In radiotherapy the main goal is to kill cancer cells, prevent them from growing and reproducing, while healthy tissue is spared. One technique to treat cancer is to use external radiotherapy where a linear accelerator (linac) is used to generate a high energy radiation photon beam. An MRI-linac is a combined magnetic resonance imaging (MRI) and linac and is used to perform adaptive radiotherapy. However, in order to perform treatments on the MRI-linac commissioning measurements must be performed to acquire all radiation beam data, verify its accuracy, and enter all these data into a com- puterized treatment planning system (TPS). To acquire the radiation beam data absorbed dose, output factors, percentage depth dose (PDD) curves and cross- and inplane profiles are measured. This was done together with a gamma analysis by Elekta in connection with the installation of the Elekta Unity MRI-linac at the Uppsala University Hospital in the year 2019. In this project these commissioning measurements and gamma analysis have been recreated and compared with the expected dose distributions calculated in the TPS Monaco. In addition to this a comparison with the result from Elekta has been done. With a water phantom, PTW BEAMSCAN MR, and three different detectors, PTW Semiflex 3D, PTW microDiamond and Farmer chamber PTW30013, PDDs and profiles have been acquired at different field sizes at gantry angles 0° and 270°. The absorbed dose was measured under reference conditions, depth 10 cm and field size 10x10 cm2, to be 0.8656 cGy/MU and 1.1666 cGy/MU at gantry angle 0° and 270°, respectively. This yielded a difference between Elekta’s result of 0.02% and -0.24% for 0° and 270°, respectively. The output factors were measured at 0° and 270° and differed with Elekta’s result in a range from -2.45% to 0.04%. From these values the PDDs and profiles were created and compared with the calculated result from Monaco.

Diagnosing abnormal fetal cardiac function using ultrasound is a complicated procedure which makes it difficult to obtain high quality results from ultrasound examinations that are performed shortly before delivery. Color tissue Doppler imaging (cTDI) is the echocardiographic technique that has been used to obtain the data for this project. Subtle changes in the fetal cardiac function caused by a variety of complications can possibly be detected using cTDI. Fetuses suffering from these complications are often involved in high-risk deliveries. Combining the data obtained from cTDI with Artificial Intelligence (AI) may improve precision and accuracy when it comes to diagnosing pathological conditions involving fetal cardiac function before delivery. AI uses machines to perform and execute tasks that are characteristic of human intelligence. AI can be achieved by using deep learning. Deep learning uses algorithms called artificial neural networks that are inspired by the biological structure and function of the human brain. The neural networks classify information in a similar manner to the human brain. A platform that uses deep learning can make statements or predictions based on the data fed to it. The AI platform Peltarion uses deep learning to perform tasks. The aim of this project was to use Peltarion to evaluate the possibility of predicting high-risk deliveries with abnormal perinatal outcome by using data obtained by cTDI velocity recordings of the fetal heart. The data included myocardial velocity recordings from 107 pregnancies, out of the 107 pregnancies 82 of the babies were born healthy while 25 babies had an adverse perinatal outcome. The data was uploaded in the platform and three models were built and trained in order to evaluate the performance of the platform using the data. The parameters that have been used to determine the results are loss, accuracy and precision. The results showed that the accuracy parameter was measured to be 0.8 in all cases which means that the model correctly predicts if a fetal heart is healthy or likely to have an adverse outcome 80% of the time. The precision parameter was measured to be around 0.4 which means out of all the times the model predicted a fetal heart to have an adverse outcome, only 40% truly had an adverse outcome. It was concluded that a substantially larger amount of evenly distributed data is required to appropriately evaluate the possibility of using fetal myocardial velocity recordings as data for the AI platform Peltarion to predict high-risk deliveries.

