<p>The cardiac wall has complex three-dimensional fiber structures and mechanical properties that enable the heart to efficiently pump the blood through the body. By studying the myocardial strains induced during diastole, information about the pumping performance of the heart and what mechanisms that are responsible for this effective blood filling, can be achieved. Two different computation methods for myocardial strain, both based on data acquired from marker technique, were compared using a theoretical cylinder model. The non-homogeneous polynomial fitting method yielded higher accuracy than a homogeneous tetrahedron method, and was further used to investigate cardiac and fiber strains at different wall depths and myocardial regions in normal and ischemic ovine hearts. Large spatial and regional variations were found, as well as alterations, conveyed by ischemic conditions, of fiber mechanisms responsible for the circumferential expansion and wall thinning during diastole.</p>

<p>The aim of this thesis is to develop and study a method for estimation of the pulse pressure in centrally located arteries. Obtaining the central pulse pressure is desirable for several reasons. For example, the central pulse pressure can be used to assess aortic stiffness, which in turn is an important predictor of cardiovascular mortality. In this thesis a method of estimation based on a one--dimensional wave propagation theory applied to a physiological model of the human systemic arterial tree is studied. For the purpose of validation, recorded pressure signals from twenty four control subjects are used. Various methods for individualization of the tree model are discussed, and a method that utilizes an optimization routine is proposed.</p>

<p>Deep brain stimulation (DBS) is a surgical treatment technique, which involves application of electrical pulses via electrodes inserted into the brain. Neurons, typically located in the basal ganglia network, are stimulated by the electrical field. DBS is currently widely used for symptomatically treating Parkinson’s disease patients and could potentially be used for a number of neurological diseases. In this study, computational modeling was used to simulate the electrical activity of neurons being affected by the electrical field, to gain better understanding of the mechanisms of DBS. The spatial and temporal distribution of the electrical field was coupled to a cable model representing a human myelinated axon. A passing fiber with ends infinitely far away was simulated. Results show that excitation threshold is highly dependent on the diameter of the fiber and the influence (threshold-distance and threshold-diameter relations) can be controlled to some extent, using charge-balanced biphasic pulses.</p>

<p>Coronary artery bypass graft (CABG) surgery is a common treatment for patients with coronary artery disease. A potential complication of CABG is myocardial ischemia or infarction. In this thesis, a method - based on laser Doppler flowmetry (LDF) - for detection of intra- and postoperative ischemia by myocardial perfusion monitoring is evaluated.</p><p>LDF is sensitive to motion artifacts. In previous studies, a method for reduction of motion artifacts when measuring on the beating heart has been developed. By using the ECG as a reference, the perfusion signal is measured in intervals during the cardiac cycle where the cardiac motion is at a minimum, thus minimizing the artifacts in the perfusion signal.</p><p>The aim of this thesis was to investigate the possibilities to use the ECG-triggered laser Doppler system for continuous monitoring of myocardial perfusion in humans during and after CABG surgery. Two studies were performed. In the first study, changes in myocardial perfusion during CABG surgery were investigated (n = 13), while the second study focused on postoperative measurements (n = 13). In addition, an ECG-triggering method was implemented and evaluated.</p><p>It was found that the large variations in myocardial perfusion during CABG surgery could be monitored with the ECG-triggered laser Doppler system. Furthermore, a perfusion signal of good quality could be registered postoperatively from the closed chest in ten out of thirteen patients. In eight out of ten patients, a proper signal was obtained also the following morning, i.e., about 20 hours after probe insertion. The results show that respiration and blood pressure can have an influence on the perfusion signal.</p><p>In conclusion, the results indicate that the method is able to detect fluctuations in myocardial perfusion under favourable circumstances. However, high heart rate, abnormal cardiac motion, improper probe attachment and limitations in the ECG-triggering method may result in variations in the perfusion signal that are not related to tissue perfusion.</p> / <p>Varje år utförs omkring 4500 kranskärlsoperationer i Sverige. En allvarlig komplikation som kan uppstå efter operationen är otillräcklig blodförsörjning till hjärtmuskeln. Den här licentiatavhandlingen handlar om utveckling och utvärdering av en metod, baserad på laserdopplerteknik, för att kunna upptäcka nedsatt blodperfusion i hjärtmuskeln på ett tidigt stadium.</p><p>Laserdopplertekniken är känslig för rörelsestörningar. I tidigare studier har en metod för reducering av rörelsestörningar vid mätning på slående hjärta tagits fram. Med EKG:t som referens mäts blodperfusionen i de faser under hjärtcykeln då hjärtats rörelse är som minst, vilket minskar bidraget av rörelsestörningar i blodperfusionssignalen.</p><p>I den här avhandlingen undersöks om metoden kan användas för kontinuerlig övervakning av hjärtmuskelns blodperfusion på patienter under och efter hjärtoperationer. Två studier har genomförts: en där hjärtmuskelns perfusion mättes i olika faser under kranskärlsoperationer och en där mätproben lades in i hjärtmuskeln under operationen och mätningar gjordes under det första dygnet efter operationen.</p><p>Det visade sig vara möjligt att följa förändringar i hjärtmuskelns blodperfusion under operation. Det var även möjligt att registrera en perfusionssignal av god kvalitet efter operationen då bröstkorgen var stängd. Hos åtta av tio patienter erhölls en bra signal även morgonen efter operationen, dvs. ca 20 timmar efter att proben lades in. Resultaten visar också att andning och blodtryck kan ha en påverkan på blodperfusionssignalen.</p><p>Slutsatsen av arbetet är att det går att se variationer i hjärtmuskelns blodperfusion med EKG-triggad laserdoppler under vissa förutsättningar. Signalen är dock i många fall svårtolkad på grund av att t ex hög hjärtfrekvens, onormal hjärtväggsrörelse eller ändrad probposition sannolikt kan ge variationer i perfusionssignalen som inte är relaterade till blodflödesförändringar.</p> / Report code: LIU-TEK-LIC-2007:35.

