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Biomedical subjects

C A Grimbergen

Publications and source records attributed to C A Grimbergen.

At least 19 recordsLinked to original sources
PubMed2005

Systems approach to reduce errors in surgery.

Reducing the number of medical errors significantly is the challenge for the coming decade. In medicine and in surgery, in particular, errors are traditionally treated as being committed by individuals. To reduce human errors, two approaches can be used: the person approach and the systems approach. In the systems approach, the operator is not blamed, but the system is analyzed in order to find the causes of errors. Furthermore, defenses are built into the system so that errors will not result in an adverse outcome anymore. This article aims to provide insight into the systems approach.

Humans↗
PubMed2005

Fundamental aspects of learning minimally invasive surgical skills.

With the introduction of minimally invasive surgery (MIS) the necessity to develop training methods to learn skills outside the operating room (OR) became clear. Several training simulators have become commercially available. However, fundamental research into the requirements for effective and efficient training in MIS is still lacking. Yet in the literature several learning models have been described that may be used when designing the structure of a training program. While learning skills, three stages can be observed: cognitive, associative and autonomous. The learning cycle also includes different learning styles and, moreover, every trainee has his/her preferred learning style. Furthermore, training should be adapted to the level of behaviour: skill-based, rule-based or knowledge-based. Training of complex skills should include multiple performance objectives, such as just-in-time supportive information and part-task practice. Finally, motivation for training can be created by assessment. In conclusion, several theories on learning can be found in the literature. These theories may help in the development of effective training programs for training MIS skills outside the OR.

Journal Article↗
PubMed2004

Validation and application of an automated rheoscope for measuring red blood cell deformability distributions in different species.

BACKGROUND: The deformability of red blood cells (RBCs) is of great importance for the conservation of oxygen delivery in the microcirculation. Even a small fraction of rigid cells is considered to harm the exchange of respiratory gases. Techniques that measure RBC deformability often provide an indication of the mean deformability. It may not be possible, however, to assess whether this mean value is reduced by the presence of a small rigid cell fraction or by a slight overall reduction in RBC deformability. A technique that provides a deformability distribution would be of great value to study diseases that are marked by subpopulations with a reduced deformability. METHODS: This paper describes a rheoscope system that uses advanced image analysis techniques to quickly quantify the deformability of many individual cells in shear flow, in order to find the RBC-deformability distribution. Since variations in the shear stress are responsible for variations in cell elongation, and hence introduce an additional spread in the cell deformability distribution, we first determined the spread caused by instrumental error. We then utilized the technique to investigate the relation between cell deformability and cell size of single blood samples of different species (human, pig, rat and rabbit). RESULTS: The spread caused by instrumental error was small compared to the actual RBC-deformability spread in blood samples. The deformability distribution of human and pig cells are alike although their cell sizes are different. Rat and rabbit cells show comparable deformability and size distributions. With this technique no correlation was found between cell deformability and cell size in animal RBCs. In the human sample a minor correlation was found between cell deformability and cell size. CONCLUSIONS: The automated rheoscope enables us to study the mechanical properties of RBCs more thoroughly by their deformability distribution. These deformability distributions are hardly influenced by the technique or by cell size.

Animals↗
PubMed2002

Measurement of the distribution of red blood cell deformability using an automated rheoscope.

BACKGROUND: Red blood cells (RBCs) have to deform markedly to pass through the smallest capillaries of the microcirculation. Techniques for measuring RBC deformability often result in an indication of the mean value. A deformability distribution would be more useful for studying diseases that are marked by subpopulations of less deformable cells because even small fractions of rigid cells can cause circulatory problems. METHODS: We present an automated rheoscope that uses advanced image analysis techniques to determine a RBC deformability distribution (RBC-DD) by analyzing a large number of individual cells in shear flow. The sensitivity was measured from density-separated fractions of one blood sample and from cells rendered less deformable by heat treatment. A preliminary experiment included the RBC-DDs of a patient with sickle cell anemia, one on dialysis and being treated with erythropoietin, and one with elliptocytosis. RESULTS: Measurement of the RBC-DD was highly reproducible. The sensitivity test showed markedly different deformability distributions of density-separated cells and yielded distinct RBC-DDs after each additional minute of heat treatment. CONCLUSION: The automated rheoscope enabled the determination of RBC-DDs from which less deformable subpopulations can be established. The shape of an RBC-DD may be valuable in assessing cell fractions with normal and anomalous deformability within pathologic blood samples.