Background: Voice is still the most important tool used by teachers, but voice is varied and subject to problems. Teachers who lecture for long hours or have taught for most of their professional lives, face issues such as voice discomfort, chronic voice disorders, occupational voice disorder, stress, physiological and psychological problems. Due to issues such as poor acoustics in the classroom and absence of any installed voice amplification system, teachers might be subject to increase their vocal load to reach all the students in the classroom. Purpose: The aim of this study is to study the fundamental frequency (fo) and the strength Leq[dB(C)] of the teacher’s voice, with and without voice amplification system.  Method: Students from the preparatory year of their studies at KTH (CBH), were asked if they would like to participate in this study that researches on the voice health of teacher. Two days of teaching sessions were recorded using a microphone attached to the teacher’s mouth and three other static microphones placed in different parts of the room. The voice amplification system used in the study, was the one that was already in use at some of the classrooms at KTH. The students and the participating teacher were given questionnaires, towards the end of the teaching session to voice their opinion on the teaching voice, with and without the voice amplification system.  Results: The results from the data collected from the recordings, have shown that the SPL increased between 0.6 dB(C) and 5 dB(C) when the voice amplification system was turned on. The fundamental frequency (fo) of the teacher’s voice reduced by 1.4% with the use of the voice amplifier. The response of the students was overwhelmingly in support of the voice amplification system used during the recordings. 60-62% of female respondents and 68-79% of male respondents felt that the voice amplification system increased the audibility in the classroom. Conclusion: Leq [dB(C)] values from the mics around the classroom showed a considerable increase and thus the amplification system provides a good acoustic condition for the teacher to communicate with his students and a significant improvement in student’s comprehension of the teacher’s voice and learning conditions. There was a decrease in the fo of the teacher’s voice with the amplification, which is good for the teacher’s vocal health and reduces voice disorders while improving the quality and audibility of teacher’s voice. Majority of the students felt that the amplification system was beneficial during the teaching sessions and would like to see more amplifiers installed in more classrooms. / Bakgrund: Rösten är fortfarande det viktigaste verktyget som en lärare har, men rösten är varierad och utsatt för en del problem. Lärare som har undervisat i hela sina professionella liv, står inför problem som obehag med sin röst, kroniska röstförluster, yrkesskador, stress, fysiologiska och psykiska problem. På grund av dålig akustik i klassrummet och frånvaron av ett installerat röstförstärkningssystem, kan lärare bli tvungna att öka sin röstvolym för att nå alla elever i klassrummet. Syfte: Syftet med denna studie är att studera den grundläggande frekvensen (fo) och styrkan Leq[dB (C)] i lärarens röst, med och utan röstförstärkningssystem. Metod: För studenter från basår på KTH (CBH) blev frågan om det skulle vilja delta i denna studie som undersöker lärarens rösthälsa. Två dagars undervisningsspel registrerades med hjälp av en mikrofon kopplad till lärarens mun och tre andra stationera mikrofoner med stativ placerades i olika delar av rummet. Det röstförstärkningssystem som användes i studien var det som redan var i bruk vid några av klassrummen på KTH. Eleverna och den deltagande läraren fick frågeformulär mot slutet av undervisningssessionen, för att svara på frågor om lärarens röst, med och utan röstförstärkningssystem. Resultat: Resultatet som samlats in från inspelningar visade att SPL ökade mellan 0,6 dB (C) och 5 dB (C) med röstförstärkningssystemet. Den grundläggande frekvens (fo) av lärarens röst minskade med 1,4% med röstförstärkaren. Svaren från eleverna var ett överväldigande stöd för röstförstärkningssystemet som användes under inspelningarna. 60-62% av det kvinnliga respondenterna och 68-79% av det manliga ansåg att röstförstärkningssystemet ökade hörbarheten i klassrummet. Slutsats: Leq [dB (C)] -värdena från mikrofonerna på olika ställen i klassrummet visade på en avsevärd ökning av hörbarheten och gav därmed förstärkningssystemet en bra akustisk möjlighet för läraren att kommunicera med sina elever och en signifikant förbättring när det gäller studentens förståelse av det som läraren ville förmedla. fo värdena minskade genom förstärkningen, vilket var bra för lärarens vokalhälsa och minskade ohälsan samtidigt som lärarens röst och kvalitet förbättrades. Flertalet studenter kände att förstärkningssystemet var fördelaktigt för undervisningen och skulle vilja se förstärkare installerade i flera klassrum.

