The optimisation of image quality in medical imaging techniques is a significant factor in favourable patient prognoses. The number of counts in a nuclear medicine image is one factor in determining the diagnostic value of the image. The current study aims to determine the variation in counts in whole-body bone scan images with patient height and weight. Three separate studies were undertaken as part of the investigation. First, 65 whole-body bone scans were analysed together with patient height, weight, age and sex. Weight was found to the most important anatomy influence on image counts. However, significant influences from patient sex and age meant that a useful relationship between image counts and patient anatomy based solely on height and weight could not be determined. For the second study, a model of General Electric Millennium MG gamma camera was created and validated within the SIMIND Monte Carlo software. The results indicate that the model is an accurate representation of the gamma camera. Third, the 4D NCAT whole-body patient phantom was modified to represent the average male and female clinical study participants. The phantoms were used in conjunction with the gamma camera model to simulate the whole-body bone scan procedure. The counts in the simulated images were consistent with the average measured counts of the clinical study indicating that it is feasible to use the NCAT phantom for nuclear medicine bone imaging. However, the phantom’s method of activity distribution should be refined to allow a more realistic distribution of activity throughout the skeleton.

Neste estudo foi realizada a caracterização das propriedades acústicas e a construção de um protótipo de phantom de mama para treinamento de biópsia guiada por ultra-som. Uma importante propriedade deste phantom é a capacidade de ser reconstruído termicamente após ter sido perfurado durante treinamento e/ou sofrido algum dano mecânico. Para tanto, foi desenvolvido um sistema de reciclagem especialmente para o phantom. Dentre os materiais avaliados, a parafina gel apresentou-se estável, nas condições experimentais propostas, tais como, temperatura ambiente entre 22 e 26oC, densidade de 0,85 g/cm3 para a amostra com concentração de 4%, a qual é inferior a do tecido mole ( 1g/cm 3), sendo então empregada em estudos seguintes. O material simulando tecido foi obtido adicionando microestrutura espalhadora (pó de vidro) à substância parafina gel. A caracterização do material foi realizada por duas técnicas de medidas acústicas; a primeira usando o modo amplitude (modo-A) e a segunda o modo brilho (modo-B). O coeficiente de atenuação, para o modo-A, observado para este material, numa faixa de freqüência dos ultra-sons diagnósticos (entre 1 e 10 MHz) foi de 0,75 dB/cm/MHz, equivalente ao indicado pela literatura para tecido biológico mole. A velocidade do som avaliada foi de 1431,2 m/s a uma temperatura de 22oC. Esse valor de velocidade está abaixo da velocidade média do tecido mamário, que é de 1510 m/s, estando mais próximo daquele encontrado para a gordura, 1470 m/s. A atenuação no modo brilho foi estudada comparando-se as diversas atenuações relativas das imagens fornecidas pelas amostras, estando inversamente correlacionadas com a atenuação encontrada no modo amplitude. A velocidade do som também foi avaliada por essa técnica obtendo-se um valor médio de 1416,1 m/s para as amostras estudadas. Partículas espalhadoras sólidas de 45 - 75 µm de diâmetro permitiram que os níveis de espalhamento se aproximassem do tecido mole humano. O phantom simula uma mama em posição de supino, apresentando um diâmetro de 12 cm e uma altura de 6 cm. No seu interior foram inseridas estruturas sólidas e viscosas, tais como cera de carnaúba e mel de abelha, Apis mellifera, e também a própria parafina gel, com 10% de micro esferas de vidro, representando \"tumores\" e \"massas císticas\", as quais são de cores diferentes para facilitar a identificação após serem aspiradas. / The main aim of work was the construction and characterization of acoustics proprieties of a prototype of phantom for the training of the breast biopsy guided by ultrasound. An important property of this phantom is its capacity of being thermically rebuilt after punctuated during the