Background: Computed tomography (CT), is commonly used imaging technique in cancer patients. In CT performed for tumour staging to detect the spread of tumours, the liver is a common place for metastases. There are two types of metastases in the liver, hypo- and hyper vascularised, which generally are best seen in the venous phase and the late arterial phase. Therefore, CT of the liver often includes a triple phase contrast-enhancement protocol.   Purpose: The aim of this study was to qualitatively and quantitatively examine, through image review and attenuation measurements, respectively, the overall image quality of CT examinations performed in conjunction with positron emission tomography, (PET)/CT and as separate, stand-alone CT-studies, at the Department of Nuclear Medicine and PET centre, Uppsala University Hospital.   Method: A retrospective cross-sectional patient records review was undertaken with a descriptive approach of the qualitatively and quantitative data. 286 examinations were included in the study.     Result: The examinations were of high-quality in terms of contrast-enhancement technique, 183/190 (96,3%) of late arterial phases and 211/286 (74%) of venous phases. Some characteristic differences in the contrast-enhancement of the liver and the metastases were found in the different CT phases, allowing for division into four separate categories based on their respective characteristics.   Conclusion: In summary, the performed CT examinations were in majority performed in the right phase. The image quality of Contrast-to-noise, (CNR) and Signal-to-noise (SNR) were satisfactory even if the CNR could be higher for a better distinguish and detected small structures in the images. / Bakgrund: Datortomografi (DT), är den vanligaste avbildningstekniken för cancerpatienter. Vid DT för utredning av tumörspridning är levern en vanlig plats för metastaser. Det finns två typer av metastaser i levern, hypo- och hypervaskulära, som vanligen ses bäst i venfas respektive i sen artärfas. DT-undersökningarna av levern inkluderar därför ofta ett trippelfas-undersöknings-protokoll. Syfte: Syftet med denna studie var att kvalitativt och kvantitativt undersöka, genom bildgranskning respektive attenueringsmätningar, den totala bildkvaliteten för DT-undersökningar utförda i samband med positronemissionstomografi (PET) / DT och som separata, fristående CT-studier, vid Institutionen för nuklearmedicin och PET-center, Uppsala universitetssjukhus.   Metod: En retrospektiv tvärsnittsstudie med patientjournaler där en beskrivande metod användes för att beskriva den kvalitativt och kvantitativt datan. 286 DT-undersökningar granskades och inkluderades i studien. Resultat: Undersökningarna utfördes med DT i samband med PET/ DT, och även som separata DT undersökningar, var av hög kvalité vad gäller kontrastförstärkningsteknik varav 183/190 (96,3%) av sena artärfasundersökningarna och 211/286 (74%) av venfasundersökningarna erhöll maximal kvalitetspoäng. Vissa karakteristiska skillnader i kontrastförstärkningen av levern gentemot metastaserna hittades för de mycket och dåligt vaskulariserade metastaserna i de olika CT-faserna, vilket möjliggjorde uppdelning i fyra separata kategorier baserat på deras respektive egenskaper.   Slutsats: Sammanfattningsvis utfördes de utförda DT-undersökningarna i majoritet i rätt fas. Bildkvaliteten på Kontrast-till-brus, (CNR) och Signal-till-brus (SNR) var tillfredsställande även om CNR kunde vara högre för att bättre skilja och upptäcka små strukturer i bilderna.

Inledning: Att som barn komma till röntgen kan vara både nytt och skrämmande. Miljön och personalen är främmande och i kombination med smärta kan detta skapa ångest hos barn vilket gör att de inte samarbetar på samma sätt som vuxna. För att upplevelsen på röntgenavdelningenska bli så bra som möjligt är det viktigt att röntgensjuksköterskan arbetar för en personcentrerad omvårdnad. Genom att använda sig av distraktionsmetoder och öka trygghetskänslan stiger chansen att genomföra undersökningen. Syfte: Kartlägga vilka distraktionstekniker röntgensjuksköterskor kan använda för att minska barns oro och ångest i samband med röntgenundersökningar. Metod: Studien genomfördes som en allmän litteraturstudie där tolvkvantitativa artiklar har analyserats och sammanställts för att besvara syftet. Resultat: Genom aktiv eller passiv distraktion kan ångest reduceras med hjälp av enkla hjälpmedel. Aktiv och passiv distraktion kan variera i material som bör vara anpassade till barnets ålder och mognad. Slutsats: Med hjälp av olika distraktionstekniker kan samarbetet med barn öka på röntgen för att möjliggöra smidigare undersökningar.