Postoperativ motion påskyndar läkeprocessen och därför uppmuntras patienter på Tema Cancer, Urologen, på Karolinska Universitetssjukhuset (KS) att motionera med hjälp av dagliga mål. För att följa upp träningen används en whiteboard som visar mål och framsteg, men verktygets otymplighet gör att de önskar en mer flexibel digital lösning. Målet med detta projekt var att åt KS utveckla en digital träningstavla som uppfyller samma funktion som whiteboarden men som är mer lätthanterlig. Mjukvara för att schemalägga övningar och registrera framsteg skrevs i Java och JavaFX för att köras på en Raspberry Pi 3 Model B kopplad till en pekskärm. En patient fick prova lösningen under ett par dygn i en kvalitativ studie. Både patienten och den ansvarige fysioterapeuten intervjuades och var nöjda med lösningen. / Postoperative exercise facilitates a faster rehabilitation process, therefore patients at Tema Cancer, Urologen, at Karolinska Universitetssjukhuset (KS) are encouraged to exercise using daily exercise routines. Currently, a whiteboard is used to track the goals and progress of a patient's daily exercises, but its unwieldiness makes KS yearn for a more flexible, digital solution. The aim of this project was to develop a digital exercise board for KS, which fulfills the same function as the whiteboard but will be easier to interact with. An exercise tracking software was developed in Java and JavaFX to run on a Raspberry Pi Model 3 B connected to a touchscreen. In a qualitative study, a patient used the digital solution for a couple of days. Both the patient who tried the solution, and the physiotherapist in charge of the patient, was interviewed and were satisfied with the solution.

Barn gastro- och nutritionsmottagningen på Astrid Lindgrens barnsjukhus använder i sitt dagliga arbete ett symtomformulär som besvaras av patienter och läkare vid varje läkarbesök. Då arbetet i samband med symtomformuläret idag är tidskrävande finns ett behov av en digital lösning i form av en applikation. För att eliminera det tidskrävande arbetet är det viktigt att applikationen är kopplad till journalsystemet TakeCare. I projektet har en applikation med tillhörande databas och server utvecklats. TakeCare har kontaktats för att svara på vilka möjligheter och krav som finns gällande att koppla applikationen till deras journalsystem. Det har även utförts en kartläggning av behovsbilden kring liknande lösningar på andra mottagningar. Resultatet visar att den framtagna applikationen måste vara CE-märkt, följa GDPR och patientdatalagen samt vara godkänd av TakeCare-förvaltningen för att få kopplas till journalsystemet. TakeCare kräver även information om hur applikationen ska förvaltas och finansieras. Genom framtida arbete kan fler krav komma att visa sig viktiga för att genomföra en sammankoppling. Kartläggningen visar att det finns ett större behov av liknande digitala lösningar inom vården vilket innebär att applikationen i framtiden kan komma att eliminera en tidskrävande process på fler mottagningar än barn gastro- och nutritionsmottagningen.

Owing to computer simulations, healthcare managers-and decision makers are more capable than ever to understand and evaluate the consequences of their decisions. In 2016, the Swedish government put forward ”Vision eHealth 2025”, emphasizing the importance of digitization within the healthcare system. This thesis aimed at studying the current demands regarding eHealth in Sweden, and what simulation architecture is capable of accurately simulating a digitized Swedish healthcare system. An extensive literature study was conducted, followed by an implementation phase, and finally a validation procedure. It was first concluded that the following three areas of eHealth applications would greatly benefit Swedish healthcare: a fully integrated journal system, systems for care consultations over the internet, and systems for tele-monitoring of chronics and the elderly. The fidelity of a provided first version of a simulation