Erythrocyte Deformability↗
PubMed2002

Investigation into the origin of the noise of surface electrodes.

In the recording of biomedical signals, a significant noise component is introduced by the electrode. The magnitude of this noise is considerably higher than the equivalent thermal noise from the electrode impedance. As the noise in surface electrodes limits the resolution of biopotential recordings, it is important to understand its origin. It was found that the noise mainly originates in the electrolyte-skin interface and that it is highly dependent on the electrode gel used and the skin properties of the test subject. Depending on skin treatment, magnitudes between 1 and 20 microVrms were measured among subjects. When the metal-electrolyte interface was allowed time to stabilise, electrodes of different metals measured face to face all showed a negligibly small noise magnitude (< 1 microVrms). In pre-gelled electrodes, where the metal-electrolyte interface has stabilised, no difference in noise properties was found between Ag-AgCl electrodes and other metals when measured on the skin. In subjects at rest, the contribution of EMG signals to the total noise level was shown to be negligibly small compared with the noise contribution of the electrolyte-skin interface. The magnitude of the noise of electrodes appeared to be inversely proportional to the square root of the area of the electrode on the skin.

Electric Impedance↗
PubMed2002

Conversion of left ventricular endocardial positions from patient-independent co-ordinates into biplane fluoroscopic projections.

Electrocardiographic body surface mapping is used clinically to guide catheter ablation of cardiac arrhythmias by providing an estimate of the site of origin of an arrhythmia. The localisation methods used in our group produce results in left-ventricular cylinder co-ordinates (LVCCs), which are patient-independent but hard to interpret during catheterisation in the electrophysiology laboratory. It is preferable to provide these results as three-dimensional (3D) co-ordinates which can be presented as projections in the biplane fluoroscopic views that are used routinely to monitor the catheter position. Investigations were carried out into how well LVCCs can be converted into fluoroscopic projections with the limited anatomical data available in contemporary clinical practice. Endocardial surfaces from magnetic resonance imaging (MRI) scans of 24 healthy volunteers were used to create an appropriate model of the left-ventricular endocardial wall. Methods for estimation of model parameters from biplane fluoroscopic images were evaluated using simulated biplane data created from these surfaces. In addition, the conversion method was evaluated, using 107 catheter positions obtained from eight patients, by computing LVCCs from biplane fluoroscopic images and reconstructing the 3D positions using the model. The median 3D distance between reconstructed positions and measured positions was 4.3mm.

Adult↗
PubMed2000

Establishment of pneumoperitoneum with a modified blunt trocar.

Veress needle and trocar-related accidents have caused many surgeons to adopt the Hasson technique for establishment of pneumoperitoneum, but this technique also has drawbacks. A modification of the sharp trocar has been developed that overcomes the disadvantages of the Veress needle and Hasson trocar.

Equipment Design↗
PubMed2000

Design and feasibility of PASSIST, a passive instrument positioner.

BACKGROUND AND PURPOSE: During minimally invasive procedures, an assistant controls the camera and often a laparoscopic grasper. Ideally, the surgeon should be able to manipulate the instruments because the indirect way of control complicates the surgeon's observation and actions and disturbs eye-hand coordination. Reported replacements for the assistant are active positioners, "robots," such as the Aesop and the EndoAssist. Because positioning instruments is often a static task, the Academic Medical Center has developed a passive assistant for instrument positioning (PASSIST) to allow solo surgery. METHODS: The PASSIST was designed to be simple, fully autoclavable, slender, and stiff. The joints have adjustable friction and spring compensation for stabilizing the instrument in a fixed position, enabling intuitive single-hand repositioning. RESULTS: The PASSIST has been tested in three laparoscopic procedures: cholecystectomy, laparoscopically assisted vaginal hysterectomy, and spondylodesis. In all of these procedures, the assistant could be replaced satisfactorily, and the surgeon was able to manipulate all of the instruments on his own. CONCLUSION: Solo surgery using the PASSIST is feasible. The positioner enables the surgeon to manipulate the viewpoint, to have a stable image, and therefore to improve observation and manipulating actions.

Equipment Design↗
PubMed2000

Comparison of efficiencies of three techniques for colon surgery.

PURPOSE: To determine the most efficient technique for performing a colectomy, we used the methodology of time-motion analysis. METHODS: The efficiency of five hand-assisted and six regular laparoscopic colectomies and one open colectomy, performed by four surgeons in three different hospitals, was measured. The open colectomy was analyzed as a reference procedure. RESULTS AND CONCLUSIONS: The hand-assisted laparoscopic technique was the most efficient. Hand-assisted laparoscopy was therefore less time consuming than laparoscopic surgery. Open surgery was the fastest technique, because the time for every surgical motion is a factor of three shorter than for the two laparoscopic techniques.