training and/or suffered any mechanic damage. For this purpose, a recycling system was developed especially for the phantom. Among the materials available for this study, the paraffin gel was shown to be stable for the proposed experimental conditions, such as room temperature between 22 and 26oC, a density of 0.85 g/cm3 for the sample with a concentration of 4%, which is inferior to the density of the soft tissue (~ 1g/cm3), therefore becoming the materials used in the following experiments. The material which simulates the tissue was obtained by the addition of solid particles of glass to the paraffin gel. Two acoustic measurement techniques were used to characterization of the material. For the first technique amplitude mode (mode-A) was applied and for the second brightness mode (mode-B) was applied. In a frequency range of diagnostic ultrasounds (between 1 and 10 MHz), the attenuation coefficient for mode-A was of 0.75 dB/cm/MHz, equivalent to the one indicated by the soft tissue literature. The sound speed was of 1431.2 m/s at a temperature of 22oC. This velocity is lower than the average velocity for the breast tissue, which is of 1510 m/s, there being closer to the velocity for fat, i.e., 1470 m/s. The attenuation of the brightness mode was studied through the comparison of various relative attenuations of the images given by the samples, being inversely correlated to the attenuation found in the amplitude mode. The speed of the sound was also evaluated by that technique being obtained a medium value of 1416.1 m/s for the studied samples. Solid particles of glass of 45-75 µm of diameter allowed the level of scattering to be close to the one the human soft tissue. The phantom simulates a breast in the supine position, with a 12 cm diameter and 6 cm height. Solid and viscose structures were inserted in its interior as honey of Apis mellifera and the carnauba wax, and also the own paraffin gel, with 10% micro glass spheres, representing \"cystic masses\" and \"tumors\", each with a different coloration to facilitate the identification after their removal.

No Brasil, o câncer de pele não-melanoma é o tipo de câncer mais comum, corresponde a cerca de 95% de todos os tipos de câncer de pele e 25% de todo o tipo de tumor maligno. O diagnóstico precoce permite tratar lesões logo nos primeiros estágios da doença, melhorando as condições do paciente. Assim, é de grande importância desenvolver técnicas para auxiliar o diagnóstico, como a fluorescência marcada. Ela consiste em usar substâncias fotossensíveis como biomarcadores e analisar sua resposta de fluorescência à excitação por luz. O uso do ácido aminolevulínico (ALA) é de interesse para tal, pois apresenta seletividade para formação da protoporfirina IX (PpIX) em células alteradas, substância esta que apresenta boa resposta de fluorescência à excitação por luz (região do UV-Azul). Para um diagnóstico adequado, portanto, é necessário entender melhor o comportamento da luz em meios túrbidos, como a pele. Assim, o objetivo do estudo é investigar fenômenos envolvidos com esta técnica in vitro e in vivo. Para a análise in vitro foi usado um phantom de pele contendo 2% de nanquim, 1% de Lipofundin® e 5% BRIJ-35. Um derivado de porfirinas (Photogem®) foi inserido no interior dessa solução e excitado de formas diferentes para estudar o comportamento da fluorescência, da luz de excitação e de ambas. No ensaio clínico, soluções de ALA (5% e 10%) foram aplicadas em lesões de pele malignas e potencialmente malignizáveis, e em intervalos regulares de tempo (15, 30, 45 e 60 minutos), as imagens de fluorescência foram coletadas com o protótipo de um sistema de diagnóstico por imagem de fluorescência. A diferente atenuação dos comprimentos de onda envolvidos foi quantificada in vitro. Verificou-se que o limitante do diagnóstico é a luz de excitação, sua penetração limitada em meios túrbidos impede que esta chegue à camadas profundas do tecido com uma intensidade suficiente para excitar o centro fluorescente, de modo que a fluorescência emitida possa ser detectada na superfície do tecido. Na investigação in vivo, o ALA proporcionou uma fluorescência marcada que distinguiu significantemente a pele normal da tumoral e as lesões de pele pré-malignas foram identificadas