The general aim of this thesis was to empirically describe the radiographers’ professional scope in diagnostic imaging from the viewpoint of the practitioners and investigate how technical development affects the relations and actions in this practice. Data was collected by interviews and observations to both studies at the same time with two different aims. Eight radiographers (n=8) were interviewed. The interviews were open in character, were recorded with a digital voice recorder, and transcribed verbatim by the interviewer. The interview guide consisted of four interview questions. The observations of radiographers during their work with Computer Tomography (CT) and Magnetic Resonance Imaging (MRI) were conducted in a middle-sized radiology department in the southern part of Sweden. The observations were ten (n=10) in total. Two different theoretical perspectives were used: phenomenology (Study I) and practice theory perspective (Study II). Data was analysed with a phenomenological method in Study I. In Study II data was firstly analysed inductively, which resulted in seven codes. Secondly, abduction was made by interpretation of these codes from a practice theory perspective. This led to four themes. The findings in Study I display the main aspect of the radiographers’ work with image production. Their general tasks and responsibilities can be viewed as a process with the goal of producing images that can be used for diagnosis purposes. The process has three different phases: planning the examination, production of images, and evaluation of the image quality. The radiographers experience the production of images as their autonomous professional area. The findings in Study II report how technology development affects the relations between different actors and their actions in the practice of Computer Tomography. Four themes were identified; 1) Changed materiality makes the practical action easier. Radiographers’ practica work with image production has become easier when working with CT  compared to conventional techniques because the CT usually performs the image production in one scan. 2) Changed machines cause conflict between the arrangements of the work and the patients` needs. It is difficult to plan the examination individually for each patient because of the arrangements of the CT practice, i.e. they have little information about the patient before the examination. 3) Changing materiality prefigures learning. The radiographers describe a need for constant learning activities because of the changing procedures for image production and new modalities for image production. If not achieved it may affect their relations with the patients. 4) How the connections between different practices lead to times when practical reasoning is required in the radiography process with CT. The connections between the different professions in CT practice mainly occur through material arrangements because physically they work in different areas. The external arrangements in CT practice pre-figure actions for securing accurate radiation level and image quality. But the radiographers, who meet the patients, have to critically judge the intended actions in relation to clinical observed data to ensure patient safety.

Background: Cyclotrons form a central infrastructure and are a resource of medical radionuclides for the development of new radiotracers as well as the production and supply of clinically established radiopharmaceuticals for patient care in nuclear medicine. Aim: To provide an updated overview of the number and characteristics of cyclotrons that are currently in use within radiopharmaceutical sciences and for the development of radiopharmaceuticals to be used for patient care in Nuclear Medicine in Germany (D), Austria (A) and Switzerland (CH). Methods: Publicly available information on the cyclotron infrastructure was (i) consolidated and updated, (ii) supplemented by selective desktop research and, last but not least, (iii) validated by members of the committee of the academic “Working Group Radiochemistry and Radiopharmacy” (AGRR), consisting of radiochemists and radiopharmacists of the D-A-CH countries and belonging to the German Society of Nuclear Medicine (DGN), as well as the Radiopharmaceuticals Committee of the DGN. Results: In total, 42 cyclotrons were identified that are currently being operated for medical radionuclide production for imaging and therapy in Nuclear Medicine clinics, 32 of them in Germany, 4 in Austria and 6 in Switzerland. Two thirds of the cyclotrons reported (67%) are operated by universities, university hospitals or research institutions close to a university hospital, less by/in cooperation with industrial partners (29%) or a non-academic clinic/ PET-center (5%). Most of the cyclotrons (88%) are running with up to 18 MeV proton beams, which is sufficient for the production of the currently most common cyclotron-based radionuclides for PET imaging. Discussion: The data presented provide an academically-updated overview of the medical cyclotrons operated for the production of radiopharmaceuticals and their use in Nuclear Medicine in the D-A-CH countries. In this context, we discuss current developments and trends with a view to the cyclotron infrastructure in these countries, with a specific focus on organizational aspects.

No description available.