Colectomy↗
PubMed2000

Continuous localization of cardiac activation sites using a database of multichannel ECG recordings.

Monomorphic ventricular tachycardia and ventricular extrasystoles have a specific exit site that can be localized using the multichannel surface electrocardiogram (ECG) and a database of paced ECG recordings. An algorithm is presented that improves on previous methods by providing a continuous estimate of the coordinates of the exit site instead of selecting one out of 25 predetermined segments. The accuracy improvement is greatest, and most useful, when adjacent pacing sites in individual patients are localized relative to each other. Important advantages of the new method are the objectivity and reproducibility of the localization results.

Algorithms↗
PubMed2000

Quantitative in vivo analysis of the kinematics of carpal bones from three-dimensional CT images using a deformable surface model and a three-dimensional matching technique.

The purpose of this study was to obtain quantitative information of the relative displacements and rotations of the carpal bones during movement of the wrist. Axial helical CT scans were made of the wrists of 11 volunteers. The wrists were imaged in the neutral position with a conventional CT technique, and in 15-20 other postures (flexion-extension, radial-ulnar deviation) with a low-dose technique. A segmentation of the carpal bones was obtained by applying a deformable surface model to the regular-dose scan. Next, each carpal bone, the radius, and ulna in this scan was registered with the corresponding bone in each low-dose scan using a three-dimensional matching technique. A detailed definition of the surfaces of the carpal bones was obtained from the regular-dose scans. The low-dose scans provided sufficient information to obtain an accurate match of each carpal bone with its counterpart in the regular-dose scan. Accurate estimates of the relative positions and orientations of the carpal bones during flexion and deviation were obtained. This quantification will be especially useful when monitoring changes in kinematics before and after operative interventions, like mini-arthrodeses. This technique can also be applied in the quantification of the movement of other bones in the body (e.g., ankle and cortical spine).

Carpal Bones↗
PubMed1999

Clinical application of an integrated 3-phase mapping technique for localization of the site of origin of idiopathic ventricular tachycardia.

BACKGROUND: Radiofrequency (RF) catheter ablation provides curative treatment for idiopathic ventricular tachycardia (VT). METHODS AND RESULTS: Nineteen consecutive patients with an idiopathic VT underwent RF catheter ablation. An integrated 3-phase mapping approach was used, consisting of the successive application of online 62-lead body surface QRS integral mapping, directed regional paced body surface QRS integral mapping, and local activation sequence mapping. Mapping phase 1 was localization of the segment of VT origin by comparing the VT QRS integral map with a database of mean paced QRS integral maps. Mapping phase 2 was body surface pace mapping during sinus rhythm in the segment localized in phase 1 until the site at which the paced QRS integral map matched the VT QRS integral map was identified (ie, VT exit site). Mapping phase 3 was local activation sequence mapping at the circumscribed area identified in phase 2 to identify the site with the earliest local endocardial activation (ie, site of VT origin). This site became the ablation target. Ten VTs were ablated in the right ventricular outflow tract, 2 at the basal LV septum, and 7 at the midapical posterior left ventricle. A high long-term ablation success (mean follow-up duration, 14+/-9 months) was achieved in 17 of the 19 patients (89%) with a low number of RF pulses (mean, 3.3+/-2.2 pulses per patient). CONCLUSIONS: This prospective study shows that integrated 3-phase mapping for localization of the site of origin of idiopathic VT offers efficient and accurate localization of the target site for RF catheter ablation.

Adult↗
PubMed1999

CART: a controlled algebraic reconstruction technique for electron microscope tomography of embedded, sectioned specimen.

Reconstruction of thick, embedded, sectioned material has to cope with the restricted tilt view of the electron microscope, with information not stemming from the object of interest in the projections, with aberrations of the objective lens and with a distorted relationship between the projected densities in the micrographs and the specimen mass densities due to incoherent electron interactions within the specimen. Micrograph densities over a full tilt-range show in general an averaged mass increase which is more than should be expected from the cosine dependency of the tilt-angles of the projections. The hereby presented reconstruction technique finds a solution for the under-determined system by a controlled algebraic iteration procedure. For this solution the procedure stabilises the region of interest by dynamically scaling the input data during the procedure. A model for the electron transport through thick specimens is proposed and microscope projection simulations are carried out to test the algorithms.