através de sua autofluorescência. A técnica de diagnóstico contribuiu também para a identificação das bordas da lesão, o que é muito importante para um tratamento eficaz. / Non melanoma skin cancer is the most common cancer lesion in Brazil. It represents about 95% of all skin cancer lesions, and 25% of tumor types. Early diagnosis allows treatment of lesions in the initial stages of the disease, improving patient´s condition. Thus, it is of great importance the development of techniques to aid diagnosis, such as marked fluorescence. This technique consists in using photosensitive substances as biomarkers and analyzing their fluorescence response to light excitation. The use of aminolevulinic acid (ALA) as a biomarker precursor is interesting because it shows selectivity for protoporphyrin IX (PpIX) formation in abnormal cells. This substance shows high fluorescence yield when excited with UV-blue range of light spectrum. For an appropriate diagnosis, therefore, better understanding of light propagation in a turbid media, such as skin, is needed. This study aim is to investigate the phenomena involved with this technique in vitro and in vivo. For in vitro analysis, a skin phantom containing 2% India ink, 1% Lipofundin® and 5% BRIJ-35 was used. A haematoporphyrin derivative (Photogem®) was placed into this phantom and excited using different setups to study fluorescence propagation and the excitation light, both individually and simultaneously. In the clinical trial, ALA water solutions (in 5% and 10% concentration) were applied to malignant and pre malignant skin lesions. At regular time intervals (15, 30, 45 and 60 minutes), fluorescence images were collected with a prototype system for fluorescence imaging. Attenuation for different wavelengths was quantified in vitro. Results show that the limiting factor for diagnosis is the excitation light penetration in turbid media the short penetration of UV-blue light avoids it to reach deeper tissue layers with sufficient intensity to excite the fluorescence sources, so that the fluorescence detected on the tissue surface comes from a limited depth. For in vivo research, ALA has provided a marked fluorescence that allowed distinguishing, significantly, normal and tumor skin. Pre-malignant lesions were identified by own autofluorescence, not requiring biomarking. The diagnostic technique also helped to better determine lesion edges, which is very important for effective treatment of malignant/pre-malignant lesions.

Aufgrund der zunehmenden komplexen Verzahnung zwischen Operateur und technischen Komponenten bei Hirntumoroperationen, werden innovative Trainingslösungen und standardisierte Evaluationsmethoden in der neurochirurgischen Facharztausbildung angestrebt. Phantombasierte Trainingssysteme können die derzeitige Ausbildung sinnvoll ergänzen, indem sie eine risikoarme Umgebung außerhalb des Operationssaal schaffen. Dabei können praktische und theoretische Komponenten der Hirntumorchirurgie in wiederholbaren Trainingseinheiten ohne Risiko für den Patienten miteinander verbunden werden. Innerhalb eines EFRE (Europäischer Fond für regionale Entwicklung) geförderten Kooperationsprojektes mit der Firma Phacon GmbH wurde ein Prototyp eines solchen Trainingssystems entwickelt. Das enthaltene Kopfphantom besteht aus einer dreiteiligen Konstruktion mit wieder verwendbarem Basissystem und Adapter in Kopfform, sowie einem austauschbaren Modul für die einmalige Verwendung je Trainingseinheit. Eine zweiarmige Kamera zeichnet Trackingdaten auf, während ein Laptop inklusive zugehöriger Software als Navigationsplattform dient. Die Grundlage für die Navigation bilden reale MRT Patientendatensätze, die entsprechend auf die Anatomie des Kopfphantoms adaptiert wurden. Ein Trainingslauf deckt die chirurgische Planung des optimalen Zugangsweges, die Kopflagerung, die Einstellung der Trackingkameras, die Registrierung des Kopfphantoms, sowie die navigierte Kraniotomie mit realen OP-Instrumenten ab. Der entwickelte Prototyp wurde hinsichtlich seiner Anwendbarkeit in der neurochirurgischen Facharztausbildung in einer ersten Proof-of-Concept- Studie evaluiert, wobei fünf Assistenzärzte verschiedenen Ausbildungsgrades jeweils ein komplettes Training auf dem gleichen Patientendatensatz