Submitted by Maria Eneide de Souza Araujo (mearaujo@ipen.br) on 2017-03-10T16:07:58Z No. of bitstreams: 0 / Made available in DSpace on 2017-03-10T16:07:58Z (GMT). No. of bitstreams: 0 / Devido as frequentes dúvidas dos usuários das câmaras de ionização do tipo lápis calibradas no Laboratório de Calibração de Instrumentos do IPEN (LCI IPEN), em como aplicar corretamente os fatores indicados em seus certificados de calibração, foi elaborado um guia orientativo para dosimetria em tomografia computadorizada. O guia orientativo inclui o conhecimento prévio da Camada Semirredutora (CSR), já que é necessário conhecer a energia efetiva do feixe para aplicação do fator de correção para qualidade (kq). A avaliação da CSR em tomógrafos torna-se uma difícil tarefa devido à geometria do sistema e por essa razão foi realizado um levantamento das metodologias existentes para a determinação da CSR em feixes clínicos de Tomografia Computadorizada (TC), levando em consideração fatores técnicos, práticos e econômicos. Neste trabalho, optou-se em testar um Sistema Tandem composto por capas absorvedoras confeccionado na oficina do IPEN, baseado em estudos preliminares devido ao baixo custo e boa reposta. O Sistema Tandem é composto por 5 capas absorvedoras cilíndricas de 1 mm, 3 mm, 5 mm, 7 mm, e 10 mm de alumínio e por 3 capas absorvedoras cilíndricas de 15 mm, 25 mm e 35 mm de acrílico (PMMA) acopladas à câmara de ionização do tipo lápis comercial amplamente utilizada em testes de controle de qualidade na dosimetria em feixes clínicos de Tomografia Computadorizada. Através das curvas Tandem, foi possível avaliar os valores de CSR e, através da curva de calibração da câmara de ionização do tipo lápis, encontrar o Kq adequado ao feixe. O Guia elaborado traz informações de como construir a curva de calibração em função da CSR, para encontrar o Kq, bem como informações para construção da curva Tandem, para encontrar valores próximos de CSR. / Dissertação (Mestrado em Tecnologia Nuclear) / IPEN/D / Instituto de Pesquisas Energeticas e Nucleares - IPEN-CNEN/SP

Inledning: Varje år besöker mellan 12 000 och 14 000 kvinnor öppenvården till följd av våld i nära relation. Röntgensjuksköterskan ska arbeta med personcentrerad vård i enlighet med sin kompetensbeskrivning samt implementera ny kunskap för att utvecklas. Utifrån detta ansågs det betydelsefullt att beskriva kunskapsläget inom området bemötande av kvinnor utsatta för våld. Syfte: Syftet var att beskriva vad som är viktigt att ta hänsyn till vid bemötande av kvinnor på röntgen utsatta för våld i nära relation och hur detta kan tillämpas i det korta mötet. Vilken kunskap om bemötandet av kvinnor utsatta för våld i nära relation finns beskriven i litteraturen? Metod: Studien utfördes som en litteraturöversikt med 12 vetenskapliga artiklar som kvalitetsgranskades, analyserades och resultatet presenterades i form av kategorier. Resultat: Sex kategorier som beskriver bemötandet och vad som påverkar hur bemötandet upplevs av kvinnorna. Bemötande, kunskap, attityder, stöd, hinder och att förhålla sig professionell. I resultatet framkommer stora brister i bemötandet av dessa kvinnor, där de hjälpsökande istället skuldbeläggs, vilket ger kvinnorna ytterligare skamkänslor. De utsatta kvinnorna är dessutom rädda att dömas av personalen och skyddar sig från dessa attityder genom att dölja våldet.  Kunskap efterfrågas av både utsatta och personal. Det framkommer attityder bland hälso- och sjukvårdspersonal som lägger skulden på kvinnorna. Kvinnorna efterfrågar stöd och personalen påtalar behovet av rutiner som stöd för att kunna ge ett gott bemötande. Hinder för att kunna bemötas kan vara frågor såsom svårigheter att kunna söka vård eller att mannen för kvinnans talan. Professionellt förhållningssätt visar sig svårgenomfört bland annat på grund av att känslor var svårhanterliga i mötet med kvinnorna. Konklusion: Det är viktigt att röntgenavdelningarna tar fram riktlinjer och rutiner för ett gott bemötande. Kunskap och samtal kring detta bör vara prioriterat för att minska negativa attityder och inspirera till förbättringsarbete som kan utveckla röntgensjuksköterskans profession. / Introduction: Every year between 12,000 and 14,000 women visit health care in relation to intimate partner violence. The radiology nurse ought to work with person centered care in accordance with their competence description and implement new knowledge to develop. Based on this, it was considered important to describe knowledge of encounter with the women. Purpose: The purpose was to describe what to consider when health personnel encounter women exposed to intimate partner violence in the radiology department and how this can be applied in the short meeting. What knowledge is described concerning encounter with the women? Method: The study was conducted as a literature review consisting of 12 scientific articles that were quality reviewed, analyzed and presented. Results: Six categories described the encounter and how the treatment of women was experienced. Encounter, knowledge, attitudes, support, obstacles, and professional conduct. The results revealed major shortcomings in the treatment of these women, when seeking help they were blamed, given a feeling of guilt and shame. The women were also afraid to be valued by the staff and protected themselves by concealing the violence. Knowledge was required by both groups. There were attitudes among healthcare professionals who blamed the women. The women demanded support and the staff wanted routines to support a good encounter. Obstacles to be treated can be issues such as difficulties in seeking care or because of the husband, who speaks for the woman. Professional approaches appeared to be difficult, among other things, since the emotions were difficult to handle in the encounter with the women. Conclusion: It is important for the radiology departments to develop guidelines and procedures to achieve a good encounter. Knowledge and discussions should be prioritized to reduce negative attitudes and inspire improvement work, that can develop the radiology nurse's profession.

