student reject rate at venue B in the prospective phase.

No description available.

The high prevalence of back and neck pain results in enormous social, psychological, and economic burden. Most seeking help for back or neck pain consult general practitioners or chiropractors. Chiropractic is a regulated health profession (serving approximately 10 – 15% of the population) that has contributed to the health and well-being of North Americans for over a century. Despite available evidence for optimal management of back and neck pain, poor adherences to guidelines and wide variations in services have been noted. For instance, overuse and misuse of imaging services have been reported in the chiropractic literature. Inappropriate use of spine imaging has a number of potential adverse outcomes, including inefficient and potentially inappropriate invasive diagnosis and subsequent treatment, and unnecessary patient exposure to ionizing radiation. Although evidence-based diagnostic imaging guidelines for spinal disorders are available, chiropractors are divided on whether these guidelines apply to them. While guidelines can encourage practitioners to conform to best practices and lead to improvements in care, reviews have demonstrated that dissemination of guidelines alone is rarely sufficient to optimise care. Evidence regarding effective methods to promote the uptake of guidelines is still lacking. There is growing acceptance that problem analysis and development of interventions to change practice should be guided by relevant theories and tailored to the target audience. To date, very little knowledge translation research has addressed research-practice gaps in chiropractic. This thesis reports rigorous methods to: (1) assess practice and providers’ characteristics, (2) determine baseline rates and variations in spine x-ray ordering, (3) evaluate the impact of disseminating guidelines to optimise spine x-ray ordering, and (4) assess determinants of spine x-ray ordering and potential targets for change prior to the design of a tailored intervention. A mixed method using two disciplinary perspectives (epidemiology and psychology) was undertaken. A cross-sectional analysis of administrative claims data was carried out on a sample of chiropractors enlisted in a large American provider network. Despite available clinical practice guidelines, wide geographical variations in x-ray use persist. Higher x-ray ordering rates were associated with practice location (Midwest and South US census regions), setting (urban, suburban), chiropractic school attended, male provider, employment, and years in practice. The impact of web-based guideline dissemination was evaluated over a five year period using interrupted time series and demonstrated a stepwise relative reduction of 5.3% in the use of x-rays. Passive guidelines dissemination appeared to be a simple, cost effective strategy in this setting to improve but not optimise x-ray ordering rates. Focus groups using the theoretical domains framework were conducted among Canadian and US chiropractors to explore their beliefs about managing back pain without x-rays. Findings were used to develop a theory-based survey to identify theoretical constructs predicting spine x-ray ordering practice. Psychological theories and theoretical constructs explained a significant portion of the variance in both behavioural simulation and intention. Results from this thesis provide an empirically-supported, theoretical basis to design quality improvement strategies to increase guidelines adherence and promote behaviour change in chiropractic. Other researchers interested in improving uptake of evidenced-based information could use this method in their own setting to investigate determinants of behaviour among other professional groups. Future research may use knowledge gained to inform the development and evaluation of a theory-based tailored intervention to improve guideline adherence and reduce the use of spine x-rays among targeted providers.

This thesis presents a novel ZnO-hydrogel based fluorescent colloidal semiconductor nanomaterial system for potential bio-medical applications such as bio-imaging, cancer detection and therapy. The preparation of ZnO nanoparticles and their surface modification to make a biocompatible material with enhanced optical properties is discussed. High quality ZnO nanoparticles with UV band edge emission are prepared using gas evaporation method. Semiconductor materials including ZnO are insoluble in water. Since biological applications require water soluble nanomaterials, ZnO nanoparticles are first dispersed in water by ball milling method, and their aqueous stability and fluorescence properties are enhanced by incorporating them in bio-compatible poly N-isopropylacrylamide (PNIPAM) based hydrogel polymer matrix. The optical properties of ZnO-hydrogel colloidal dispersion versus ZnO-Water dispersion were analyzed. The optical characterization using photoluminescence spectroscopy indicates approximately 10 times enhancement of fluorescence in ZnO-hydrogel colloidal system compared to ZnO-water system. Ultrafast time resolved measurement demonstrates dominant exciton recombination process in ZnO-hydrogel system compared to ZnO-water system, confirming the surface modification of ZnO nanoparticles by hydrogel polymer matrix. The surface modification of ZnO nanoparticles by hydrogel induce more scattering centers per unit area of cross-section, and hence increase the luminescence from the ZnO-gel samples due to multiple path excitations. Furthermore, surface modification of ZnO by hydrogel increases the radiative efficiency of this hybrid colloidal material system thereby contributing to enhanced emission.