Algorithms↗
PubMed1998

Electrocardiographic identification of abnormal ventricular depolarization and repolarization in patients with idiopathic ventricular fibrillation.

OBJECTIVES: We sought to gain more insight into the arrhythmogenic etiology of idiopathic ventricular fibrillation (VF) by assessing ventricular depolarization and repolarization properties by means of various electrocardiographic (ECG) techniques. BACKGROUND: Idiopathic VF occurs in the absence of demonstrable structural heart disease. Abnormalities in ventricular depolarization or repolarization have been related to increased vulnerability to VF in various cardiac disorders and are possibly also present in patients with idiopathic VF. METHODS: In 17 patients with a first episode of idiopathic VF, 62-lead body surface QRST integral maps, QT dispersion on the 12-lead ECG and XYZ-lead signal-averaged ECGs were computed. RESULTS: All subjects of a healthy control group had a normal dipolar QRST integral map. In patients with idiopathic VF, either a normal dipolar map (29%,), a dipolar map with an abnormally large negative area on the right side of the thorax (24%) or a nondipolar map (47%) were recorded. Only four patients (24%) had increased QT dispersion on the 12-lead ECG and late potentials could be recorded in 6 (38%) of 16 patients. During a median follow-up duration of 56 months (range 9 to 136), a recurrent arrhythmic event occurred in 7 patients (41%), all of whom had an abnormal QRST integral map. Five of these patients had late potentials, and three showed increased QT dispersion on the 12-lead ECG. CONCLUSIONS: In patients with idiopathic VF, ventricular areas of slow conduction, regionally delayed repolarization or dispersion in repolarization can be identified. Therefore, various electrophysiologic conditions, alone or in combination, may be responsible for the occurrence of idiopathic VF. Body surface QRST integral mapping may be a promising method to identify those patients who do not show a recurrent episode of VF.

Adult↗
PubMed1998

Detection of the carpal bone contours from 3-D MR images of the wrist using a planar radial scale-space snake.

In this paper we consider the problems encountered when applying snake models to detect the contours of the carpal bones in 3-D MR images of the wrist. In order to improve the performance of the original snake model introduced by Kass [1], we propose a new image force based on one-dimensional (1-D) second-order Gaussian filtering and contrast equalization. The improved snake is less sensitive to model initialization and has no tendency to cut off contour sections of high curvature, because 1-D radial scale-space relaxation is used. Contour orientation is used to minimize the influence of neighboring image structures. Due to 1-D contrast equalization an intensity insensitive measure of external energy is obtained. As a consequence a good balance between internal and external energetic contributions of the snake is established, which also improves convergence. By incorporating this new image force into the snake model, we succeed in accurate contour detection, even when relatively high noise levels are present and when the contrast varies along the contours of the bones.

Algorithms↗
PubMed1997

Body-surface QRST integral mapping. Arrhythmogenic righ ventricular dysplasia versus idiopathic right ventricular tachycardia.

BACKGROUND: Ventricular tachycardia originating in the right ventricle may arise in the presence or absence of structural heart disease. The two main causes of right ventricular tachycardia are arrhythmogenic right ventricular dysplasia (ARVD) and idiopathic right ventricular tachycardia (IRVT) originating from the outflow tract. This study was carried out to determine whether body-surface QRST integral mapping can differentiate patients with ARVD from patients with IRVT. METHODS AND RESULTS: Body-surface QRST integral maps were obtained during sinus rhythm in 8 patients with ARVD, 8 patients with IRVT, and 27 healthy control subjects. QRST integral maps were analyzed both visually and mathematically. All control subjects had a normal dipolar QRST integral map. In all patients with ARVD, a specific dipolar QRST integral map with an abnormally large negative area covering the entire inferior and right anterior thorax was recorded. In 6 of 8 patients with IRVT, a normal map pattern was found, whereas the remaining 2 patients showed an abnormally large negative area on the right anterior thorax. CONCLUSIONS: Patients with ARVD display a specific abnormal QRST integral map that may be related to delayed repolarization in the structurally abnormal right ventricle. The majority of patients with IRVT demonstrate a normal QRST integral map. A slightly abnormal QRST integral map was noted in 2 of 8 patients with IRVT, which may be related to minor structural abnormalities, undetectable by the present routine diagnostic techniques. These preliminary results indicate that body-surface QRST integral mapping may become an important diagnostic tool to differentiate patients with ARVD from those with IRVT.

Adult↗