durchführten. Anschließend war ein Fragebogen zur Bewertung der einzelnen Systemkomponenten auszufüllen. Die Auswertung der Fragebögen ergab im Mittel das Resultat gut für die Phantomkonstruktion und die verwendeten Materialien. Der Lerneffekt bezüglich der navigierten Planung wurde genauso wie der Effekt auf das Sicherheitsgefühl des Operateurs vor Ausführung der ersten eigenständig durchgeführten Kraniotomien als sehr gut eingeschätzt. Konstruktive Verbesserungsvorschläge wurden nach Studienabschluss bereits umgesetzt [23]. In einer zweiten Evaluationsstudie lag der Fokus auf potentiell erreichbaren Lernkurven durch wiederholte Trainingseinheiten auf verschiedenen Datensätzen. Dazu führten neun Assistenzärzte verschiedener Ausbildungsgrade jeweils drei Trainings auf Datensätzen mit differenten Tumorlokalitäten durch. Während des Trainings wurden durch einen Facharzt die einzelnen Ausführungsschritte beobachtet und bewertet. Insgesamt konnten in einem Trainingsdurchlauf 23 Punkte erreicht werden, welche für Kriterien wie Tumoridentifikation, Kopflagerung, Registrierungsgenauigkeit, Schonung vordefinierter Risikostrukturen, Planungs- und Ausführungsgenauigkeit, Tumorerreichbarkeit und Hautnaht vergeben wurden. Für alle Schritte wurde die benötigte Zeit aufgezeichnet. Im Mittel wurde ein Punktanstieg zwischen dem ersten und dem dritten Training von 16.9 auf 20.4 Punkte verzeichnet. Die mittlere Zeit bis zur Kraniotomie verbesserte sich von rund 29 Minuten auf rund 21 Minuten zwischen dem ersten und dem dritten Trainingsdurchlauf. Die benötigte Zeit bis zur Hautnaht sank im Mittel von rund 38 Minuten auf rund 27 Minuten zwischen dem ersten und dem dritten Training. Signifikante Korrelationen wurden zwischen Zeit bis zur Kraniotomie und Trainingsanzahl (p < .05), zwischen Zeit bis zur Hautnaht und Trainingsanzahl (p < .05) sowie zwischen erreichter Punktzahl und Trainingsanzahl (p < .01) gefunden. Die Ergebnisse beider Studien weisen darauf hin, dass das entwickelte Trainingssystem einen vielversprechenden Ansatz für die Ergänzung der derzeitigen Facharztausbildung in der Neurochirurgie darstellt. Durch die risikoarme Simulationsumgebung können theoretische und praktische Aspekte der Hirntumorchirurgie sinnvoll verbunden werden. Dem Assistenzarzt wird die Möglichkeit gegeben, sich mit den komplexen Strukturen von eigenständig durchgeführten Kraniotomien vertraut zu machen und damit die anfängliche Lernkurve in die Trainingsumgebung zu verlagern. Hinterfragt werden muss, inwieweit es das Trainingssystem ermöglicht, die chirurgischen Fähigkeiten so zu verbessern, dass diese auch in die reale OP-Umgebung unter realen Bedingungen übertragbar sind und wie diese potentielle Verbesserung zu messen ist [3]. Natürlich unterscheidet sich das haptische Feedback am Trainingsphantom gegenüber der realen menschlichen Anatomie. Weiterhin sind die psychologische Situation und der Erwartungsdruck im OP-Saal nicht mit einer Trainingsumgebung vergleichbar. Es ist daher nicht einfach, ein geeignetes Messinstrument für die Übertragbarkeit des Lerneffektes auf reale OP-Bedingungen zu finden. Nichts desto trotz konnten die beiden durchgeführten Studien bereits zeigen, dass eine Trainingsumgebung Vorteile gegenüber der Situation im OP-Saal bietet. Gerade die Anfangszeit der Facharztausbildung ist größtenteils durch Assistieren im OP-Saal gekennzeichnet, was den Lerneffekt bezüglich autonomer Entscheidungen und Schlussfolgerungen aus begangenen Fehlern begrenzt. Am Phantom hingegen kann die direkte Konsequenz, beispielsweise am Ergebnis der Nichterreichbarkeit des Tumors, direkt erfahren werden. Die theoretischen Konzepte für die Kopflagerung des Patienten in Abhängigkeit von der Tumorlokalisation können als übertragbar auf die OP-Situation angesehen werden, wenngleich das haptische Feedback am Phantom ein anderes ist. Der dadurch erreichbare Lerneffekt bietet das Potential, Lagerungen häufiger selbstständig durch den Assistenzarzt im OP-Saal vorbereiten zu lassen. Die Handhabung des Navigationssystems ist ebenfalls sehr nahe an den technischen Bedingungen im OP-Saal und trägt damit zu einem besseren Verständnis bei. Gegenüber virtuellen Systemen bieten phantom-basierte Trainingssysteme den Vorteil des taktilen Kopfphantoms