Slutna cylinderformade MRT-kameror ger bilder av patienten i liggande position men studier visar att ländryggen beter sig annorlunda under den belastning som en sittande eller stående position innebär. Syfte: Syftet med denna litteraturstudie var att sammanställa kunskap om diagnostik av ländrygg med hjälp av öppen MRT-kamera som tillåter belastade bilder i viktbärande position. Metod: Studien genomfördes som en allmän litteraturstudie, med 16 inkluderade vetenskapliga artiklar. Resultat: Belastning såväl som extension av ländryggen kan påverka flertalet av ländryggens strukturer. Vid belastade bilder upptäcktes fler fall av spinal stenos, spondylolistes, nervkompression och facettcystor. Flertalet studier visade dock på mer smärta vid bildtagning i belastad position. Slutsats: Belastade bilder kan vara mer fördelaktigt än icke-belastade för att upptäcka patologi, samtidigt som extension och flexion är viktiga faktorer anatomiskt vid diagnostisering av ländryggssmärta. / Closed cylindrical MRI cameras provide images of the patient in a supine position, but studies show that the lumbar spine behave differently in a sitting or standing position with axial load. Objective: The purpose of this literature overview was to compile knowledge of lumbar diagnosis using open MRI camera that allows loaded images in weight-bearing positions. Methods: A literature overview including 16 articles. Results: Weight-bearing position as well as extension of the lumbar spine can affect many of the lumbar structures. Weight-bearing position revealed more cases of spinal stenosis, spondylolisthesis, nerve compression and juxtafacet cysts. However, the majority of studies showed imaging in the weight-bearing position to be more painful. Conclusion: Weight-bearing MRI may be more advantageous than non-weight-bearing to detect pathology. Extension and flexion are also important factors in the diagnosis of the lumbar spine.