<p>Heart failure is a common disease which is difficult to diagnose. To aid physicians in diagnosing heart failure, a decision support system has been proposed. Parameters useful to the system are suggested. Some of these, such as age and gender, should be provided by the physician, and some should be derived from electro- and phonocardiographic signals.</p><p>Various methods of signal processing, such as wavelet theory and principal components analysis, are described. Heart failure should be diagnosed based on the parameters, and so various forms of decision support systems, such as neural networks and support vector machines, are described. The methods of signal processing and classification are discussed and suggestions on how to develop the system are made.</p>

<p>Sjukvården lever med knappa resurser och investeringar i medicinsk teknik binder mycket kapital under en längre tid, vilket har ökat behovet av systematiska och noggranna utvärderingar av investeringarnas konsekvenser, både ekonomiska och icke-ekonomiska.</p><p>Huvudsyftet med studien var att undersöka hur investeringsbedömningar inom sjukvården görs, och vilken roll ekonomiska utvärderingar har vid investeringsbeslut. Delsyftet var att utarbeta en investeringskalkyl och bedöma kostnadseffektiviteten för införandet av ett nytt undersökningsmetod för hjärtdiagnostik på Karolinska universitetssjukhuset i Huddinge (Cardiotom).</p><p>Utgångspunkten i undersökningen finns i investeringsteori och hälsoekonomisk teori som därför presenteras i uppsatsen. En redogörelse av tidigare forskning både inom sjukvården och inom andra branscher ges, för att läsaren skulle kunna jämföra utfallet i den här studien med de andra studierna i ämnet.</p><p>Som undersökningsmetod valde författarna att kombinera intervjuer med en enkätundersökning och på det sättet få en samlad bild av kalkyleringens betydelse och övrig problematik kring lönsamhetsbedömningen vid investeringar i medicinsk teknik.</p><p>Resultatet av studien tyder bland annat på att investeringskalkyler spelar fortfarande ett begränsad roll vid investeringsbeslut, samt att dess betydelse kan komma att öka i samband med att kraven på kvantitativ utvärdering av samhällsekonomisk nytta ökar.</p><p>Investeringsbedömningen av införandet av Cardiotom visar att investeringen är lönsam och utifrån kalkylens utfall, där hänsyn till patientnyttan också tagits med, borde genomföras.</p>