welches mit realen Instrumenten bearbeitet werden kann und damit eine realistische Hand-Auge-Koordination während des Trainings gewährleistet. Die geringeren Investitionskosten für die Anschaffung ermöglicht auch kleineren Kliniken, eine Simulationsumgebung in die Facharztausbildung zu integrieren. Nachteilig gegenüber virtuellen Systemen ist die auf einmalige Verwendung begrenzte Modulverfügbarkeit, welche permanent laufende Kosten und Materialverlust verursacht. Das vorgestellte Trainingssystem soll nicht als Konkurrenzprodukt zu virtuellen Systemen, sondern vielmehr als sinnvolle Ergänzung innerhalb der verfügbaren Trainingsmethoden verstanden werden. Die derzeitige und zukünftige Weiterentwicklung des Systems fokussiert sich auf die Implementierung des automatisierbaren Evaluationskonzeptes basierend auf vordefinierten, verschiedenen Master-Zugängen, sowie auf die Simulation von Risikostrukturen und Einbezug entsprechender Verletzungen in das Evaluationskonzept. Die getrackten Instrumente während der Simulation können so zusammen mit den vordefinierten Zugangswegen die zukünftige Basis für ein essentielles objektives Trainingsfeedback bilden. Auch in der Entwicklung befindet sich die Umsetzung des Ultraschall-Simulationstools, welches eine finale transdurale Identifikation des Tumors bei korrekt ausgeführter Kraniotomie ermöglichen soll. Aus den intraoperativ akquirierten Patienten-Ultraschalldaten können aufgrund des getrackten Ultraschalldummy’s die korrespondierenden Ultraschallschichten berechnet und visualisiert werden. Dadurch bekommt der Trainierende den Eindruck einer realen Ultraschalluntersuchung und kann die Handhabung und Koordination einer Ultraschallaufnahme sowie die Orientierung im resultierenden Ultraschallvolumen trainieren. Generell haben phantom-basierte Trainingssysteme durch effektive Trainingseinheiten das Potential, die neurochirurgische Facharztausbildung zu bereichern und hinsichtlich Risikomanagement, Patientensicherheit und OP-Verfügbarkeit zu verbessern.

This thesis aims to provide a critical account of Gaston Leroux’s Le Fantôme de l’Opéra (1910), which has become one of the most enduring and visible of modern myths. Leroux’s text discloses anxieties about a rapidly changing world, and these anxieties manifest themselves artistically in a simultaneous fascination and horror with the emerging episteme. Leroux’s story subsequently took on a life of its own in popular culture, yet, this thesis argues, many of these adaptations remain bound up in the same issues of futurity and dichotomies of masculinity, as well as concerns about the role of the artist in determining the values of his society.

The optimisation of image quality in medical imaging techniques is a significant factor in favourable patient prognoses. The number of counts in a nuclear medicine image is one factor in determining the diagnostic value of the image. The current study aims to determine the variation in counts in whole-body bone scan images with patient height and weight. Three separate studies were undertaken as part of the investigation. First, 65 whole-body bone scans were analysed together with patient height, weight, age and sex. Weight was found to the most important anatomy influence on image counts. However, significant influences from patient sex and age meant that a useful relationship between image counts and patient anatomy based solely on height and weight could not be determined. For the second study, a model of General Electric Millennium MG gamma camera was created and validated within the SIMIND Monte Carlo software. The results indicate that the model is an accurate representation of the gamma camera. Third, the 4D NCAT whole-body patient phantom was modified to represent the average male and female clinical study participants. The phantoms were used in conjunction with the gamma camera model to simulate the whole-body bone scan procedure. The counts in the simulated images were consistent with the average measured counts of the clinical study indicating that it is feasible to use the NCAT phantom for nuclear medicine bone imaging. However, the phantom’s method of activity distribution should be refined to allow a more realistic distribution of activity throughout the skeleton.

