Inledning: När en höftfraktur är ockult betyder det att den inte syns på en konventionell röntgenbild. Cirka fem procent av alla cervikala höftfrakturer är ockulta. För att diagnostisera en ockult höftfraktur behöver patienten undersökas vidare med en annan modalitet. En sådan potentionell modalitet är datortomografin, som på ett detaljrikt sätt återger patientens anatomi. Fördröjning till operation ökar risken för dödlighet under tiden patienten är hospitaliserad och det är därför viktigt att patienten får sin diagnos så snabbt som möjligt. Syfte: Att skapa en översikt om kunskapsläget gällande datortomografi vid diagnostisering av ockulta höftfrakturer som inte detekterats på konventionell röntgen. Metod: Studien genomfördes som en allmän litteraturöversikt. Tio vetenskapliga artiklar av kvantitativ metod inkluderades. Resultat: Modaliteten datortomografi detekterade inte alla ockulta höftfrakturer utan patienter fick i flera fall genomgå ytterligare undersökning. Det gemensamma medelvärdet av sensitiviteten hos fyra av de vetenskapliga studierna var 83,3 % och det gemensamma medelvärdet för specificiteten var 99,15 %. Vidare visade sex studier att datortomografi tillsammans missat totalt 15 ockulta höftfrakturer hos 595 patienter. Tiden efter första undersökning med konventionell röntgen till dess att patienten fått genomgå en datortomografiundersökning skiljde sig mellan patienterna och de olika studierna. Det snabbaste medelvärdet för tiden mellan konventionell röntgen och undersökning med datortomografi var 3 timmar och 42 minuter. Slutsats: Datortomografi detekterar inte alla ockulta höftfrakturer och patienter behöver i många fall genomgå ytterligare undersökning för att rätt diagnos ska ställas. / Background: A hip fracture is occult when it is not visible on plain x-rays. About five percent of all cervical hip fractures are occult. To diagnose the occult hip fracture, the patient must undergo further examination with another modality. Computed tomography can be such a potential examination since it gives a clear picture of the patient’s anatomy. Delay to surgery increases the risk of mortality while the patient is hospitalized, and it is therefore important that the patient get the diagnosis as quickly as possible. Purpose: To create an overview of the knowledge situation regarding computed tomography in the diagnosis of occult hip fractures not detected by plain x-rays. Method: The study was conducted as a general literature review. Ten scientific articles of quantitative method were included. Results: Computed tomography did not detect all occult hip fractures and in many cases patients had to undergo further examination. The common meantime of the sensitivity based on four of the scientific articles was 83.3 % and the common specificity was 99.15 %. Of the remaining six articles computed tomography missed a total of 15 occult hip fractures in 595 patients. The meantime after the first examination with plain x-ray until the patient received a computed tomography differed between the patients and studies. The fastest meantime was 3 hours and 42 minutes. Conclusion: Computed tomography does not detect all occult hip fractures, and in many cases patients need to undergo further examination for the correct diagnosis.