Introduktion: Dagens strålskyddsprinciper om gonadskydd är i grunden baserade på ALARA principen utöver de olika lagar och författningar som implementeras med tidens gång. Att uppnå diagnostisk kvalitet på bilden utan att ta bort vital information är därför av intresse för röntgensjuksköterskan. Felaktig placering av gonadskyddet kan leda till ökad stråldos samt informationsbortfall, eventuellt även omtag av bilden. Ökande stråldos ger högre risk för genetiska skador på arvsmaterialet samt risken att utveckla cancer. Syfte: Att undersöka förekomsten, mängden felplacerade gonadskydd samt effekten av felplacerade gonadskydd. Metod: En allmän litteraturöversikt baserat på kvantitativa artiklar genomfördes där elvavetenskapliga artiklar kvalitetsgranskades. Sökningar gjordes i databaserna PubMed, CINAHL och Google Scholar. Resultat: Resultat visar att felplacerade gonadskydd leder till omtag av röntgenbilder och patienter utsätts för mer stråldos. Det ökar risken för strålskador. Detta går emot ALARA-principen som ska tillämpas av röntgensjuksköterskor. Slutsats: Mycket av nyligt utkommen forskning pekar på att gonadskydd används ofta felaktigt och skapar då förutsättningar för ökad stråldos för patienten. Huruvida gonadskydd bör avskaffas är något som kräver mer forskning för att avgöra

Den globala medellivslängden i världen ökar samtidigt som en åldrande befolkning leder till att behovet av vård och omsorg blir mer omfattande. Människor lever allt längre men är även sjuka en längre tid vilket ställer krav på kapaciteten inom vården. Kommunikationen utgör i dagsläget ett problem som försvårar sjukvårdens möjligheter att hantera den rådande vårdsituationen, vil-ket indikerar att sektorn är i behov av förändring. En möjlig lösning på detta problem är att utnyttja digitaliseringens möjligheter genom e-hälsa för att åstadkomma utveckling av välfär-den där vården håller en hög kvalitet och patienten står i fokus. Mobiltelefoner har visat sig vara ett lämpligt verktyg för detta ändamål då de idag utgör ett viktigt kommunikationsverktyg i samhället. Nuklearmedicinen syftar till den diagnostik och behandling som sker med hjälp av radioaktiva preparat och används exempelvis för behandling av sköldkörtelsjukdom. Behandlingen med dessa preparat medför restriktioner vilka skall beaktas av patienten och är information som skall förmedlas av sjukvården. En mobilapplikation har utvecklats på uppdrag av avdelningen för Nuklearmedicin vid Karolinska universitetssjukhuset med målet att på ett lättillgängligt sätt förmedla information till patienter och anhöriga. Med applikationen kan en kompletterande informationskanal skapas mellan patienten och av-delningens personal för att stödja kommunikationen. Vikten av korrekt och tydlig information i ett nära samarbete med kunnig vårdpersonal har diskuterats, vilket utgjort grunden för appli-kationens utformning. I syfte att utreda behovet och potentialen av ICT i sjukvården har en förstudie i form av en intervju genomförts. Tillsammans med en enkätundersökning, för att evaluera prototypen, utgör dessa grunden för den diskussion som förts kring applikationens möjligheter att bidra till kommunikationen inom denna del av sjukvården. Resultatet visar att potentialen för ICT inom vården är stor men att det finns brister som gör att systemen inte håller den kvalitet som förväntas och krävs av vårdsituationen. Genom införandet av prototypen kan patienter i tidigt skede ta del av information kring behandlingen och således förberedas efter egna villkor vilket är ett steg mot framtidens sjukvård. / The global life expectancy increases with an aging population, which leads to more demanding requirements on healthcare. Humans live longer but at the same time spend longer time of their lives being sick, which requires higher capacities within the healthcare system. Communication forms a problem by complicating the possibilities of healthcare to handle the situation, which indicates a need of change. A possible solution is to utilize the possibilities of digitalisation, with the help of e-health, to achieve development of the welfare where healthcare maintains high quality and patients are in focus. Mobile phones have shown to be a suitable tool for this cause due to the fact that they form a central tool for communication in today’s society. Nuclear medicine is the diagnostics and treatment with the help of radioactive substances and is part of today’s treatment of thyroid diseases. Using these preparations results in a number of restrictions, which has to be taken into consideration by the patient and should be given by the responsible physician. On behalf of the department for nuclear medicine at Karolinska univer-sity hospital a mobile application has been developed where patients and relatives, in a conven-ient way, can take part of information about their treatment. With the application, a complementary information channel can be created between patients and the department staff in order to support the communication. The importance of correct and transparent information in close cooperation with healthcare professionals has been discussed, which forms the base of the applications design. For the purpose of investigating the potential of ICT in healthcare, a pre-study in form of an interview was conducted. Together with a survey in order to evaluate the concept, these two form the basis of the discussion on the possibilities to contribute to the communication in the studied section of healthcare. The result shows that there is a lot of potential for ICT within healthcare, but the systems that are in use today lacks in quality, which is demanded and expected by the care situation. By introducing the concept, patients can take part of information about their treatment in an early stage, which allows them to prepare on their own terms, and is a step towards the healthcare of the future.

