Introdução: O desenvolvimento de novos procedimentos cirúrgicos minimamente invasivos para o tratamento dos sintomas do trato urinário inferior (LUTS), relacionados à hiperplasia prostática benigna (HPB), está se tornando importante campo de pesquisa, na medida em que tenta minimizar os efeitos adversos e complicações decorrentes dos tratamentos convencionais. A embolização das artérias prostáticas (EAP) vem sendo utilizada como alternativa para o tratamento de pacientes com HPB. O objetivo deste trabalho é avaliar e comparar a segurança e eficácia da EAP para o tratamento dos LUTS em pacientes com HPB, utilizando microesferas (Embospheres®) de 100-300 um e 300-500 um. Métodos: Realizou-se estudo de ensaio clínico fase II, prospectivo, no período entre agosto de 2011 e junho de 2013, pela Disciplina de Urologia e Departamento de Radiologia do HCFMUSP. O protocolo de pesquisa foi aprovado pela Comissão de Ética para Análise de Projetos de Pesquisa (CAPPesq) do HCFMUSP. Foram selecionados 30 pacientes com sintomas moderados ou graves (IPSS > 7), refratários ao tratamento clínico para HPB, com volume prostático entre 30g e 100g pela ressonância magnética (RM). Foram excluídos os pacientes com câncer de próstata comprovado por biópsia; prostatite ou infecção ativa do trato urinário; cirurgia ou intervenção prévia para HPB; doença com impacto sobre funcionamento da bexiga; impossibilidade para realizar RM; e distúrbio de coagulação não corrigido clinicamente. Os pacientes foram avaliados de acordo com os sintomas clínicos (IPSS e QoL), toque retal, exames laboratoriais de rotina incluindo o antígeno prostático específico (PSA), urofluxometria livre (Qmax) e RM em diferentes períodos de acompanhamento. Os procedimentos foram realizados no Serviço de Radiologia Intervencionista do HCFMUSP, por meio de punção unilateral da artéria femoral comum, sob anestesia local, usando-se microcateter, agente embolizante do tipo microesferas 100-300 ?m em 15 pacientes (Grupo A) e 300-500 ?m em 15 pacientes (Grupo B). Foi considerado sucesso técnico a identificação, cateterismo e embolização bilateral das artérias prostáticas. Definiu-se como sucesso clínico a retirada da sonda vesical nos pacientes em retenção urinária, melhora dos sintomas de acordo com o escore IPSS < 8 e índice QoL < 3. Considerou-se o valor de p < 0,05 como estatisticamente significante. Resultados: Sucesso técnico foi obtido em todos os casos. Ambos os grupos apresentaram melhoria significativa do IPSS, QoL e do Qmax, assim como redução do PSA e do volume prostático em relação aos dados demográficos (p < 0,05). Houve um aumento volumétrico prostático significativo entre 3 e 12 meses no grupo A (p < 0,05). As diferenças observadas entre os dois grupos não foram significativas, com maior ocorrência de eventos adversos (p = 0,066) e maior redução do PSA no acompanhamento de 3 meses (p = 0,056) nos pacientes tratados com microesferas de 100-300 um. Conclusão: As microesferas de 100-300 ?m e 300-500 um demonstraram serem agentes embolizantes seguros e eficazes na EAP para o tratamento dos LUTS relacionados à HPB. Embora os resultados clínicos e por imagem não tenham diferido significativamente entre os grupos de estudo, os pacientes tratados com 100-300 um apresentaram mais eventos adversos do que aqueles tratados com 300-500 um. O volume da próstata aumentou significativamente entre o terceiro e o décimo segundo mês após EAP no grupo tratado com microesferas 100-300 um, embora se mantivesse significativamente menor que antes da EAP / Introduction: The development of new minimally invasive surgical procedures for the treatment of low urinary tract symptoms (LUTS), related to benign prostatic hyperplasia (BPH), is becoming an important field of research as it attempts to minimize adverse effects and complications resulting from conventional treatments. Prostatic artery embolization (PAE) is increasingly being used as an alternative for the treatment of patients with BPH. The aim of this study was to evaluate