Made available in DSpace on 2015-07-22T20:49:47Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-06-24 / INTRODUÇÃO. A segunda opinião médica pode ser definida como a busca de conselhos ou informações médicas entre profissionais de saúde. OBJETIVO. Este trabalho tem o objetivo de apresentar os passos da construção de um sistema de segunda opinião médica, bem como os resultados da avaliação do sistema desenvolvido. MÉTODOS. No trabalho realizou-se um estudo observacional com enfoque etnográfico de investigação empírica. Um sistema web que reproduz o processo de segunda opinião médica definido foi construído a partir de tecnologias de software livre. Para a avaliação, o sistema foi utilizado por 49 médicos residentes da Universidade Federal de São Paulo que emitiram a sua opinião para 52 solicitações de segunda opinião médica. Como instrumentos de avaliação foram utilizados questionários a respeito do conhecimento prévio, da solicitação, de opinião e de satisfação. RESULTADOS. Foram emitidas 1.891 respostas de segunda opinião pelos médicos para as 52 solicitações. Na avaliação da satisfação subjetiva do usuário, o sistema apresentou média de 87,8% no quesito facilidade de utilização e 95,6% no quesito aprendizado para a utilização do sistema. Os médicos indicaram a necessidade de incluir recursos para auxiliar a observação de imagens como, por exemplo, ampliação (zoom), brilho e contraste, em 38,2% das respostas. Apontaram também, em 47,3% das respostas, que os dados clínicos constituem a informação de maior importância para a emissão da segunda opinião. Respostas às solicitações de segunda opinião apresentaram linguagem inadequada que poderia prejudicar a colaboração entre os médicos. CONCLUSÃO. Os resultados da construção e da avaliação deixam em evidência a efetividade do processo definido para a obtenção de segunda opinião médica em radiologia à distância. Palavras-chave: Telemedicina, Consulta Remota, Referência e Consulta, Radiologia, Diagnóstico por Imagem. / INTRODUCTION. The second opinion can be defined as the search of advices or medical information between health professionals. OBJECTIVE. The objective of this work is to present the steps of the construction of a second opinion system, as well as the evaluation results of the developed system. METHODS. In this work an observational study with an empirical ethnographic research focus was implemented. A web system was developed based on open-source technologies. For the evaluation, the system was used by 49 residents from the Federal University of São Paulo that informed their opinion to 52 medical second opinion requests. Questionnaires of previous knowledge, request, opinion and satisfaction where employed as evaluation tools. RESULTS. 1.891 second opinion responses were given by the physicians to the 52 requests. Regarding to the user satisfaction evaluation, the system presents a 87,8% mean in the easy utilization item and a 95,6% mean in learning to operate the system. The physicians showed the necessity to add resources to help observing images, as example, magnifying, brightness and contrast, on 38,2% of the responses. 47,3% responses indicated also that clinical information is the most important information for a second opinion emission. Inappropriate language was found on responses for medical second opinion requests which could difficult physicians’ cooperation. CONCLUSION. The results of the development and evaluation of the second opinion system show that the defined process was effective for the achievement of remote radiology second opinion. / TEDE / BV UNIFESP: Teses e dissertações

Submitted by Mario Mesquita (mbarroso@fiocruz.br) on 2014-10-14T18:11:18Z No. of bitstreams: 1 Isis Pereira Coutinho.pdf: 2318853 bytes, checksum: cde36d58c332b405c18454bb28818d95 (MD5) / Approved for entry into archive by Mario Mesquita (mbarroso@fiocruz.br) on 2014-10-14T18:11:40Z (GMT) No. of bitstreams: 1 Isis Pereira Coutinho.pdf: 2318853 bytes, checksum: cde36d58c332b405c18454bb28818d95 (MD5) / Made available in DSpace on 2014-10-14T18:11:40Z (GMT). No. of bitstreams: 1 Isis Pereira Coutinho.pdf: 2318853 bytes, checksum: cde36d58c332b405c18454bb28818d95 (MD5) / Fundação Oswaldo Cruz. Escola Politécnica de Saúde Joaquim Venâncio. Laboratório do Trabalho e da Educação Profissional em Saúde / A presente dissertação tem como objetivo identificar, a partir da percepção dos trabalhadores técnicos em radiologia, como a qualificação influencia nas práticas de saúde e segurança no Trabalho. Partindo do pressuposto de análise “Qualificação”, campo que pretende avaliar não apenas a educação escolar, mas também a maneira como a sociedade percebe um determinado trabalho como “qualificado”, procurou-se verificar em que medida tal percepção social reflete nas trajetórias formativas, nas formas de inserção no mercado de trabalho e na remuneração dos trabalhadores. Associado a isso, pretende-se também refletir à luz do Campo da Saúde do Trabalhador, a carga às quais estão submetidos os trabalhadores técnicos em radiologia no interior dos serviços de saúde. Na constituição destas duas temáticas associadas, o trabalhador tem um papel primordial, através do seu conhecimento sobre o cotidiano do serviço, na construção de espaços ocupacionais que considerem as prerrogativas de saúde e segurança no trabalho como prioridade ao exercício profissional. Assim, a partir dos elementos que os trabalhadores técnicos em radiologia trazem para esta pesquisa, poderemos observar indícios de como a formação e o trabalho confluem para a produção de um trabalho qualificado e atento à saúde ocupacional dos trabalhadores. / The aim of the thesis is to identify how the idea of qualification influences on Work Health and Safety practices concerning radiology technicians. The analytic starting point is the concept of “Qualification”; field that takes into consideration not only the level of education a work requires but also how a society understands a specific occupation as a “qualified job”. The thesis intended to verify - using as its basis the field of Workers Health - to what extent the social perception reflects on the learning trajectories, the entry into employment, and the salaries earned. Moreover, the thesis ponders on the workload the radiology technicians are submitted to in the context of the Health Services. When these two matters are associated it is possible to understand the relevance of these workers - as subjects who hold the specific knowledge - on the occasion of the construction of work spaces in which the prerogatives of Work Health and Safety are considered priorities. Therefore, it is based on the information given by radiology technicians that it is possible to examine how education and work converge to the production of a true “qualified job”, one which gives importance to the occupational health.