Bakgrund Artificiell intelligens (AI) har utvecklats i stor utsträckning i samband med magnetresonans (MR) undersökningar. Röntgensjuksköterskans roll vid MR-undersökningar är bland annat bildframställning och säkerställning av patientsäkerhet. Tillämpning av AI-teknik kan innebära förändringar i röntgensjuksköterskans roll inom MR-verksamheten.  Syfte Syftet med denna litteraturstudie är att studera faktorer där AI kan påverka röntgensjuksköterskans roll inom MR-verksamheten. Metod En systematisk litteraturstudie har genomförts. Datainsamlingen har utförts via databaserna PubMed och CINAHL. De valda artiklarna uppfyllde studiens inklusionskriterier. Artiklarna genomgick sedan en kvalitetsgranskning och artiklarna som uppnådde medel till hög kvalité analyserades och samanställdes i en tabell utefter analysmetoden metasyntes.  Resultat Resultatet i denna studie presenterar flera faktorer där AI kan påverka röntgensjuksköterskans roll inom MR-verksamheten. AI kan förbättra arbetsflöden och öka effektivitet genom att förbättra bildkvalitén, minska undersökningstiden, kontrollera metallimplantat inför en MR-undersökning, ersätta användningen av gadoliniumkontrastmedel samt stödja röntgensjuksköterskan vid förberedelser inför en MR-undersökning. Slutsats AI i samband med MR-undersökningar kan påverka röntgensjuksköterskans roll under den peri-radiografiska processen. AI kan optimera radiografiska arbetsflöden och förändra arbetsuppgifter för röntgensjuksköterskan inom MR-verksamheten. Det är möjligt att fokus flyttas från tekniska aspekter till personcentrerade vård. Röntgensjuksköterskan behöver anpassa sig till nya kompetenskrav samt erhålla en djupare förståelse av AI inom MR-verksamheten. / Background Artificial intelligence (AI) is advancing rapidly in the context of magnetic resonance imaging (MRI) examinations. Radiographers’ role in MRI imaging includes image acquisition and ensuring patient safety. The implementation of AI-technologies may imply changes in the radiographers’ role within the MRI-department. Purpose The purpose of this literature review is to examine the factors which AI can affect radiographers’ role within the MRI-department. Method A systematic literature review was conducted. The data collection has been executed via the databases PubMed and CINAHL. The selected articles fulfilled the chosen inclusion criteria. The articles were then quality assessed and those who achieved medium or high quality were analysed and subsequently compiled into a table according to the analytical method meta-synthesis.  Result This study presents several factors in which AI can affect the radiographers’ role within the MRI department. AI technologies can improve workflow and increase efficiency by improving image quality, reducing examination times, checking for metal implants prior to an MRI, replacing use of contrast media, and assisting radiographers during preparations prior to MRI scans. Conclusion The applications of AI in MRI imaging can affect radiographers’ role in the peri-radiographic process. AI can optimize the workflow and change work tasks for radiographers within the MRI department. The focus may shift from technical aspects to person-centered care. Radiographers should adapt to new competency requirements as well as obtain a deeper understanding of AI technologies.