architecture was then examined, and potential areas for improvement were identified. The implementation phase subsequently included changes to the following aspects of the provided simulation platform: level of generality, the patient agent class (pHome), healthcare resources, illness dynamics & levels of care, workflow chart logic, optimization criteria, user-interface, and output variables. The validation procedure consisted of four interviews with professionals knowledgeable about the Swedish healthcare system, for which the developed simulation architecture was demonstrated. It was concluded that, while the level of detail required for a simulation platform to accurately model the consequences of decision making in a digitized Swedish healthcare system is not known, the developed simulation platform is currently not satisfactory. Above all, it lacks specificity in the output variables. / Tack vare datorsimuleringar kan beslutsfattare inom sjukv˚arden b¨attre ¨an n˚agonsin f¨orst˚a och utv¨ardera konsekvenserna av sina beslut. ˚Ar 2016 publicerade den svenska regeringen ”Vision eH¨alsa 2025”. Dokumentet betonade vikten av digitalisering inom sjukv˚arden. Det h¨ar examensarbetet syftar p˚a att studera de aktuella krav som finns inom eH¨alsa i Sverige, och ¨aven simuleringsarkitekturen n¨odv¨andig f¨or att sanningsenligt simulera ett digitaliserat svenskt sjukv˚ardssystem. En omfattande litteraturstudie genomf¨ordes, f¨oljt av en implementationsfas, och till sist en valideringsprocess. F¨orst drogs slutsatsen att f¨oljande tre omr˚aden av eH¨alsa skulle bidra med stor nytta till svensk sjukv˚ard: ett fullst¨andigt integrerat journalsystem, system f¨or v˚ardkonsultationer ¨over internet, och system f¨or tele¨overvakning av kroniker och ¨aldre patienter. Sedan unders¨oktes trov¨ardigheten av en f¨orsedd f¨orsta version av en simuleringsarkitektur, och dess potentiella omr˚aden f¨or f¨orb¨attringar identifierades. Den p˚af¨oljande implementationsfasen inkluderade modifieringar till f¨oljande aspekter av den f¨orsedda simuleringsplattformen: generalitetsniv˚a, patientagentklassen (pHome), sjukv˚ardsresurser, sjukdomsdynamik & olika niv˚aer av v˚ardleverans, logiken bakom arbetsfl¨odesdiagrammen, optimiseringskriterier, anv¨andargr¨anssnittet, och outputvariabler. Valideringsprocessen bestod av fyra intervjuer med professionela yrkesm¨an kunniga om det svenska sjukv˚ardssystemet. Simuleringsplattformen demonstrerades under alla fyra intervjuer. Slutsatsen drogs att detaljniv˚an hos den utvecklade simuleringsplattformen inte ¨ar tillr¨acklig i nul¨aget f¨or att utf¨ora korrekta simuleringar. Framf¨or allt saknar outputvariablerna specificitet. Det ¨ar fortfarande inte k¨ant vilken detaljniv˚a som skulle vara tillr¨acklig i det h¨ar avseendet.

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I dagens samhälle har spårbarhet av medicintekniska hjälpmedel fått en allt viktigare innebörd inom sjukvården. En anledning till det är att de flesta hjälpmedel klassas som medicintekniska produkter vilka enligt Socialstyrelsens föreskrifter måste kunna spåras. Därför märks många hjälpmedel med streckkoder eller liknande markörer. På Karolinska Universitetssjukhuset i Solna önskar man förbättra spårbarheten av rullstolar och få en bättre översikt över vilka som är utlånade och förskrivna. En metod för att lösa detta problem är genom att digitalisera flödesprocessen för rullstolar. I det här arbetet har ett digitalt program utvecklats för att ersätta ett antal steg i flödesprocessen som i nuläget hanteras manuellt med penna och papper. Genom att digitalisera delar av processen och se över möjligheter att implementera scanners kan informationen kvalitetssäkras och arbetet effektiviseras. Resultatet visar att ett sådant program som det som utvecklades skulle vara gynnsamt för sjukhuset och skulle bidra till en bättre kontroll över rullstolsflödet. I och med arbetet har en god grund lagts för att digitalisera hanteringen av hjälpmedel och utveckla processerna.