Introduction: The aim of this research work was to compare the radiographic periapical lesions in teeth of diabetic and nondiabetic rats and do an analysis of the metabolic differences of these animals. Methods: 16 male Wistar rats divided into two groups: Group I (n = 8) group rats received chow and filtered water; Group II (n = 8) rats received hypercaloric diet during a 10-week period. After 6 weeks the start of administration of the diet, periapical lesions were induced in the first molars with coronary opening, pulp removel and root canal exposure to the oral environment for a period of 28 days. After this period, the animals were euthanized, blood was made collection was perfomed, followed by liver and abdominal fat removal and, subsequently, the mandible was removed to perform radiographic analysis. Data were subjected to statistical analysis with a significance level set at α=0:05. The difference between groups was analyzed by Student's t-test. Results: There was no statistical difference between diabetic and nondiabetic rats (P>0.05) in radiographic analysis. In blood test statistical difference between diabetic and non-diabetic mice (P<0.05) in the level of catalase cosumo weekly weighed and feed was observed. Conclusion: The induction of diabetes with a high calorie diet for a period of 10 weeks did not show differences in the sizes of periapical lesions evaluated in these animals. In addition, the metabolic differences in these animals were not observed, except in the level of catalase, weekly weighing and feed intake. / Introdução: O objetivo desse trabalho de pesquisa foicomparar radiograficamente as lesões periapicais em dentes de ratos diabéticose não diabéticos e fazer uma análise das diferenças metabólicas desses animais. Métodos: Foram utilizados 16 ratos machos Wistar divididos em dois grupos: no grupo I (n=8) os ratos receberam ração e água filtrada; no grupo II (n=8) os ratos receberam ração hipercalórica, durante o período de 10 semanas. Após 6 semanas do início da administração da dieta, lesões periapicais foram induzidas nos primeiros molares inferiores, com abertura coronária, remoção da polpa e exposição do canal radicular ao meio bucal por um período de 28 dias. Após este período, os animais foram eutanasiados, foi feita a coleta sanguínea, remoção do fígado, remoção da gordura abdominale, posteriormente, amandíbula foi removida para realização da análise radiográfica.Os dados foram submetidos à análise estatística com nível de significância fixado em α=0.05. A diferença entre os grupos foi analisada pelo teste T-Student.Resultados: Não houve diferença estatística entre ratos diabéticos e não diabéticos (P>0.05) para análise radiográfica. Na análise sanguínea foi observada diferença estatística entre ratos diabéticos e não diabéticos (P<0.05) no nível de catalase, pesagem semanal e cosumo de ração. Conclusão:A indução da diabetes com uma dieta hipercalórica, por um período de 10 semanas não demostrou diferenças nos tamanhos das lesões periapicais avaliadas nesses animais. Além disso, as diferenças metabólicas nesses animais não foram observadas, com exceção do nível de catalase, pesagem semanal e consumo de ração.