<p>Uppsatsens syfte är att undersöka vilka ekonomiska effekter införandet av distansuppföljning för ICD-patienter har ur ett samhällsperspektiv. Delsyftet är att identifiera ekonomiska argument och kvalitativa aspekter för och emot införandet av tjänsten distansuppföljning.</p><p>Författarna har kommit fram till ett antal slutsatser. Att införa distansuppföljning som uppföljningsmetod för ICD-patienter istället för konventionella återbesök på sjukhus innebär stora kostnadsbesparingar. Nettonuvärdet uppgår till drygt 268 miljoner kronor efter femton år. Vid tidsperiodens slut erhålls en kostnadsbesparing på cirka 35,6 procent. De ekonomiska fördelarna överstiger kostnaderna redan efter ett år, och hela investeringskostnaden återfås efter sju år. Kvalitativa argument som talar för distansuppföljning är tidsbesparingar, förenklad uppföljning, bättre övervakning och att patienterna upplever en större trygghet.</p>

<p>Prostate cancer is the most common type of cancer in men in Europe and the USA. Some prostate tumours are regarded as stiffer than the surrounding normal tissue, and therefore it is of interest to be able to reliably measure prostate tissue stiffness. The methods presently used to detect prostate cancer are inexact, and new techniques are needed. In this licentiate thesis resonance sensor technology, with its ability to measure tissue stiffness, was applied to normal and cancerous prostate tissue.</p><p>A piezoelectric transducer element in a feedback system can be set to vibrate at its resonance frequency. When the sensor element contacts an object a change in the resonance frequency is observed, and this feature has been utilized in sensor systems to describe physical properties of different objects. For medical applications it has been used to measure stiffness variations due to various pathophysiological conditions.</p><p>An impression-controlled resonance sensor system was used to quantify stiffness in human prostate tissue in vitro using a combination of frequency change and force measurements. Measurements on prostate tissue showed statistically significant (p < 0.001) and reproducible differences between normal healthy tissue and tumour tissue when using a multivariate parameter analysis. Measured stiffness varied in both the normal tissue and tumour tissue group. One source of variation was assumed to be related to differences in tissue composition. Other sources of error could be uneven surfaces, different levels of dehydration of the prostates, and actual differences between patients.</p><p>The prostate specimens were also subjected to morphometric measurements, and the sensor parameter was compared with the morphology of the tissue with linear regression. In the probe impression interval 0.5–1.7 mm, the maximum coefficient of determination was R2 ≥ 0.60 (p < 0.05, n = 75). An increase in the proportion of prostate stones (corpora amylacea), stroma, or cancer in relation to healthy glandular tissue increased the measured stiffness. Cancer and stroma had the greatest effect on the measured stiffness. The deeper the sensor was pressed, the greater, i.e., deeper, volume it sensed.</p><p>It is concluded that prostate cancer increases the measured stiffness as compared with healthy glandular tissue, but areas with predominantly stroma or many stones could be more difficult to differentiate from cancer. Furthermore, the results of this study indicated that the resonance sensor could be used to detect stiffness variations in human prostate tissue in vitro, and especially due to prostate cancer. This is promising for the development of a future diagnostic tool for prostate cancer.</p>

Currently film is being replaced by electronic detectors for portal imaging in radiation therapy. This development offers obvious advantages such as on-line quality assurance and digital images that can easily be accessed, processed and communicated. In spite of the improvements, the image quality has not been significantly enhanced, partly since the quantum efficiency compared to film is essentially the same, and the new electronic devices also suffer from sensitivity to the harsh radiation environment. In this thesis we propose a third generation electronic portal imaging device with increased quantum efficiency and potentially higher image quality. Due to the parallel readout capability it is much faster than current devices, providing at least 200 frames per second (fps), and would even allow for a quality assurance and adaptive actions after each accelerator pulse. The new detector is also sensitive over a broader range of energies (10 keV - 50 MeV) and can be used to obtain diagnostic images immediately prior to the treatment without repositioning the patient. The imaging could be in the form of portal imaging or computed tomography. The new detector is based on a sandwich design containing several layers of Gas Electron Multipliers (GEMs) in combination with, or integrated with, perforated converter plates. The charge created by the ionizing radiation is drifted to the bottom of the assembly where a tailored readout system collects and digitizes the charge. The new readout system is further designed in such a way that no sensitive electronics is placed in the radiation beam and the detector is expected to be radiation resistant since it consists mainly of kapton, copper and gas. A single GEM detector was responding linearly when tested with a 50 MV photon beam at a fluence rate of ~1010 photons mm-2 s-1 during 3-5 μs long pulses, but also with x-ray energies of 10-50 keV at a fluence rate of up to ~108 photons mm-2 s-1. The electron transmission of a 100 μm thick Cu plate with an optical transparency of ~46% was found to be ~15.4%, i.e. the effective hole transmission for the electrons was about one third of the hole area. A low effective GEM gain is enough to compensate for the losses in converters of this dimension. A prototype for the dedicated electronic readout system was designed with 50 x 100 pixels at a pitch of 1.27 mm x 1.27 mm. X-ray images were achieved with a single GEM layer and also in a double GEM setup with a converter plate interleaved. To verify the readout speed a Newton pendulum was imaged at a frame rate of 70 fps and alpha particles were imaged in 188 fps. The experimental studies indicates that the existing prototype can be developed as a competitive alternative for imaging in radiation therapy.