Inledning: Autism eller Autismspektrumtillstånd (AST) kännetecknas av varierande svårigheter inom tre områden: förmåga till ömsesidigt socialt samspel, förmåga till ömsesidig kommunikation och föreställningsförmåga, flexibilitet och variation i beteende och intressen. AST drabbar cirka 1 % av barnen i Sverige och anses uppkomma till följd av avvikelser i vissa delar av hjärnan. Diagnosen AST görs vanligen efter två års ålder med hjälp av intervjuer med närstående och observationer av barnets beteende. Sökandet efter abnormiteter i hjärnan hos barn med AST har pågått sedan 1980-talet. Tekniska framsteg i datorer och magnetisk resonanstomografi (MR) innebär att forskare kan kartlägga hjärnan som aldrig tidigare. Syftet: Syftet med studien var att sammanställa och beskriva den senaste forskningen om MRs användning för tidig diagnos av autism och beskriva konsekvenser för röntgensjuksköterskans yrke. Metod: Studien har gjorts som en allmän litteraturöversikt. Fjorton vetenskapliga artiklar kvalitetsgranskades och analyserades. Resultat: Resultaten delades först upp i tre olika grupper: fynd från strukturell MR, fynd från funktionell MR och konsekvenser för röntgensjuksköterskor. Dessa grupper delades ytterligare till ett antal underkategorier. Slutsats: Ett flertal avvikelser i hjärnan hittades hos barn som senare utvecklar AST. Avvikelser i hjärnvolymen, extra-axiell vätska, corpus callosum, anisotropiska värden, bearbetning av ljud och visuell orienteringsförmåga. Det verkar troligt att efter mer forskning blir dessa biomarkörer tillräckligt pålitliga att användas som diagnostiskt verktyg. Om MR undersökningar av barn med AST blir rutinmässiga kommer röntgensjuksköterskor att behöva ny kunskap och ny kompetens framför allt med hantering av barn med AST. / Introduction: Autism or Autism spectrum disorder (ASD) is characterized by varying degrees of difficulty in three areas: mutual social interaction, mutual communication and imagination, flexibility and variety of behavior and interests. ASD affects approximately 1% of children in Sweden and is thought to be due to deviations in certain regions of the brain. A diagnosis is usually made after the age of two with the help of interviews with family members and observations of the child’s behaviour. The search for abnormalities in the brains of children with ASD had been going on since the 1980s. Technical advances in computers and magnetic resonance imaging (MRI) mean that researchers can map the brain like never before. Aim: The aim of this study was to compile and describe the latest research on MRI's use for the early diagnosis of autism and describe the consequences for the radiology nurse's profession. Method: The study has been conducted as a literature review. Fourteen scientific articles were quality controlled and analyzed. Results: The results were first divided into three different groups: findings from structural MRI, findings from functional MRI and consequences for radiology nurses. These groups were then divided further into a number of subgroups. Conclusion: A number of abnormalities were found in the brains of children who later develop ASD. Abnormalities were found in brain volume, extra-axial fluid, corpus callosum, fractional anisotropy values, processing of sound and visual orientation. It seems probable that after more research these biomarkers will become reliable enough to be used as a diagnostic tool. If MRI examinations of children with ASD become routine then radiology nurses will need new knowledge and skills above all in the handling of children with ASD.

Hepatocellular carcinoma is a primary liver cancer.Among treatment options for hepatocellular carcinoma, Yttrium-90 radioembolization is a promising transarterial therapy.This thesis investigates potential clinical applications of radioembolization in the treatment of the hepatocellular carcinoma (techniques of radiation segmentectomy and radiation lobectomy), and adress the problematic of the response Assessment after radioembolization. / Doctorat en Sciences médicales (Médecine) / info:eu-repo/semantics/nonPublished

Copper radionuclides possess physical properties suitable for utilization in nuclear medicine. Important part of their preparation is separation from mother elements, usually zinc or nickel. Currently used methods of separation have their limits, what opens field for finding new ways. One part of the Thesis contains preparation of simple ion exchangers and their selectivity study. The other part of the Thesis is dedicated to optimization of synthetic steps leading to new bifunctional ligands in suitable form for binding to macromolecular carriers and preparation of new set of exchangers.

Portal hypertension (PHT) is a condition with serious complications, such as variceal bleeding, refractory ascites and bowel ischemia. The cause of PHT may be pre-, intra- or post-hepatic. Initial treatment is pressure-reducing drugs and the treatment of acute symptoms. Ten patients presented with severe abdominal pain and acute portomesenteric venous thrombosis. Their response to systemic anticoagulation was insufficient. Treatment with primary continuous thrombolysis by a transhepatic or transjugular approach in four patients resulted in major complications, incomplete recanalization and a 75% survival rate. Treatment with repeated transjugular thrombectomy (TT) combined with the creation of a transjugular intrahepatic portosystemic shunt (TIPS) achieved near complete recanalization, prompt symptom relief and 100% survival in five patients treated with this method as the primary intervention. In one patient, treated with TT and TIPS secondary to surgical thrombectomy and bowel resection, the outcome was fatal. Nineteen patients with portal vein thrombosis presented with acute or threatening variceal bleeding or refractory ascites. TIPS was feasible in 16 of the 18 patients in whom it was attempted and symptom relief was achieved in the majority of them. In 14 patients with Budd-Chiari syndrome, 13 patients were treated with TIPS, four of them after previous liver vein angioplasty. The 5-year transplantation-free survival rate was 100% in patients treated with primary TIPS. In 131 patients with variceal bleeding treated with TIPS, the survival at 12 months in patients with and without cirrhosis was 70% and 100% respectively and in accordance with previous studies. A high Child-Pugh score prior to TIPS and severe HE within 12 months after TIPS was related to an increased mortality. The occurrence of HE after TIPS did not correlate with the PSG after TIPS. Re-bleeding within 12 months after TIPS occurred in 10 patients and was associated with TIPS dysfunction. In conclusion, endovascular intervention, mainly TIPS, seems to be safe and effective for treating patients with complications of PHT, regardless of the underlying cause of disease and site of venous blood flow obstruction. HE may occur more frequently after TIPS than medical and endoscopic treatment, but is often mild and easily treated. In selected patients with PHT, TIPS may improve survival.