and compare the safety and efficacy of PAE for the treatment of LUTS in patients with BPH, using microspheres (Embosphere®) of 100-300 um and 300-500 um. Methods: A prospective Phase II clinical trial was conducted between August 2011 and June 2013 by the Urology Department and the Radiology Department. The research protocol was approved by the Ethics Committee for Analysis of Research Projects (CAPPesq) of HC-FMUSP. In fact, 30 patients with moderate or severe symptoms (IPSS > 7), refractory to the clinical treatment for BPH, with a prostatic volume of 30 g and 100 g were selected by magnetic resonance imaging (MRI). Patients with the following conditions were excluded from the study: biopsy-proven prostate cancer; prostatitis or active urinary tract infection; surgery or previous intervention for BPH; diseases affecting the bladder function; impossibility to perform MRI; and clinically uncorrected coagulation disorders. Patients were evaluated according to clinical symptoms (IPSS and QoL), rectal examination, laboratory tests (PSA), uroflowmetry (Qmax) and imaging (MR) at different follow-up periods. Procedures were performed at the interventional radiology suite of the HCFMUSP, by means of unilateral puncture of the common femoral artery, under local anesthesia, using a microcatheter, microspheres type 100-300 um in 15 patients (Group A) and 300-500 um in 15 patients (Group B). Identification, catheterization and bilateral embolization of the prostatic arteries were considered technical success. Clinical success was defined as the removal of the bladder catheter and improvement of symptoms according to the IPSS score < 8 and QoL index < 3. Results: The PAE was technically successful in all cases. Both groups showed a significant improvement in IPSS, QoL and Qmax, as well as reduction of PSA and prostate volume in relation to demographic data (p < 0.05). There was a significant prostatic volumetric increase between 3 and 12 months in group A (p < 0.05). Differences observed between the two groups were not significant, with a higher number of adverse events (p = 0.066) and lower level of blood PSA at 3 months follow-up (p = 0.056) in Group A (100-300 um). Conclusion: Microspheres of 100-300 ?m and 300-500 ?m are safe and effective embolic agents in PAE for the treatment of LUTS related to BPH. Although functional results did not differ significantly between study groups, patients treated with 100-300 ?m reported more adverse events than those treated with 300-500 um. The prostate volume increased significantly between the third and the twelfth month post-PAE in the group treated with 100-300 um microspheres, although it remained significantly lower than pre-PAE

Introdução: Os principais objetivos do tratamento das metástases cerebrais (MC) são no auxílio do controle da doença no encéfalo e a melhora da qualidade de vida dos pacientes. A cirurgia convencional tem um importante papel no tratamento das MCs e os métodos de monitoração intraoperatória podem auxiliar na obtenção de resultados cirúrgicos melhores. Objetivos: Avaliar a influência da ultrassonografia encefálica durante cirurgia para ressecção de MC no índice de Karnofsky e no grau de ressecção do tumor. Métodos: Neste estudo prospectivo controlado e não randomizado, doentes com indicação de tratamento cirúrgico de MCs foram incluídos. A ultrassonografia intraoperatória (USIO) foi realizada por um neurossonologista. O índice de Karnofsky foi avaliado por equipe multidisciplinar de oncologia; o grau de dificuldade para ressecção cirúrgica do tumor foi avaliado pelo cirurgião e o volume tumoral foi avaliado pelo neurorradiologista por meio da RM realizada no pré e pós-operatório. Resultados: Dos 78 doentes, 40 homens e 38 mulheres com idade média de 53 anos, 35 foram submetidos a tratamento cirúrgico com auxílio da USIO. Não houve diferença estatística no KPS e volume tumoral pré-operatório entre os grupos. O KPS pós-operatório no grupo da USIO foi de 80 e no grupo-controle de 70 (p=0,045). Considerando-se a melhora do KPS no pós-operatório, a quantidade de doentes tiveram melhora do KPS foi superior no grupo da USIO (p=0,036) destacando-se os seguintes subgrupos: tumores com grau de dificuldade de ressecção < 4 (p=0,037), tumores nas áreas eloquentes (p=0,043), tumores não relacionados aos grandes vasos e nervos (p=0,007), e lesões únicas no leito cirúrgico (p=0,038). O tumor residual na RM pós-operatória foi menor no grupo da USIO: 9,5% no grupo da USIO e 30,8% no grupo-controle; 1,6 mm3 no grupo da USIO e 9 mm3 do grupo-controle; p=0,05. Considerando-se doentes com KPS >= 70, o número de doentes com volume de tumor residual inferior a 10% em relação ao volume pré-operatório foi superior no grupo da USIO (p=0,032 e OR de 3,8). Conclusão: Os achados deste estudo sugerem que a USIO encefálica pode influenciar na melhora do índice de Karnofsky e na redução do volume de tumor residual / Object: The goals of treating a cerebral metastasis (CM) are to achieve local control of the disease and to improve patient quality of life. The aim of this study was to analyse the effect of using conventional surgery supported by intra-operative ultrasound (IOUS) to approach a CM. To perform this analysis, we determined Karnofsky post-operative scores (KPS) and tumour resection grades. Methods: Patients with CM who were eligible to undergo a surgical approach were included in this study. Surgical treatment was either supported or not supported by IOUS. A neural oncology team determined the pre- and post-operative KPS. A radiologist examined the tumour volume using pre- and post-operative magnetic resonance imaging. Before the surgery, the surgeon determined whether it was possible to perform a total CM resection. Results: A total of 78 patients with CM diagnosis were treated using a surgical approach (35 with and 43 without IOUS). The post-operative median KPS was higher in the IOUS group (80 versus 70, p=0.045). Within the IOUS group, KPS evolution was superior (p=0.036), especially in the following CM subgroups: a difficulty of tumour resection ranking score<4 (p=0.037), the tumour was in an eloquent area (p=0.043), the tumour was not associated with vessels or nerves (p=0.007), and solitary lesions (p=0.038). The volume of residual tumours was lower in the IOUS group (9.5% and 1.6 mm3 versus 30.8% and 9 mm3, p=0.05). In patients with a KPS >= 70, the residual tumour volume was categorized as < 10% or >= 10%, and 62% of patients had < 10% residual tumours (76% in the IOUS group and 45% in the non-IOUS group; p=0.032 and OR=3.8). Conclusion: This study suggests that IOUS can play a role in improving post-operative KPS and in decreasing residual tumours in CM surgeries

近年来，血管类疾病已经成为人类健康的第一杀手。每年有成百上千万人死于血管疾病。血管介入术是一种非常有前景的血管类疾病的治疗手段。血管介入术是一种微创手术，它已经被广泛的用于治疗中风，血管狭窄，血管瘤等疾病。相对于传统的开放式手术，它具有风险低，恢复快，住院时间短等优点。该疗法通常在透视影像的引导下由导管和导线在血管内协同完成手术过程。因为介入术的复杂性和特殊性，作为介入手术医生的必要技能，掌握手术中手眼协同，各种手术器具的使用和复杂细致的手术流程无疑是一个巨大的挑战。因此，迫切地需要一种高效、安全的训练系统。相对于传统的训练方法，基于虚拟现实技术的训练系统是一种非常好的训练手段。 / 为了建立一套高仿真的介入手术训练模拟器，首先，我们要为病人的血管网重建三维模型。我们提出了一种自动的提取中心线的方法，用来从分割好的CTA/MRA体数据中获取病人血管网的中心线。基于改进的平行传递算法，沿着这些中心线，生成了一系列连续的标架。根据这些标架，我们构造了血管的横截面，并在此基础上生成了光滑连续的三维血管模型。 / 其次，作为血管介入术中最基础和最重要的手术器械，我们为导管和导线建立了物理模型。我们提出了一种基于最小势能原理的可变形的模型用于模拟导管和导线对于受力的反应。我们还提出了一个快速并且稳定的多网格算法来保证模拟的真实性和严格的实时交互要求。另外，我们做了几组实验。通过这些实验，验证了多网格算法在稳定性、实时性、模拟的真实性等方面满足了我们对于训练用模拟系统的要求。 / 再次，为了模拟血管栓塞术的手术过程，我们提出了一种模拟线圈填充血管瘤的过程的新方法。通过加总线圈弯曲变形的弹性势能、血管瘤变形的弹性势能以及外力做的功，我们建立了在血管栓塞术的环境下的总势能模型。为了求解这个模型，我们提出了一个基于有限元方法的求解器。从而模拟了线圈在介入医生的操作下慢慢的进入血管瘤，并缠绕起来的过程。 / 另外，我们提出了一个分层圆柱网格模型（LCGM）用于模拟在血管网中血流的运动。这一模型在几何上和拓扑结构上都非常适合我们的应用。我们将血液在血管中的流动近似为一维的层流，并用一组线性等式描述了血管网中流速与血压的关系。通过求解这一线性系统，得到了在分层圆柱网格模型下血流的速度场。依据这个血流的速度场，我们采用平流-扩散模型来模拟造影剂在血管中的传播的过程。 / Vascular diseases have been becoming the number one cause of death worldwide in recent years. Millions of people were killed by vascular diseases each year. An increasingly promising therapy for treating vascular diseases is Vascular Interventional Radiology (VIR). VIR is a minimally invasive surgery (MIS) procedure, which has been widely used to cure stroke, angiostenosis, aneurysm and etc. A low risk, an accelerated recovery and a shorter stay in hospital are important advantages over the traditional vascular surgery. This therapy is performed by a guidewire-catheter combination inside the blood vessels under the guidance of the fluoroscopic imaging. Because of the complexity and particularity of these procedures, it is a great challenge to master hand-eye coordination, instrument manipulation and procedure protocols for each radiologist mandatory. An efficient and safe training system is needed urgently. In contrast to these traditional training methods, virtual reality (VR) based simulation systems is a pretty good surrogate. / In order to build a high fidelity interventional simulator for physician training, firstly, we reconstructed the three dimensional (3D) model for the vascular network of the patients. An method of automatic skeleton extraction was proposed to acquire the centerline of the vascular network from the segmented volume data from CTA/MRA. A series of continuing frames were generated along with the centerline based on improved parallel transporting method. According to these frames we built the crossections of the vessels and further the 3D vascular model with the smooth meshes. / Secondly, as the most basic and important instruments in the VIR procedure, the catheter and guidewire were modeled and simulated physically. We developed a deformable model to simulate complicated behaviors of guidewires and catheters based on the principle of minimum total potential energy. A fast and stable multigrid solver was proposed to ensure both realistic simulation and real time interaction. A series of experiments were conducted to evaluate our multigrid solver in terms of stability, time performance, the capability of simulating catheter behaviors and the realism of catheter deformation. / Thirdly, to simulate the procedure of embolization, we proposed a novel method to simulate the motion of coil and their interactions with the aneurysm. We formulated the total potential energy in the embolization circumstance by summing up the elastic energy deriving from the bending of coils, the potential energy due to the deformation of the aneurysm and the work by the external forces. A novel FEM-based approach was proposed to simulate the deformation of coils. And the motion of coils and their responses to every input from the interventional radiologist can be calculated globally. / Fourthly, we proposed our Layered Cylindrical Gird Model (LCGM) for simulating blood flow in vascular network, which is pretty suitable for sampling the vascular network geometrically and topologically. The blood flow in vessels was regarded as 1D laminar flow and formulated into a set of linear equations based on the Poiseuille law to describe the relationship between the speed of flow and the pressure. Solving those equations, we got the velocity fields in the blood flow. In terms of the velocity fields, an advection-diffusion model was adopted to simulate the propagation of contrast agent with the blood flow. / Finally, all above techniques and procedures were implemented and integrated into a simulation system for training the medical students to acquire the endovascular skill, and an empirical study was also designed based on a typical selective catheteriza- tion procedure to assess the feasibility and effectiveness of the proposed system. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / 最后，我们将所有以上提到的技术和方法集成到模拟系统中用于训练医学院的学生，并使他们获得血管介入术的技能。并且，我们基于一个典型的导管插入术过程，使用经验分析的方法对模拟系统的可用性和效率进行了评估。 / Li, Shun. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 105-116). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in also Chinese. / Abstract --- p.i / Acknowledgement --- p.vi / Chapter 1 --- Introduction --- p.1 / Chapter 2 --- Vascular Modeling --- p.14 / Chapter 2.1 --- Introduction and Related Work --- p.14 / Chapter 2.2 --- Vascular Skeleton Graph Construction --- p.15 / Chapter 2.2.1 --- Chamfer distance transform and Dijkstra's shortest-path algorithm --- p.17 / Chapter 2.2.2 --- End vertices retrieval --- p.19 / Chapter 2.2.3 --- The algorithm of vascular skeleton extraction --- p.21 / Chapter 2.3 --- Vascular Modeling --- p.21 / Chapter 2.3.1 --- Tubular Model --- p.21 / Chapter 2.3.2 --- Bifurcation Model --- p.23 / Chapter 3 --- Catheter Simulation --- p.28 / Chapter 3.1 --- Introduction and Related Works --- p.28 / Chapter 3.2 --- Catheter Simulation --- p.31 / Chapter 3.2.1 --- Kirchhoff Theory of Elastic Rod --- p.32 / Chapter 3.2.2 --- Problem Formulation --- p.34 / Chapter 3.2.3 --- The Multigrid Iterative Solver --- p.38 / Chapter 3.3 --- Collision detection --- p.45 / Chapter 3.4 --- Validation of the Catheter Simulation Method --- p.47 / Chapter 3.4.1 --- Stability --- p.49 / Chapter 3.4.2 --- Time Performance --- p.50 / Chapter 3.4.3 --- Preservation of Curved Tip --- p.51 / Chapter 3.4.4 --- The realism of catheter deformation --- p.53 / Chapter 4 --- Coil Embolization Simulation --- p.59 / Chapter 4.1 --- Introduction and Related Work --- p.59 / Chapter 4.2 --- Methodology --- p.61 / Chapter 4.2.1 --- Total potential energy of a coil --- p.61 / Chapter 4.2.2 --- The FEM-based numeric solver for interactive coil simulation --- p.61 / Chapter 5 --- Angiography Simulation --- p.70 / Chapter 5.1 --- Introduction and related works --- p.70 / Chapter 5.2 --- The Equations of Fluid --- p.72 / Chapter 5.3 --- Layered Cylindrical Gird Model --- p.73 / Chapter 5.4 --- Numerical Method --- p.76 / Chapter 5.4.1 --- Evaluation of the velocity field of blood flow --- p.76 / Chapter 5.4.2 --- Evaluation of the density field --- p.78 / Chapter 5.5 --- Results --- p.81 / Chapter 6 --- System Implementation and Evaluation --- p.84 / Chapter 6.1 --- Introduction and Related Work --- p.84 / Chapter 6.2 --- System Construction --- p.85 / Chapter 6.3 --- Empirical Study of the Training System --- p.89 / Chapter 7 --- Conclusion and Discussion --- p.98 / Chapter 7.1 --- Geometric Modeling of Vasculature --- p.99 / Chapter 7.2 --- Catheterization Simulation --- p.99 / Chapter 7.3 --- Embolization Simulation --- p.100 / Chapter 7.4 --- Angiography Simulation --- p.101 / Chapter 7.5 --- System and Evaluation --- p.102 / Publication List --- p.103 / Bibliography --- p.105

No description available.

Interventional magnetic resonance imaging (MRI) aims at performing minimally invasive percutaneous interventions, such as tumor ablations and biopsies, under MRI guidance. During such interventions, the acquired MR image planes are typically aligned to the surgical instrument (needle) axis and to surrounding anatomical structures of interest in order to efficiently monitor the advancement in real-time of the instrument inside the patient's body. Object tracking inside the MRI is expected to facilitate and accelerate MR-guided interventions by allowing to automatically align the image planes to the surgical instrument. In this PhD thesis, an image-based workflow is proposed and refined for automatic image plane alignment. An automatic tracking workflow was developed, performing detection and tracking of a passive marker directly in clinical real-time images. This tracking workflow is designed for fully automated image plane alignment, with minimization of tracking-dedicated time. Its main drawback is its inherent dependence on the slow clinical MRI update rate. First, the addition of motion estimation and prediction with a Kalman filter was investigated and improved the workflow tracking performance. Second, a complementary optical sensor was used for multi-sensor tracking in order to decouple the tracking update rate from the MR image acquisition rate. Performance of the workflow was evaluated with both computer simulations and experiments using an MR compatible testbed. Results show a high robustness of the multi-sensor tracking approach for dynamic image plane alignment, due to the combination of the individual strengths of each sensor.