Part 1: The bandwidth of the ultrasound Doppler signal is proposed as a classification function of blood and tissue signal in transthoracial echocardiography of the left ventricle. The new echocardiographic mode, Bandwidth Imaging, utilizes the difference in motion between tissue and blood. Specifically, Bandwidth Imaging is the absolute value of the normalized autocorrelation function with lag one. Bandwidth Imaging is therefore linearly dependent on the the square of the bandwidth estimated from the Doppler spectrum. A 2-tap Finite Impulse Response high-pass filter is used prior to autocorrelation calculation to account for the high level of DC clutter noise in the apical regions. Reasonable pulse strategies are discussed and several images of Bandwidth Imaging are included. An in vivo experiment is presented, where the apparent error rate of Bandwidth Imaging is compared with apparent error rate of Second-Harmonic Imaging on 15 healthy men. The apparent error rate is calculated from signal from all myocardial wall segments defined in \cite{Cer02}. The ground truth of the position of the myocardial wall segments is determined by manual tracing of endocardium in Second-Harmonic Imaging. A hypotheses test of Bandwidth Imaging having lower apparent error rate than Second-Harmonic Imaging is proved for a p-value of 0.94 in 3 segments of end diastole and 1 segment in end systole on non averaged data. When data is averaged by a structural element of 5 radial, 3 lateral and 4 temporal samples, the numbers of segments are increased to 9 in end diastole and to 6 in end systole. These segments are mostly located in apical and anterior wall regions. Further, a global measure GM is defined as the proportion of misclassified area in the regions close to endocardium in an image. The hypothesis test of Second-Harmonic Imaging having lower GM than Bandwidth Imaging is proved for a p-value of 0.94 in the four-chamber view in end systole in any type of averaging. On the other side, the hypothesis test of Bandwidth Imaging having lower GM than Second-Harmonic Imaging is proved for a p-value of 0.94 in long-axis view in end diastole in any type of averaging. Moreover, if images are averaged by the above structural element the test indicates that Bandwidth Imaging has a lower apparent error rate than Second-Harmonic Imaging in all views and times (end diastole or end systole), except in four-chamber view in end systole. This experiment indicates that Bandwidth Imaging can supply additional information for automatic border detection routines on endocardium. Part 2: Knowledge Based Imaging is suggested as a method to distinguish blood from tissue signal in transthoracial echocardiography. This method utilizes the maximum likelihood function to classify blood and tissue signal. Knowledge Based Imaging uses the same pulse strategy as Bandwidth Imaging, but is significantly more difficult to implement. Therefore, Knowledge Based Imaging and Bandwidth Imaging are compared with Fundamental Imaging by a computer simulation based on a parametric model of the signal. The rate apparent error rate is calculated in any reasonable tissue to blood signal ratio, tissue to white noise ratio and clutter to white noise ratio. Fundamental Imaging classifies well when tissue to blood signal ratio is high and tissue to white noise ratio is higher than clutter to white noise ratio. Knowledge Based Imaging classifies also well in this environment. In addition, Knowledge Based Imaging classifies well whenever blood to white noise ratio is above 30 dB. This is the case, even when clutter to white noise ratio is higher than tissue to white noise ratio and tissue to blood signal ratio is zero. Bandwidth Imaging performs similar to Knowledge Based Imaging, but blood to white noise ratio has to be 20 dB higher for a reasonable classification. Also the highpass filter coefficient prior to Bandwidth Imaging calculation is discussed by the simulations. Some images of different parameter settings of Knowledge Based Imaging are visually compared with Second-Harmonic Imaging, Fundamental Imaging and Bandwidth Imaging. Changing parameters of Knowledge Based Imaging can make the image look similar to both Bandwidth Imaging and Fundamental Imaging.