abstract: Three dimensional (3-D) ultrasound is safe, inexpensive, and has been shown to drastically improve system ease-of-use, diagnostic efficiency, and patient throughput. However, its high computational complexity and resulting high power consumption has precluded its use in hand-held applications. In this dissertation, algorithm-architecture co-design techniques that aim to make hand-held 3-D ultrasound a reality are presented. First, image enhancement methods to improve signal-to-noise ratio (SNR) are proposed. These include virtual source firing techniques and a low overhead digital front-end architecture using orthogonal chirps and orthogonal Golay codes. Second, algorithm-architecture co-design techniques to reduce the power consumption of 3-D SAU imaging systems is presented. These include (i) a subaperture multiplexing strategy and the corresponding apodization method to alleviate the signal bandwidth bottleneck, and (ii) a highly efficient iterative delay calculation method to eliminate complex operations such as multiplications, divisions and square-root in delay calculation during beamforming. These techniques were used to define Sonic Millip3De, a 3-D die stacked architecture for digital beamforming in SAU systems. Sonic Millip3De produces 3-D high resolution images at 2 frames per second with system power consumption of 15W in 45nm technology. Third, a new beamforming method based on separable delay decomposition is proposed to reduce the computational complexity of the beamforming unit in an SAU system. The method is based on minimizing the root-mean-square error (RMSE) due to delay decomposition. It reduces the beamforming complexity of a SAU system by 19x while providing high image fidelity that is comparable to non-separable beamforming. The resulting modified Sonic Millip3De architecture supports a frame rate of 32 volumes per second while maintaining power consumption of 15W in 45nm technology. Next a 3-D plane-wave imaging system that utilizes both separable beamforming and coherent compounding is presented. The resulting system has computational complexity comparable to that of a non-separable non-compounding baseline system while significantly improving contrast-to-noise ratio and SNR. The modified Sonic Millip3De architecture is now capable of generating high resolution images at 1000 volumes per second with 9-fire-angle compounding. / Dissertation/Thesis / Doctoral Dissertation Electrical Engineering 2015

abstract: Recent advances in medical imaging technology have greatly enhanced imaging based diagnosis which requires computational effective and accurate algorithms to process the images (e.g., measure the objects) for quantitative assessment. In this dissertation, one type of imaging objects is of interest: small blobs. Example small blob objects are cells in histopathology images, small breast lesions in ultrasound images, glomeruli in kidney MR images etc. This problem is particularly challenging because the small blobs often have inhomogeneous intensity distribution and indistinct boundary against the background. This research develops a generalized four-phased system for small blob detections. The system includes (1) raw image transformation, (2) Hessian pre-segmentation, (3) feature extraction and (4) unsupervised clustering for post-pruning. First, detecting blobs from 2D images is studied where a Hessian-based Laplacian of Gaussian (HLoG) detector is proposed. Using the scale space theory as foundation, the image is smoothed via LoG. Hessian analysis is then launched to identify the single optimal scale based on which a pre-segmentation is conducted. Novel Regional features are extracted from pre-segmented blob candidates and fed to Variational Bayesian Gaussian Mixture Models (VBGMM) for post pruning. Sixteen cell histology images and two hundred cell fluorescent images are tested to demonstrate the performances of HLoG. Next, as an extension, Hessian-based Difference of Gaussians (HDoG) is proposed which is capable to identify the small blobs from 3D images. Specifically, kidney glomeruli segmentation from 3D MRI (6 rats, 3 humans) is investigated. The experimental results show that HDoG has the potential to automatically detect glomeruli, enabling new measurements of renal microstructures and pathology in preclinical and clinical studies. Realizing the computation time is a key factor impacting the clinical adoption, the last phase of this research is to investigate the data reduction technique for VBGMM in HDoG to handle large-scale datasets. A new coreset algorithm is developed for variational Bayesian mixture models. Using the same MRI dataset, it is observed that the four-phased system with coreset-VBGMM has similar performance as using the full dataset but about 20 times faster. / Dissertation/Thesis / Doctoral Dissertation Industrial Engineering 2015