Thesis (M.S.)--Uniformed Services University of the Health Sciences, 2005. / Typescript (photocopy).

Introduktion: Ett av röntgensjuksköterskans ansvarsområden är att förebygga spridning av vårdrelaterade infektioner, och inom interventionell radiologi innebär detta att arbeta med aseptisk teknik. Munskydd har varit standard inom kirurgi i ett århundrade men inom interventionell radiologi saknas nationella riktlinjer för dess användande, trots att den sterila tekniken i övrigt är densamma. Syfte: Syftet med denna litteraturöversikt var att klargöra huruvida kirurgiska munskydd kan förebygga infektion hos patienten vid interventionell radiologi. Metod: Studien genomfördes som en allmän litteraturöversikt enligt Friberg (2017) för att sammanställa kunskapsläget inom området. Tolv kvantitativa artiklar hittades genom systematisk litteratursökning i PubMed. Artiklarna kvalitetsgranskades, analyserades och resultatet presenterades i två huvudkategorier. Resultat: Munskydd har ingen påvisad effekt att förebygga postoperativa sårinfektioner vid kirurgi eller coronarangiografi men förhindrar till viss del spridning av bakterier. Slutsats: Forskningen på munskydd är begränsad vilket gör det svårt att dra några slutsatser. Fler studier som fokuserar på munskydds effektivitet inom interventionell radiologi behövs. Författarna anser att munskydd inom interventionell radiologi inte bör vara obligatoriskt utan upp till varje avdelning att från fall till fall bestämma huruvida det ska användas eller inte. / Introduction: One of the radiographer's responsibilities is to prevent the spread of healthcare-associated infections. In interventional radiology, this means working with aseptic technique. Surgical face mask protection has been the standard of surgery for a century, but in interventional radiology there are no national guidelines for its use, even though the sterile technique is the same. Aim: The aim of this study was to clarify whether surgical face masks prevent infection in patient in interventional radiology. Methodology: A literature review (Friberg, 2017) has been done to identify the current knowledge in the field. The study includes twelve quantitative articles collected through a systematic literature search in PubMed. After quality review the articles were analyzed and presented into two main categories. Result: Concerning postoperative wound infections, there is no strong evidence to prove that using surgical face masks prevents infections during surgery or coronary angiography. However, using such mask prevents the spread of bacteria to some extent. Conclusion: Research on oral protection is limited, making it difficult to draw any conclusions. A set of new tests are needed to identify the effect of using mask in today’s interventional radiology. Based on the results of the studies, it can be concluded that: generally, mouth protection within interventional radiology should not be mandatory. However, each radiology department need to consider the operating condition and status of the patient and decide if the personal should follow mouth protection process.