Orientadores: Plauto Chrisptopher Aranha Watanabe, Deborah Queiroz de Freitas / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-22T04:06:31Z (GMT). No. of bitstreams: 1 Vasconcelos_TaruskaVentorini_M.pdf: 4859018 bytes, checksum: c363a84d1cdfd032d7453c1b0626f663 (MD5) Previous issue date: 2013 / Resumo: Imagens por tomografia computadorizada de feixe cônico (TCFC) são frequentemente utilizadas; no entanto, seu uso envolve doses de radiação que não podem ser indiscriminadas. A redução da miliamperagem (mA) é um dos meios mais práticos para se reduzir a dose de radiação; porém, ainda não se sabe o efeito isolado de protocolos de baixa mA na qualidade das imagens, fundamental para uma correta análise dessas. Com isso, o objetivo desse estudo foi avaliar a influência da variação da miliamperagem na qualidade da imagem de TCFC de diferentes regiões ósseas de mandíbulas edêntulas. Os exames tomográficos foram realizados em oito mandíbulas secas, utilizando os diferentes valores de miliamperagem disponíveis (2, 4, 6,3, 8, 10, 12 e 15 mA), em um aparelho de tomografia computadorizada de feixe cônico (K9000, Kodak). Após a obtenção das imagens, os cortes parassagitais das regiões correspondentes às de incisivos, caninos, prémolars, 1º molares e 2º molares foram avaliados por três radiologistas, de duas maneiras. Inicialmente, foi realizada uma avaliação subjetiva da qualidade, na qual foi adotada uma escala de quatro pontos (0 a 3), de acordo com a visibilidade das estruturas; posteriormente, os avaliadores realizaram uma avaliação objetiva, através da obtenção de medidas nas imagens, as quais foram posteriormente comparadas com medidas obtidas diretamente nas mandíbulas. Vinte e cinco por cento das imagens foram reavaliadas pelos examinadores, após 30 dias, para avaliação da concordância intraexaminador. Os resultados intra e interexaminador variaram entre bom a muito bom para avaliação da qualidade da imagem e foram excelentes quando foram avaliadas as medidas. Após a aplicação do teste estatístico de Tukey, foi possível observar que existiu uma influência da corrente utilizada na qualidade da imagem; entretanto, essa influência foi limitada ao uso de mA baixas (2 e 4). Após a mA 6,3, as imagens apresentaram desempenho semelhante, demonstrando não haver associação linear entre aumento dessa e melhora da qualidade da imagem. As medidas da altura óssea não sofreram influência da mA utilizada; porém, as imagens obtidas com 6,3 mA apresentaram a menor diferença em relação às medidas reais. Assim, pôde-se concluir que a mA 6,3 apresenta um equilíbrio adequado entre dose de radiação e qualidade da imagem no aparelho avaliado, devendo assim ser utilizada, e que o uso de mA maiores deve ser evitado, uma vez que não resultaram em imagens de maior qualidade e, com isso, apresentariam maior dose de radiação sem benefícios para o paciente / Abstract: Despite cone beam computed tomography (CBCT) images are often used; this involves radiation doses that require attention. The milliamperage (mA) reduction is an easy way to reduce radiation dose; however, the isolated effect of low mA settings on image quality is not knowed. This study aimed to evaluate the milliamperage in the image quality of the CBCT in different edentulous bone regions. The examinations were done in eight dry mandibles with different milliamperage values (2, 4, 6.3, 8, 10, 12 and 15) using the KODAK 9000 CBCT unit. The cross-sectional slices of the incisive, canine, premolar, first and second molar were analyzed by three oral radiologists, in two ways. Initially, a subjective evaluation of the visibility of the anatomical structures was performed based on a four grade scale and, afterwards, an objective evaluation through bone height measurement, which was compared with the real measures obtained in the mandible. After 30 days, 25% of the sample was re-evaluated by the observers, in order to obtain the intraobserver reproducibility. The intra and interobserver values varied between good and very good for the image quality evaluation, and they were excellent when evaluating the