abstract: Colorectal cancer is the second-highest cause of cancer-related deaths in the United States with approximately 50,000 estimated deaths in 2015. The advanced stages of colorectal cancer has a poor five-year survival rate of 10%, whereas the diagnosis in early stages of development has showed a more favorable five-year survival rate of 90%. Early diagnosis of colorectal cancer is achievable if colorectal polyps, a possible precursor to cancer, are detected and removed before developing into malignancy. The preferred method for polyp detection and removal is optical colonoscopy. A colonoscopic procedure consists of two phases: (1) insertion phase during which a flexible endoscope (a flexible tube with a tiny video camera at the tip) is advanced via the anus and then gradually to the end of the colon--called the cecum, and (2) withdrawal phase during which the endoscope is gradually withdrawn while colonoscopists examine the colon wall to find and remove polyps. Colonoscopy is an effective procedure and has led to a significant decline in the incidence and mortality of colon cancer. However, despite many screening and therapeutic advantages, 1 out of every 4 polyps and 1 out of 13 colon cancers are missed during colonoscopy. There are many factors that contribute to missed polyps and cancers including poor colon preparation, inadequate navigational skills, and fatigue. Poor colon preparation results in a substantial portion of colon covered with fecal content, hindering a careful examination of the colon. Inadequate navigational skills can prevent a colonoscopist from examining hard-to-reach regions of the colon that may contain a polyp. Fatigue can manifest itself in the performance of a colonoscopist by decreasing diligence and vigilance during procedures. Lack of vigilance may prevent a colonoscopist from detecting the polyps that briefly appear in the colonoscopy videos. Lack of diligence may result in hasty examination of the colon that is likely to miss polyps and lesions. To reduce polyp and cancer miss rates, this research presents a quality assurance system with 3 components. The first component is an automatic polyp detection system that highlights the regions with suspected polyps in colonoscopy videos. The goal is to encourage more vigilance during procedures. The suggested polyp detection system consists of several novel modules: (1) a new patch descriptor that characterizes image appearance around boundaries more accurately and more efficiently than widely-used patch descriptors such HoG, LBP, and Daisy; (2) A 2-stage classification framework that is able to enhance low level image features prior to classification. Unlike the traditional way of image classification where a single patch undergoes the processing pipeline, our system fuses the information extracted from a pair of patches for more accurate edge classification; (3) a new vote accumulation scheme that robustly localizes objects with curvy boundaries in fragmented edge maps. Our voting scheme produces a probabilistic output for each polyp candidate but unlike the existing methods (e.g., Hough transform) does not require any predefined parametric model of the object of interest; (4) and a unique three-way image representation coupled with convolutional neural networks (CNNs) for classifying the polyp candidates. Our image representation efficiently captures a variety of features such as color, texture, shape, and temporal information and significantly improves the performance of the subsequent CNNs for candidate classification. This contrasts with the exiting methods that mainly rely on a subset of the above image features for polyp detection. Furthermore, this research is the first to investigate the use of CNNs for polyp detection in colonoscopy videos. The second component of our quality assurance system is an automatic image quality assessment for colonoscopy. The goal is to encourage more diligence during procedures by warning against hasty and low quality colon examination. We detect a low quality colon examination by identifying a number of consecutive non-informative frames in videos. We base our methodology for detecting non-informative frames on two key observations: (1) non-informative frames most often show an unrecognizable scene with few details and blurry edges and thus their information can be locally compressed in a few Discrete Cosine Transform (DCT) coefficients; however, informative images include much more details and their information content cannot be summarized by a small subset of DCT coefficients; (2) information content is spread all over the