Domestic violence highlights as a significant social problem, it introduces frequent and least controlled form of violence included all manifestations of violence among close people. Domestic violence is a form of violence widespreaded throughout the world, in all cultures, appears among people of all social levels, regardless of education, economic situation or ethnicity. Victims of domestic violence are in up to 98% women. In families with domestic violence living minor children, so that they are also victims. According to available research domestic violence takes place in the presence of children in nearly 90% of families. The child itself is a family environment affected by domestic violence for the healthy development very threatening.The theory explains the basic concepts in the field of domestic violence. By children, victims of domestic violence, it is described the impact of domestic violence on the mental and social development of the child. The thesis also summarizes the possibilities of legal protection for persons at risk of domestic violence. They are characterized major institutions involved in solving this problem, including intervention and assistance to victims of the various actors involved. From 2007 operates in the Czech Republic interventional centres that provide emergency assistance to victims of domestic violence and at the same time coordinate interdisciplinary collaboration between other related services. In cases reporting a violent person out of household cooperate with the Police, in the event that in the family with domestic violence are living minor children involved in the process of help the social and legal protection of children, because a child who lives in a family with domestic violence can described as a threatened child.The objective of practical part of the thesis is to determine how cooperation works between the Interventional Centre České Budějovice and the authorities for social and legal protection of children in South Bohemia cases of domestic violence, to find out the view of the issues on the part of social and legal protection of children and intervention center and to map the differences between specific interventions and professional care dedicated to victims of domestic violence with a view to the minor children present violence in families. The qualitatively research uses the method of questioning and analysis of documents. The main techniques of data collection are, with regard to the objective of the thesis, semi-structured interviews with open questions with the staff of the authorities for social and legal protection of children selected municipal authorities of municipalities with extended powers and personnel Interventional Centre České Budějovice, made with a face to face meeting. Another method used is content analysis of secondary data generated by studying the documents of cases currently handled by the authorities for social and legal protection of children and Interventional Centre. Through selected case studies of children attending domestic violence and analysis is found functioning cooperation between the intervention center and the authorities for social and legal protection of children, described the process and specifics of the work, it is obtained information by looking at the issue of domestic violence in families with minor children, and specific interventions of stakeholders assistance and their subsequent comparison. On the basis are the hypotheses formulated.Domestic violence is a complex issue with many specifics, which should take into account the system of assistance to vulnerable persons and indirect victims. Cooperation of bodies in the course of the intervention and assistance to victims of domestic violence are entering, is very important, it´s increase the efficiency of the process. Based on the collected data was pointed out the major importance of the interdisciplinary team, as well as cooperation with problems and possible solutions.

Les ``C-arm'' sont des systémes de radiologie interventionnelle fréquemment utilisés en salle d'opération ou au lit du patient. Des images 3D des structures anatomiques internes peuvent être calculées à partir de multiples radiographies acquises sur un ``C-arm mobile'' et isocentrique décrivant une trajectoire généralement circulaire autour du patient. Pour cela, la géométrie conique d'acquisition de chaque radiographie doit être précisément connue. Malheureusement, les C-arm se déforment en général au cours de la trajectoire. De plus leur motorisation engendre des oscillations non reproductibles. Ils doivent donc être calibrés au cours de l'acquisition. Ma thèse concerne la calibration intrinsèque d'un C-arm à partir de la détection de la projection du collimateur de la source dans les radiographies.Nous avons développé une méthode de détection de la projection des bords linéaires du collimateur. Elle surpasse les méthodes classiques comme le filtre de Canny sur données simulées ou réelles. La précision que nous obtenons sur l'angle et la position (phi,s) des droites est de l'ordre de: phi{RMS}=+/- 0.0045 degrees et s{RMS}=+/- 1.67 pixels. Nous avons évalué nos méthodes et les avons comparés à des méthodes classiques de calibration dans le cadre de la reconstruction 3D. / Mobile isocentric x-ray C-arm systems are an imaging tool used during a variety of interventional and image guided procedures. Three-dimensional images can be produced from multiple projection images of a patient or object as the C-arm rotates around the isocenter provided the C-arm geometry is known. Due to gravity affects and mechanical instabilities the C-arm source and detector geometry undergo significant non-ideal and possibly non reproducible deformation which requires a process of geometric calibration. This research investigates the use of the projection of the slightly closed x-ray tube collimator edges in the image field of view to provide the online intrinsic calibration of C-arm systems.A method of thick straight edge detection has been developed which outperforms the commonly used Canny filter edge detection technique in both simulation and real data investigations. This edge detection technique has exhibited excellent precision in detection of the edge angles and positions, (phi,s), in the presence of simulated C-arm deformation and image noise: phi{RMS} = +/- 0.0045 degrees and s{RMS} = +/- 1.67 pixels. Following this, the C-arm intrinsic calibration, by means of accurate edge detection, has been evaluated in the framework of 3D image reconstruction.