Neste estudo foi realizada a caracterização das propriedades acústicas e a construção de um protótipo de phantom de mama para treinamento de biópsia guiada por ultra-som. Uma importante propriedade deste phantom é a capacidade de ser reconstruído termicamente após ter sido perfurado durante treinamento e/ou sofrido algum dano mecânico. Para tanto, foi desenvolvido um sistema de reciclagem especialmente para o phantom. Dentre os materiais avaliados, a parafina gel apresentou-se estável, nas condições experimentais propostas, tais como, temperatura ambiente entre 22 e 26oC, densidade de 0,85 g/cm3 para a amostra com concentração de 4%, a qual é inferior a do tecido mole ( 1g/cm 3), sendo então empregada em estudos seguintes. O material simulando tecido foi obtido adicionando microestrutura espalhadora (pó de vidro) à substância parafina gel. A caracterização do material foi realizada por duas técnicas de medidas acústicas; a primeira usando o modo amplitude (modo-A) e a segunda o modo brilho (modo-B). O coeficiente de atenuação, para o modo-A, observado para este material, numa faixa de freqüência dos ultra-sons diagnósticos (entre 1 e 10 MHz) foi de 0,75 dB/cm/MHz, equivalente ao indicado pela literatura para tecido biológico mole. A velocidade do som avaliada foi de 1431,2 m/s a uma temperatura de 22oC. Esse valor de velocidade está abaixo da velocidade média do tecido mamário, que é de 1510 m/s, estando mais próximo daquele encontrado para a gordura, 1470 m/s. A atenuação no modo brilho foi estudada comparando-se as diversas atenuações relativas das imagens fornecidas pelas amostras, estando inversamente correlacionadas com a atenuação encontrada no modo amplitude. A velocidade do som também foi avaliada por essa técnica obtendo-se um valor médio de 1416,1 m/s para as amostras estudadas. Partículas espalhadoras sólidas de 45 - 75 µm de diâmetro permitiram que os níveis de espalhamento se aproximassem do tecido mole humano. O phantom simula uma mama em posição de supino, apresentando um diâmetro de 12 cm e uma altura de 6 cm. No seu interior foram inseridas estruturas sólidas e viscosas, tais como cera de carnaúba e mel de abelha, Apis mellifera, e também a própria parafina gel, com 10% de micro esferas de vidro, representando \"tumores\" e \"massas císticas\", as quais são de cores diferentes para facilitar a identificação após serem aspiradas. / The main aim of work was the construction and characterization of acoustics proprieties of a prototype of phantom for the training of the breast biopsy guided by ultrasound. An important property of this phantom is its capacity of being thermically rebuilt after punctuated during the training and/or suffered any mechanic damage. For this purpose, a recycling system was developed especially for the phantom. Among the materials available for this study, the paraffin gel was shown to be stable for the proposed experimental conditions, such as room temperature between 22 and 26oC, a density of 0.85 g/cm3 for the sample with a concentration of 4%, which is inferior to the density of the soft tissue (~ 1g/cm3), therefore becoming the materials used in the following experiments. The material which simulates the tissue was obtained by the addition of solid particles of glass to the paraffin gel. Two acoustic measurement techniques were used to characterization of the material. For the first technique amplitude mode (mode-A) was applied and for the second brightness mode (mode-B) was applied. In a frequency range of diagnostic ultrasounds (between 1 and 10 MHz), the attenuation coefficient for mode-A was of 0.75 dB/cm/MHz, equivalent to the one indicated by the soft tissue literature. The sound speed was of 1431.2 m/s at a temperature of 22oC. This velocity is lower than the average velocity for the breast tissue, which is of 1510 m/s, there being closer to the velocity for fat, i.e., 1470 m/s. The attenuation of the brightness mode was studied through the comparison of various relative attenuations of the images given by the samples, being inversely correlated to the attenuation found in the amplitude mode. The speed of the sound was also evaluated by that technique being obtained a medium value of 1416.1 m/s for the studied samples. Solid particles of glass of 45-75 µm of diameter allowed the level of scattering to be close to the one the human soft tissue. The phantom simulates a breast in the supine position, with a 12 cm diameter and 6 cm height. Solid and viscose structures were inserted in its interior as honey of Apis mellifera and the carnauba wax, and also the own paraffin gel, with 10% micro glass spheres, representing \"cystic masses\" and \"tumors\", each with a different coloration to facilitate the identification after their removal.