image in the case of informative frames, whereas in non-informative frames, depending on image artifacts and degradation factors, details may appear in only a few regions. We use the former observation in designing our global features and the latter in designing our local image features. We demonstrated that the suggested new features are superior to the existing features based on wavelet and Fourier transforms. The third component of our quality assurance system is a 3D visualization system. The goal is to provide colonoscopists with feedback about the regions of the colon that have remained unexamined during colonoscopy, thereby helping them improve their navigational skills. The suggested system is based on a new 3D reconstruction algorithm that combines depth and position information for 3D reconstruction. We propose to use a depth camera and a tracking sensor to obtain depth and position information. Our system contrasts with the existing works where the depth and position information are unreliably estimated from the colonoscopy frames. We conducted a use case experiment, demonstrating that the suggested 3D visualization system can determine the unseen regions of the navigated environment. However, due to technology limitations, we were not able to evaluate our 3D visualization system using a phantom model of the colon. / Dissertation/Thesis / Doctoral Dissertation Biomedical Informatics 2015

Bakgrund: Att genomgå en magnetisk resonanstomografi (MR) undersökning kan för patienter som lider av klaustrofobi och ångest innebära att de har svårt att genomföra undersökningen. Röntgensjuksköterskan kan ge stesolid intravenöst till patienten som då oftast klarar av att genomföra undersökningen. Syfte: Det övergripande syftet med studien var att undersöka patienters upplevelse vid MR med stesolid. Studien skulle också ge svar på vid vilken typ av undersökning som stesolid var mest förekommande samt om det fanns en skillnad i upplevelsen beroende på kön och ålder.  Metod: Studien var en kvantitativ enkätstudie med egenkonstruerade frågor om patienters upplevelse under MR med stesolid. Från februari till och med april 2018 delades enkäter ut på fem utvalda sjukhus i södra Sverige till patienter som genomgick MR med stesolid. Resultat: Resultatet visade att de patienter som genomgick MR med stesolid hade en god upplevelse av undersökningen och det fanns ingen signifikant skillnad i upplevelsen beroende på kön eller ålder. Huvud/hals var den vanligaste undersökningen med stesolid. Slutsats: Patienterna hade en god upplevelse av MR med stesolid. I stort sett alla patienter fick stesolid på grund av att de tyckte det var trångt utrymme i kameran. Med detta resultat kan patienter som önskar sövas på grund av oro och ångest inför undersökningen istället få stesolid med god effekt. / Background: Undergoing magnetic resonance imaging (MRI) examinations can be difficult to endure for patients suffering from claustrophobia and anxiety. The radiographer can give the patient stesolid and then usually all of them can perform the examination. Purpose: The overall purpose of the study was to investigate patients experience undergoing MRI with sedation. The study would also provide the most frequent examinated part of body with stesolid and if there was any difference in the experience depending on gender and age. Method: The study was a quantitative questionnaire study with self-designed questions about patients experience during MRI with stesolid. From February to April 2018, the questionnaire was distributed at five selected hospitals in southern Sweden to patients who underwent MRI with stesolid. Result: The result showed that patients who underwent MRI with stesolid had a good experience of the examination and there was no significant difference between the gender and age. Head/throat was the most common examination with stesolid. Conclusion: The patients had a good experience of MRI with stesolid. Almost all of the patients got stesolid because they thought there was a restricted space in the camera. With this result, patients who want anaesthesia because of anxiety may be able to get stesolid instead with good effect.

Made available in DSpace on 2014-10-09T12:43:27Z (GMT). No. of bitstreams: 0 / Made available in DSpace on 2014-10-09T13:58:26Z (GMT). No. of bitstreams: 1 06634.pdf: 17873720 bytes, checksum: 7d4caa5b4a8bbc0193c8ee1522743f57 (MD5) / Tese (Doutoramento) / IPEN/T / Instituto de Pesquisas Energeticas e Nucleares - IPEN/CNEN-SP

Made available in DSpace on 2014-10-09T12:49:50Z (GMT). No. of bitstreams: 0 / Made available in DSpace on 2014-10-09T14:02:57Z (GMT). No. of bitstreams: 0 / Tese (Doutoramento) / IPEN/T / Instituto de Pesquisas Energeticas e Nucleares - IPEN/CNEN-SP