measurements. The Tukey test showed the influence of the milliamperage in the image quality, but only in the lowest values (2 and 4). The other milliamperage values had a similar performance. The measurements of bone height were not influenced by milliamperage, but the images obtained with 6.3 mA showed the lowest difference compared to the real measurements. Thus, it was concluded that the 6.3 mA provides an appropriate balance between radiation dose and image quality, and therefore the use of higher milliamperage values should be avoided since it does not provide an improvement of the image quality and it uses higher radiation dose without any benefit for the patient / Mestrado / Radiologia Odontologica / Mestra em Radiologia Odontológica

Orientador: Wu Shin-Ting / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia Elétrica e de Computação / Made available in DSpace on 2018-08-26T15:53:26Z (GMT). No. of bitstreams: 1 Loos_WallaceSouza_M.pdf: 21840648 bytes, checksum: 8bb81a3fcf4de4d44de658f543435dda (MD5) Previous issue date: 2014 / Resumo: A reformatação curvilínea é uma técnica computacional de exploração, portanto, não invasiva, que permite realizar cortes curvilíneos sobre as neuroimagens. Ela complementa as reformatações multiplanares na localização de displasia cortical focal, causa comumente associada a epilepsia refratária. Foi desenvolvido um algoritmo de reformatação curvilínea baseado em malhas de offset pelo nosso grupo de pesquisa. Dois problemas foram identificados no algoritmo: artefatos visuais e limitação da região a ser reformatada em áreas visíveis. Neste trabalho apresentamos soluções para contornar estes problemas. Mostramos que a causa dos artefatos são as auto-interseções locais e que um algoritmo de simplificação pode removê-las de forma eficiente sem comprometer a geometria de reformatação. Desenvolvemos um algoritmo de costura para juntar malhas obtidas em diferentes ângulos de vista numa única malha de corte. Desta forma, é possível realizar a reformatação simultânea nos dois hemisférios cerebrais propiciando um diagnóstico baseado em análise comparativa dos dois lados. Na implementação dos nossos algoritmos procuramos explorar as vantagens de uma estrutura de dados eficiente e do paralelismo das unidades de processamento gráfico (GPUs) para termos resultados em tempo interativo. Experimentos preliminares com as neuroimagens dos pacientes com crises epilépticas apontam que a ferramenta pode colaborar na identificação de lesões sutis / Abstract: Curvilinear Reformatting is a computational exploration technique, therefore noninvasive, that allows making curvilinear slices on 3D neuroimaging data. It complements multiplanar reformatting to find lesions of focal cortical dysplasia, a common cause of refractory epilepsy. Our research group has developed an algorithm for curvilinear reformatting based on offset meshes. Two problems were identified: visual artifacts and limitations of the visible area to be reformatted. In this work we presented two solutions to solve these problems. We show that the cause of the artifacts are the local self-intersections and that an simplification algorithm can remove them efficiently without compromising the geometry of reformatting. We developed an sewing algorithm to join meshes from different angles of view on a single mesh. In this way, it is possible to make the curvilinear reformatting in both hemispheres of the brain, providing a diagnosis based on comparative analysis of the two sides. In the implementation of our algorithms we tried to explore the advantages of efficient data structure and parallelism of graphic processor units (GPU) to achieve results at interactive rates. Preliminary results with neuroimages from patients with epileptic seizures indicate that the tool may collaborate in the finding of subtle lesions / Mestrado / Engenharia de Computação / Mestre em Engenharia Elétrica