No Brasil, o câncer de pele não-melanoma é o tipo de câncer mais comum, corresponde a cerca de 95% de todos os tipos de câncer de pele e 25% de todo o tipo de tumor maligno. O diagnóstico precoce permite tratar lesões logo nos primeiros estágios da doença, melhorando as condições do paciente. Assim, é de grande importância desenvolver técnicas para auxiliar o diagnóstico, como a fluorescência marcada. Ela consiste em usar substâncias fotossensíveis como biomarcadores e analisar sua resposta de fluorescência à excitação por luz. O uso do ácido aminolevulínico (ALA) é de interesse para tal, pois apresenta seletividade para formação da protoporfirina IX (PpIX) em células alteradas, substância esta que apresenta boa resposta de fluorescência à excitação por luz (região do UV-Azul). Para um diagnóstico adequado, portanto, é necessário entender melhor o comportamento da luz em meios túrbidos, como a pele. Assim, o objetivo do estudo é investigar fenômenos envolvidos com esta técnica in vitro e in vivo. Para a análise in vitro foi usado um phantom de pele contendo 2% de nanquim, 1% de Lipofundin&reg; e 5% BRIJ-35. Um derivado de porfirinas (Photogem&reg;) foi inserido no interior dessa solução e excitado de formas diferentes para estudar o comportamento da fluorescência, da luz de excitação e de ambas. No ensaio clínico, soluções de ALA (5% e 10%) foram aplicadas em lesões de pele malignas e potencialmente malignizáveis, e em intervalos regulares de tempo (15, 30, 45 e 60 minutos), as imagens de fluorescência foram coletadas com o protótipo de um sistema de diagnóstico por imagem de fluorescência. A diferente atenuação dos comprimentos de onda envolvidos foi quantificada in vitro. Verificou-se que o limitante do diagnóstico é a luz de excitação, sua penetração limitada em meios túrbidos impede que esta chegue à camadas profundas do tecido com uma intensidade suficiente para excitar o centro fluorescente, de modo que a fluorescência emitida possa ser detectada na superfície do tecido. Na investigação in vivo, o ALA proporcionou uma fluorescência marcada que distinguiu significantemente a pele normal da tumoral e as lesões de pele pré-malignas foram identificadas através de sua autofluorescência. A técnica de diagnóstico contribuiu também para a identificação das bordas da lesão, o que é muito importante para um tratamento eficaz. / Non melanoma skin cancer is the most common cancer lesion in Brazil. It represents about 95% of all skin cancer lesions, and 25% of tumor types. Early diagnosis allows treatment of lesions in the initial stages of the disease, improving patient´s condition. Thus, it is of great importance the development of techniques to aid diagnosis, such as marked fluorescence. This technique consists in using photosensitive substances as biomarkers and analyzing their fluorescence response to light excitation. The use of aminolevulinic acid (ALA) as a biomarker precursor is interesting because it shows selectivity for protoporphyrin IX (PpIX) formation in abnormal cells. This substance shows high fluorescence yield when excited with UV-blue range of light spectrum. For an appropriate diagnosis, therefore, better understanding of light propagation in a turbid media, such as skin, is needed. This study aim is to investigate the phenomena involved with this technique in vitro and in vivo. For in vitro analysis, a skin phantom containing 2% India ink, 1% Lipofundin&reg; and 5% BRIJ-35 was used. A haematoporphyrin derivative (Photogem&reg;) was placed into this phantom and excited using different setups to study fluorescence propagation and the excitation light, both individually and simultaneously. In the clinical trial, ALA water solutions (in 5% and 10% concentration) were applied to malignant and pre malignant skin lesions. At regular time intervals (15, 30, 45 and 60 minutes), fluorescence images were collected with a prototype system for fluorescence imaging. Attenuation for different wavelengths was quantified in vitro. Results show that the limiting factor for diagnosis is the excitation light penetration in turbid media the short penetration of UV-blue light avoids it to reach deeper tissue layers with sufficient intensity to excite the fluorescence sources, so that the fluorescence detected on the tissue surface comes from a limited depth. For in vivo research, ALA has provided a marked fluorescence that allowed distinguishing, significantly, normal and tumor skin. Pre-malignant lesions were identified by own autofluorescence, not requiring biomarking. The diagnostic technique also helped to better determine lesion edges, which is very important for effective treatment of malignant/pre-malignant lesions.