Prostate cancer (PCa) is the most common male cancer in Europe and the US, and only lung and colorectal cancer have a higher mortality among European men. In Sweden, PCa is the most common cause of cancer-related death for men.The overall aim of this licentiate work was to explore the need for new and complementary methods for PCa detection and to take the first step towards a novel approach: combining Raman spectroscopy and resonance sensor technology. Firstly, the main methods for PCa detection were reviewed. Secondly, to establish a robust protocol for Raman experiments in vitro, the effects of snap-freezing and laser illumination on porcine prostate tissue were studied using Raman spectroscopy and multivariate statistics. Thirdly, measurements on pork belly tissue using both a resonance sensor and a Raman fiberoptic probe were evaluated regarding correlation of the data.It was concluded that the gold standard for PCa detection and diagnosis, the prostate specific antigen test and systematic biopsy, have low sensitivity and specificity. Indolent and aggressive tumors cannot be reliably differentiated, and many men are therefore treated either unnecessarily or too late. Clinical benefits of the state-of-the-art in PCa imaging - advanced ultrasound and MR techniques - have still not been convincingly shown. There is a need for complementary and cost-effective detection methods. Raman spectroscopy and resonance sensor technology are promising alternative techniques, but hitherto their potential for PCa detection have only been investigated in vitro.No evidence of tissue degradation due to 830 nm laser illumination at an irradiance of 3 1010 W/m2 were found. Snap-freezing and subsequent storage at -80◦C gave rise to subtle but significant changes in Raman spectra, most likely related to alterations in the protein structure. The major changes in cancerous prostate tissue do not seem to be related to the protein structure, hence snap-freezing may be applied.The combined measurements on pork belly tissue showed that Raman spectroscopy provided additional discriminatory power to the resonance sensor. The Raman data explained 67% of the variability of the stiffness parameter. The differentiation of tissue types using the resonance sensor was relatively poor, likely due to its large sample volume compared to the Raman sensor. A smaller resonance sensor tip may improve the results.In summary, this work indicates that an instrument combining Raman spectroscopy and resonance sensor technology is a promising complementary method for PCa detection. Snap-freezing of samples may be used in future Raman studies of PCa. A combined instrument could potentially be used to guide prostate biopsies towards lesions suspicious for cancer, and for tumor-border demarcation during surgery. All of this should provide a more secure diagnosis and consequently more efficient treatment of the patient.

A stroke is caused by interruption of the blood supply to the brain. Yearly 15 million people around the globe endure a stroke and the costs and suffering for the people involved and the society are immense. The aim of this thesis was to investigate the response to oxygen deprivation in neurons from the medial preoptic nucleus (MPN) that have a high abundance of neuroglobin. The long term goal is to investigate the neuroprotective role of the protein in relation to stroke. Initially, the electrophysiological response of neurons to hypoxic exposure in an open system was assessed with a conventional patch-clamp setup. The first aim was to see how well the conventional system worked and if it needed improvement. Secondly, the MPN had never been investigated regarding oxygen, deprivation; hence the electrophysiological response under hypoxia needed to be investigated. The conventional patch-clamp system only allowed a reduction of the oxygen content to a level of 3-6% but not total control of the cell environment. The medial preoptic neurons showed mainly an increase of their resting membrane potential at hypoxia. The voltage activated Ca2+ and K+ currents displayed a clear attenuation when cells were subjected to hypoxia. Non-L-type Ca2+ channels were affected by hypoxic exposure and one cell indicated participation of Ca2+ activated K+ channels. However, a response could only be seen in approximately fifty percent of the neurons in the open system. This may have been due to the fact that full control of the oxygen around the neurons at hypoxia could not be achieved. A new system with full control of the ambient oxygen had to be developed in order to investigate this. After the conclusions of the first experiments, a system was developed were a labon- a-chip system was combined with the patch-clamp technique. A microfluidic system with a patch-clamp micropipette integrated was combined with optical tweezers for 3D maneuvering of the neurons. The development of patch-clamp in combination with a microfluidic system and optical tweezers allowed for full oxygen control. The experiments showed that the electrophysiological measurements were not affected by the laser when an infrared laser was used. The microfluidic system allowed very good oxygen control reaching levels of 0.5-1.5 % compared to 3-6 % in the open system. In summary, this work suggests that high voltage activated Ca2+ channels, and K+ channels are involved in the hypoxic depolarization of medial preoptic neurons. Full control of ambient oxygen in cell vicinity could be achieved by the combination of microfluidics, patch-clamp and optical tweezers. The results can be used in future studies to better understand the reaction of the brain to oxygen deprivation caused by stroke.