INTRODUÇÃO: A angioplastia carotídea com stent (ACS) sob proteção cerebral é opção terapêutica em pacientes com estenose carotídea. Existe o risco de embolia apesar da utilização do filtro e as modificações na perfusão cerebral após tratamento da estenose carotídea não são claras. O propósito deste estudo é avaliar, após ACS sob proteção cerebral por filtros, modificações nas seqüências de RM de difusão (DWI) e perfusão (PWI), correlacionando-as com os aspectos técnicos da ACS, com as características da estenose e com dados demográficos dos pacientes. MÉTODO: Trinta e seis pacientes portadores de estenose carotídea com idade média de 72,08 anos foram submetidos a exame de RM um dia antes e até 72 horas após a ACS com filtro de proteção. Todos os pacientes eram assintomáticos após a ACS. Áreas de restrição na DWI após a ACS foram correlacionadas com aspectos demográficos, com aspectos da técnica de angioplastia e com a presença de infartos prévios por RM. Os parâmetros CBV volume sanguíneo cerebral, MTT tempo de trânsito médio e TTP tempo para o pico são empregados para análise por PWI. RESULTADOS: Na DWI, 18 de 36 (50,00%) pacientes apresentaram novos focos (NF) de restrição na DWI após ACS. Todos os NF foram clinicamente silenciosos (100%). Estes NF eram localizados em território cerebral nutrido pela artéria carótida submetida à ACS em 77,19% e menores que 10 mm em 91,53%. Os NF em território cerebral não irrigado pela artéria carótida submetida à angioplastia correspondiam a 22,81% destes. A presença de infartos cerebrais prévios na RM foi o único fator com influência no aparecimento de NF (p=0,037). Fatores demográficos e aspectos relacionados com a técnica de angioplastia não tiveram importância na gênese dos NF. Na PWI foi observada melhora nos parâmetros temporais TTP (p<0,001) e MTT (p=0,019) quando comparados de forma normalizada em relação ao território contralateral. CONCLUSÃO: Os novos focos de restrição na DWI após ACS (NF) foram mais comuns no território ipsilateral (77,19%), no entanto houve NF no território contralateral à ACS (22,81%), possivelmente, associados ao cateterismo diagnóstico. Os NF, na sua maioria, são de pequeno diâmetro (<10 mm em 91,53%). Melhora precoce na PWI, observada nos dados normalizados, foi demonstrada nos parâmetros temporais (TTP e MTT). / INTRODUCTION: Carotid angioplasty with stent (CAS) under cerebral protection is a therapeutic option in patients with carotid stenosis. There is a risk of embolism even with a filter, and changes in cerebral perfusion after treatment are not clearly understood. The purpose of this study was to evaluate changes in diffusion- (DWI) and perfusion- (PWI) weighted magnetic resonance imaging (MRI) sequences correlating them with the technical aspects of CAS, stenosis characteristics and patient demographic data. METHODS: Thirty-six carotid stenosis patients with an mean age of 72.08 years were submitted to MRI exam one day before and up to 72 hours after CAS with filter protection. All patients were asymptomatic after CAS. Areas of restriction on DWI were correlated to demographic aspects, technique of angioplasty as well the presence of previous stroke by MRI. The parameters, CBV - cerebral blood volume; MTT - mean transit time, and TTP- time to peak, are used for PWI analysis. RESULTS: Eighteen of the 36 patients (50.00%) presented new focus (NF) of restriction by DWI after CAS. All new focus were clinically silent. The NF were located in the cerebral area fed by the carotid artery submitted to CAS in 77.19% and smaller than 10mm in 91.53%. NF in cerebral area not irrigated by carotid artery submitted by angioplasty correspond to 22,81 %. The presence of previous ischemic lesion on MRI was the only factor which influenced the appearance of NF (p=0.037). Demographic factors and aspects related to angioplasty technique had no importance on NF genesis. Improvement in PWI timing parameters - TTP (p<0.001) and MTT (p=0.019) were observed in relation to the contralateral territory (normalized data). CONCLUSION: The restriction NF in the DWI after CAS are more common in the ipsilateral territory (77.19%), however there were some NF in the contralateral territory to the CAS (22.81%), possibly associated with diagnostic catheterization. Most of the NF were small in diameter (<10mm in 91.53%). Short-term improvement in PWI were demonstrated by normalized timing parameters (TTP and MTT).