Les gliomes sont des tumeurs cérébrales primitives représentant le deuxième cancer le plus fréquent chez l’enfant et la troisième cause de mortalité chez l’adulte jeune. Il a été démontré qu’une chirurgie d’exérèse tumorale permet d’augmenter la qualité et la durée de vie du patient, voir même dans certains cas, d’obtenir sa guérison. L’identification intraopératoire des résidus tumoraux permettrait au chirurgien de vérifier, in situ, la qualité de son geste d’exérèse. Une nouvelle modalité d’imagerie intraopératoire a été proposée comme solution pour détecter les tumeurs résiduelles. Elle se base sur l’utilisation d’une sonde nucléaire combinée à un système de localisation optique. Cette nouvelle modalité, appelée imagerie surfacique de positons (ISP), permet la génération d’images de la distribution surfacique d’un radiotraceur comme le 18 F − F DG d’une zone d’intérêt scannée. L’ISP n’étant actuellement pas utilisée en clinique, nous proposons pour la première fois une étude de faisabilité de son utilisation pour l’optimisation de la chirurgie des tumeurs cérébrales. Nous montrons les limites de l’utilisation potentielle de l’ISP dans un contexte neurochirurgical par des études expérimentales en considérant des facteurs intraopératoires pouvant influencer la qualité des images générées par le système. Les contributions présentées se concentrent sur trois axes. Dans un premier temps, nous souhaitons obtenir des images fonctionnelles d’ISP avec un temps de calcul faible. L’application de modèles d’acquisition aux mesures permettent d’améliorer la qualité des images, au détriment d’un temps de calcul élevé. Nous suggérons un nouveau modèle d’acquisition dédié au contexte intraopératoire, permettant l’amélioration de la résolution et du contraste des images pour un temps de calcul réduit. Un deuxième axe est dédié à l’étude de l’impact d’une acquisition intraopératoire sur les performances du système. Nous proposons l’estimation des paramètres intrinsèques de la sonde nucléaire utilisée et de l’influence de la hauteur du processus de scan sur leurs valeurs. Le dernier axe est consacré à la validation de modèles d’acquisition dans le contexte intraopératoire. Nous présentons une étude comparative des performances de modèles d’acquisition en considérant l’impact potentiel de la vitesse de scan durant l’acquisition. L’ensemble de ces travaux a contribué à l’étude de faisabilité de l’utilisation d’un système d’ISP en intraopératoire, proposée pour la première fois en neurochirurgie. / Gliomas are primitive brain tumors, which represent the second most frequent cancer among children and the third cause of death among young adult. It has been shown that resection surgery improves patient outcomes, leading to its cure for some cases. Intraoperative detection of residual tumor allows the surgeon to check the quality of its resection gesture. A new intraoperative imaging modality has been proposed as a solution to detect residual tumors. It relies on a nuclear probe associated with an optical localization system. This new modality, called positron surface imaging (PSI), generates images of the activity surface distribution of a 18 F based radiotracer of a scanned area of interest. Not used in clinical context yet, we proposed for the first time a feasibility study of its usage to optimize brain tumor surgery. We show limitations of the potential usage of PSI in neurosurgery through experimental studies, considering intraoperatives factors which may influence quality of generated images. Contributions in this study are presented on three axes. First, we want to generate PSI functional images with a low computational time. Acquisition models applied to measurements improve image quality at the cost of high computational time. We suggest a new acquisition model dedicated to intraoperative usage, allowing enhancement of spatial resolution and contrast of images for a low computational time. The second axis is dedicated to the study of the intraoperative acquisition impact on system performance. We propose to estimate the intrinsic parameters of nuclear probe and the study of scanning process on their values. Finally, we present the validation of acquisition models dedicated to intraoperative context. We show a comparative study of acquisition models performance considering potential impact of scanning speed process during acquisition. This work has contributed to the feasibility study of using an ISP system in the intraoperative context, proposed for the first time in neurosurgery.