A doença arterial coronária (DAC) avançada caracteriza-se pela presença de vasos calcificados e difusamente estenosados, o que reduz a acurácia da angiografia coronária não-invasiva por meio dos atuais aparelhos de tomografia computadorizada (CT) com 16 colunas de detectores (16-MDCTA). O principal objetivo deste estudo foi tentar demonstrar uma acurácia diagnóstica global de pelo menos 90% para a detecção de estenoses coronárias >= 50% em pacientes com DAC avançada e alta probabilidade de possuírem escores de cálcio coronário elevados, mediante a utilização de um sistema de CT com 32 colunas de detectores, todas capazes de adquirir simultaneamente cortes com 0,5 mm de espessura (32x0,5-MDCTA). Angiografias coronárias sincronizadas ao traçado de ECG foram obtidas por meio da 32x0,5-MDCTA (32 cortes de 0,5 mm, voxels isotrópicos de 0,35x0,35x0,35 mm³, rotação do gantry a 400 ms) em 30 pacientes consecutivos (25 do sexo masculino, com idade média igual a 59±13 anos e índice de massa corpórea médio de 26,2±4,9 Kg/m²) e portadores de DAC avançada. As principais artérias nativas, incluindo seus ramos de primeira ordem com diâmetro >= 1,5 mm bem como os enxertos coronários existentes, foram avaliados de forma independente quanto à presença de estenoses >= 50%. Os stents foram excluídos. As angiografias coronarianas convencionais (realizadas em média 18±12 dias antes das respectivas 32x0,5-MDCTAs) foram analisadas de maneira quantitativa (angiografia coronária quantitativa). A mediana do escore de cálcio de Agatston foi igual a 510 (variação entre 3 e 5066). A sensibilidade, a especificidade e os valores preditivos positivo e negativo para a detecção de estenoses >= 50% nas artérias coronárias nativas foram seguintes: 76% (29/38), 94% (190/202), 71% (29/41), e 96% (190/199), respectivamente. A acurácia diagnóstica global foi de 91% (219/240). Do total de vasos analisados, 20% (69/352) foram excluídos devido à existência de um dos seguintes artefatos: movimento, ruído e baixo realce do contraste radiológico isoladamente ou em conjunto (45/69 ou 65%), distorção da imagem secundária à presença de eletrodo de desfibrilador ou marcapasso (18/69 ou26%), e calcificação arterial excessiva (6/69 ou 9%). Conclui-se que a 32x0,5-MDCTA exclui com precisão as estenoses coronarianas >= 50% em pacientes com DAC avançada e escore de cálcio coronário elevado, com acurácia diagnóstica global de 91% / Advanced coronary artery disease (CAD) is characterized by calcified and diffusely stenotic vessels, hampering accuracy of noninvasive coronary angiography with current 16-detector computed tomography (CT) scanners. The main purpose of this study was to try to demonstrate an overall diagnostic accuracy of at least 90% for detection of coronary stenoses >= 50% by half-millimeter 32-detector CT angiography (32x0.5-MDCTA) in patients with advanced CAD and a high likelihood of having elevated coronary calcium scores. ECG-gated coronary 32x0.5-MDCTA (32x0.5 mm cross-sections, 0.35x0.35x0.35 mm³ isotropic voxels, 400 ms gantry rotation) was performed in 30 consecutive patients (25 male, 59±13 years-old, 26.2±4.9 Kg/m²) with advanced CAD. Major coronary arteries, including >=1.5-mm first order branches, and bypass grafts were independently evaluated for >= 50% stenoses. Stents were excluded. Conventional coronary angiography (performed on average 18±12 days before their corresponding 32x0.5-MDCTAs) was analyzed by quantitative coronary angiography. Median Agatston calcium score was 510 (3-5066 range). Sensitivity, specificity, positive and negative predictive values for detection of >= 50% stenoses in the native coronary arteries were: 76% (29/38), 94% (190/202), 71% (29/41), and 96% (190/199), respectively. Overall diagnostic accuracy was 91% (219/240). Twenty percent (69/352) of the vessels were excluded from the analysis due to one of the following artifacts: motion, noise, and low contrast enhancement isolated or in combination (45/69 or 65%), image distortion secondary to an ICD or pacemaker lead (18/69 or 26%), and severe arterial calcification (6/69 or 9%). We concluded that 32x0.5-MDCTA accurately excludes >= 50% coronary stenoses in patients with advanced CAD and high calcium scores, showing an overall diagnostic accuracy of 91%