Bakgrund: Fantomsmärta upplevs av cirka 50-85% av alla som genomgår amputation. Antalet amputationsingrepp ökar i världen likväl som i Sverige, detta på grund av en generellt åldrande befolkning samt ökad sjukdomsprevalens. Trots ett så pass vanligt förekommande fenomen är patienters erfarenheter sparsamt beskrivet och då även i svensk vårdkontext. Syfte: Syftet med detta arbete är att beskriva patienters erfarenheter av att leva med fantomsmärta efter amputation.  Metod: Åtta kvalitativa studier identifierades till denna studie. Relevanta data söktes fram i CINAHL och PubMed. Innehållsanalys utfördes med inspiration av Fribergs modell, innehållande fem steg. Resultat: Patienters erfarenheter av fantomsmärta presenteras i fyra kategorier och nio subkategorier: Olika dimensioner av smärta, Självbild i förändring, Nya utmaningar i vardagslivet och Behöver stöd från omgivningen. Konklusion: Att leva med fantomsmärta är komplext. Amputation medför en förändringsprocess med både påfrestningar och begränsningar men också anpassning till en förändrad livssituation. Livskvalitet trots dessa utmaningar är möjligt och som sjuksköterska är det således essentiellt att identifiera varje enskild patients hinder för och möjligheter till anpassning. Detta för att gemensamt uppnå hälsa i största möjliga mån. / Background: Phantom limb pain occurs in circa 50-85% of all the cases of amputation. Amputations are increasing worldwide as well as in Sweden because of an ageing population and an increase of disease-prevalence. Although phantom limb pain is common, there is a lack of knowledge and information when it comes to patients’ experiences. Aim: The aim of this study is to describe patients’ experiences of living with phantom limb pain after amputation. Methods: Eight qualitative studies were identified for this review. Relevant data was collected from CINAHL and PubMed. Qualitative content analyses were conducted, inspired by Friberg’s five step model for analysis.  Results: Patients’ experiences of phantom limb pain were presented in four categories and nine subcategories: Different dimensions of pain, Self-image in change, New challenges in everyday-life and The need of support from the surroundings.  Conclusion: Living with phantom limb pain is complex. Amputation induces a process of change, presenting limitations, stresses and a need to adapt. However, good quality of life is possible and as a nurse it is essential to identify patients’ possibilities and obstacles to strive for the best possible health care.

Intra-Body Communication (IBC) is a prospective technology where human tissue may be used as a signal medium in order to transmit useful data within the human body. Proposed applica- tions of this technology are prosthetics control or implanted device communication, potentially by establishing an Intra-Body Area Network (IBAN), which could further be enhanced by other IoT applications and 5G radio systems. Previous research at Uppsala University has shown the fat tissue to be a promising medium due to its low permittivity and loss tangent. This form of implementation is named Fat-IBC. This thesis aimed to produce a Fat-IBC enabled device, as a proof of concept. This project successfully produced and characterized phantom tissue, produced a basic demonstrator device in the form of a 3D-printed arm prosthetic, and integrated a wireless communication system into the arm prosthetic. The communication system was implemented using Arduino microcontrollers and XBee RF modules, based on the 802.15.4-based ZigBee protocol at 2.45 GHz. Muscle, fat, and skin phantom tissues were produced, with the muscle tissue being similar to other comparable tissue samples, while the fat and skin tissues deviated from such samples. A signal loss transmission test measured a -67 dB loss over 20 cm of fat tissue. Several potential issues with production and measurement were discussed. The arm demonstrator device was also tested by transmitting the control signal across phantom fat tissue, being fully functional through 10cm of tissue, and of limited function across 20cm of tissue.