Ionizing radiation is applied in healthcare for diagnostics or cancer therapy in various human populations, including pediatric patients. To ensure children's stillness during radiological procedures, they are usually sedated/anesthetized with anesthetics, such as ketamine. Previous studies have shown that exposure to ketamine, ionizing radiation, or a combination of both during critical periods of brain development can result in cognitive impairment later in life.The purpose of the project is to investigate developmental neurotoxic effects of ketamine and low-dose ionizing radiation.Female NMRI-mice were exposed on postnatal day 10 to ketamine (7.5 mg/kg), low-dose ionizing radiation (200 mGy), or co-exposure. Then, gene expression patterns in hippocampusfor Jagged1, Hes5, Nrf2, Keap1, Bdnf and Grin2b were studied by qPCR.Two primers were designed for the mouse genes Cat, Sod2, Tia1 and G3bp1 respectively. Subsequently, efficiency of each primer was investigated using qPCR to generate a standard curve.The gene expression of Grin2b showed/displayed statistically significant downregulation in all exposed groups. No statistically significant change in the gene expression of Jagged-1, Hes5, Nrf2, Keap1 and Bdnf were observed.Due to appearance of secondary peaks, primers for Tia1:1, G3bp1:2 and Sod2:1 were excluded from the study. The efficiency of Cat1, Cat2, Sod2-2, Tia1-2 and G3bp1-1 did not meet the criteria (90–110%) for further work.Exposure to ketamine, low-dose ionizing radiation or a co-exposure may affect Grin2bexpression in children and consequently result in cognitive impairment. More studies are required to determine the underlying mechanism. Additional aspects to consider when designing primers should be implemented.

The liver is one of the largest organs within the human body and it handles many vital tasks such as nutrient processing, toxin removal, and synthesis of important proteins. The number of people suffering from chronic liver disease is on the rise, likely due to the present ‘western’ lifestyle. As disease develops in the liver there are pathophysiological manifestations within the liver parenchyma that are both common and important to monitor. These manifestations include inflammation, fatty infiltration (steatosis), excessive scar tissue formation (fibrosis and cirrhosis), and iron loading. Importantly, as the disease progresses there is concurrent loss of liver function. Furthermore, postoperative liver function insufficiency is an important concern when planning surgical treatment of the liver, because it is associated with both morbidity and mortality. Liver function can also be hampered due to drug-induced injuries, an important aspect to consider in drug-development. Currently, an invasive liver needle biopsy is required to determine the aetiology and to stage or grade the pathophysiological manifestations. There are important limitations with the biopsy, which include, risk of serious complications, mortality, morbidity, inter- and intra-observer variability, sampling error, and sampling variability. Cleary, it would be beneficial to be able investigate the pathophysiological manifestations accurately, non-invasively, and on regional level. Current available laboratory liver function blood panels are typically insufficient and often only indicate damage at a late stage. Thus, it would be beneficial to have access to biomarkers that are both sensitive and responds to early changes in liver function in both clinical settings and for the pharmaceutical industry and regulatory agencies. The main aim of this thesis was to develop and evaluate methods that can be used for a ‘non-invasive liver biopsy’ using magnetic resonance (MR). We also aimed to develop sensitive methods for measure liver function based on gadoxetate-enhanced MR imaging (MRI). The presented work is primarily based on a prospective study on c. 100 patients suffering from chronic liver disease of varying aetiologies recruited due to elevated liver enzyme levels, without clear signs of decompensated cirrhosis. Our results show that the commonly used liver fat cut-off for diagnosing steatosis should be lowered from 5% to 3% when using MR proton-density fat fraction (PDFF). We also show that MR elastography (MRE) is superior in staging fibrosis. Finally we presented a framework for quantifying liver function based on gadoxetate-enhanced MRI. The method is based on clinical images and a clinical approved contrast agent (gadoxetate). The framework consists of; state-of the-art image reconstruction and correction methods, a mathematical model, and a precise model parametrization method. The model was developed and validated on healthy subjects. Thereafter the model was found applicable on the chronic liver disease cohort as well as validated using gadoxetate levels in biopsy samples and blood samples. The liver function parameters correlated with clinical markers for liver function and liver fibrosis (used as a surrogate marker for liver function). In summary, it should be possible to perform a non-invasive liver biopsy using: MRI-PDFF for liver fat and iron loading, MRE for liver fibrosis and possibly also inflammation, and measure liver function using the presented framework for analysing gadoxetate-enhanced MRI. With the exception of an MREtransducer no additional hardware is required on the MR scanner. The liver function method is likely to be useful both in a clinical setting and in pharmaceutical trials.