Amyloid PET imaging with [11C]PIB enabled detection of Aβ for the first time in vivo. However, [11C]PIB is a small molecule that binds only the insoluble Aβ plaque. Rather, the soluble Aβ aggregates are considered the cause of Alzheimer’s disease (AD). As such, a more sensitive and specific PET tracer is needed for tracking longitudinal AD pathology. Soluble Aβ aggregates likely interact with the metabotropic glutamate receptor 5 (mGluR5) to cause neurotoxic effects. However, with [11C]ABP688 PET we were unable to detect aberrant mGluR5 binding in AD mouse models, although we find elevated mGluR5 protein levels with immunoblotting. Antibodies are highly specific large molecules that can bind specifically to soluble Aβ aggregates, thus they can be a good marker for AD pathology. Unfortunately, due to their large size they cannot cross the blood-brain barrier (BBB). However, it is possible to shuttle antibodies into the brain by taking advantage of endogenous transporter systems on the BBB. By creating bispecific antibodies binding both to soluble Aβ aggregates and to the transferrin receptor (BBB target), we successfully transported the antibody into the brain and could visually detect soluble Aβ aggregates with PET. Recombinant expression further improved and optimized antibody design, creating smaller bispecific antibody-based constructs that had better pharmacokinetic properties allowing for earlier PET scanning (1 day instead of 3), and more sensitive signal. Lastly, using TCO-tetrazine click chemistry, we indirectly labeled our antibodies with fluorine-18, and could successfully perform PET already 11 h post-injection with a fluorine-18 labeled antibody.

Den senaste utvecklingen av artificiell intelligens (AI) och djupinlärning (DL) har gjort bild- och funktionsmedicin till en högst trolig kandidat att tidigt anta tekniken. AI inom mammografiscreening syftar till hälsofrämjande effekter genom en förhoppning om säkrare bilddiagnostik. Röntgensjuksköterskans (RSS) arbete präglas av korrekt utförd bildtagning och ett aktivt aktualiserande av den egna yrkesrollen gällande såväl tekniska framsteg som förnyade arbetssätt. Litteraturstudien har upprättats i syfte att belysa potentiella effekter av AI på bilddiagnostik inom mammografiscreening. Genom manifest innehållsanalys av resultat erhållna ur ämnesrelevanta vetenskapliga studier publicerade i databaserna Cinahl och Medline under år 2019–2020 identifierades och beskrevs kategorier sammanställda av subkategorier med liknande innehåll. Effekter inom granskningsprocessen och diagnostisk säkerhet skildrar flera perspektiv gällande AI:s effekter på bilddiagnostik. Utöver en stundtals ökad förmåga till cancerdetektion vid AI-assistans har artificiell bildgranskning även visat sig kunna reducera arbetsbördan för radiologer i form av friskrivning av mammogram med låg sannolikhet för bröstcancer. Vid tillämpning av AI ses lovande effekter inom framförallt klassificering av bröstvävnad samt vid reducering av falska positiva svar. Forskningen förbehålls dock med kvarstående etiska dilemman och avsaknad av ett juridiskt ramverk, vilket lämnar utrymme för vidare studier. / Recent developments in artificial intelligence (AI) and deep learning (DL) have made diagnostic imaging a prime candidate to adopt the technology. AI in mammography screening aims at promoting health with hopes of higher diagnostic accuracy. The radiographers work is characterized by properly performed imaging and actively updating the profession regarding technical developments and renewed working methods. The aim of this systematic review was to illustrate feasible effects of AI on diagnostic imaging within mammography screening. Through manifest content analysis of results obtained from subject related scientific studies published 2019–2020 in the databases Cinahl and Medline the authors identified and described categories compiled by subcategories with similar contents. Effects within the image interpretation process and diagnostic accuracy describes several perspectives regarding the outputs of AI on diagnostic imaging. AI-systems have proven to be useful in both assisting with image interpretation and reducing the workload for radiologists by disclaiming mammograms with low probability of breast cancer. Most promising effects are seen in the classification of breast tissue and reduction of false positives, but research is challenged by ethical dilemmas and the need for a legal framework, which are areas suggested for future research.