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PubMed1992

Beam's eye view--based radiation therapy: description of methods.

Improving three-dimensional target definitions and dose delivery may improve local control rates in radiation therapy. Computed tomography (CT)-based treatment planning is one step toward achieving this goal, but further progress is possible with beam's eye view (BEV)-based planning. Initially, CT is performed with the patient in the treatment position, and data are transferred to a computerized treatment planning system. Target volumes and vital structures are outlined on CT sections and digitized, and a treatment plan is produced. BEV display is used to calculate the angles needed for oblique fields that would avoid irradiation of vital structures. A BEV printout is obtained along with simulation radiographs. The radiograph is overlaid on the printout, all identified structures are matched, and the target volumes are transferred from the printout to the radiograph. BEV-based planning can improve three-dimensional coverage of a tumor, irradiation techniques, and the therapeutic ratio by decreasing the irradiation of normal tissue. The extra time required for BEV planning is acceptable, but further studies of long-term outcomes and cost-benefit analyses are needed.

Humans↗
PubMed1992

Computers in healthcare: overview and bibliography.

OBJECTIVE: The objective of this article is to provide an overview of computer technology and an associated bibliography, emphasizing institutional-based healthcare applications and pharmacoinformatics. DATA SOURCES: References were selected from the authors' files and from a computerized search over the last five years on computers in healthcare/medical informatics and in pharmacy. STUDY SELECTION: Articles selected for review and discussion were considered to be important contributions to the respective areas listed in the bibliography and representative of advancements in computer applications in healthcare and pharmacy. DATA SYNTHESIS: The computer has become an important support tool for healthcare professionals. Medical informatics and the discipline related to pharmacy, called pharmacoinformatics, have evolved from the cognitive underpinnings of medicine, pharmacy, and computer science. Recent developments in computer technology have resulted in computers that are fast, increasingly portable, and user friendly. Hospital information systems employ computers in various ways to deal with the vast amount of information used by various departments. Standards for electronic data exchange are being developed to increase the integration potential of these systems. Hospital pharmacists have used computers for drug distribution, financial analysis and inventory control, drug interaction detection, pharmacokinetic dosing, drug information, and drug therapy monitoring. Expert systems are being developed in several areas of drug therapy. Pharmacy educators have developed interactive courseware to help students learn problem-solving skills in the areas of calculations, therapeutics, and drug information. CONCLUSIONS: Pharmacists need to become more involved with applications of technology to pharmacy. Properly implemented, computers can provide more time for pharmacists to use their cognitive skills in the delivery of pharmaceutical care.

Clinical Pharmacy Information Systems↗
PubMed1992

[Numerical analysis of orthodontic treatment elements of pseudo-elastic NiTi alloys].

In orthodontic treatment malpositions of teeth are often corrected by fixed appliances, consisting, in part, of loops made by the orthodontist. The most important alloys in use are steel, cobalt-chromium, or titanium-molybdenium alloys. The static force systems of fixed appliances made of these materials are well known from experimental and numerical studies, but as they may change during tooth movement, we are often confronted with problems in therapy. The introduction of pseudoelastic nickel titanium alloys (NiTi) into orthodontic treatment, offers the chance of improving the effectiveness and reliability of orthodontic devices. In the present paper a plane finite element (FE) for the analysis of orthodontic loops is presented. It enables the determination of the nonlinear behaviour of pseudoelastic NiTi-alloys and is capable of simulating large structural displacements and rotations accompanied by moderate strains. A comparative numerical and experimental study shows the efficiency of this element. The associated results reflect pseudoelastic effects on certain loop designs, and reveal the benefits for the orthodontist and his patients.

Computer Simulation↗
PubMed1992

Radiographic methods in the evaluation of periodontal therapy.

Radiographic methods are commonly utilized to assess periodontal bone changes in clinical trials. Radiographs are unique as a data source in that they provide a permanent visual record of the bone support and allow for linear, area, and volume measurements of periodontal lesions. The major limiting factors in the use of radiographic outcomes measures are geometric distortion and radiographic processing errors. The use of standardized methods and computer algorithms has reduced the effect of these errors on data from radiographs. Radiographic analysis in clinical trials is largely done in digital format by indirect digitizing film with a video camera. Direct digital detectors are now available for intra-oral use. The use of a direct detector eliminates the need for film processing and allows for dose reduction. The detectors currently available are limited in size and resolution. Subtraction radiography allows for area and volume estimates of bone gain or loss. The subtraction methods are highly precise, but are also technically exacting and labor intensive. The clinical trial hypothesis, size, length, and accuracy required should be the final consideration in choosing a radiographic method.

Alveolar Bone Loss↗
PubMed1975

[Marker-evidence for documentation and evaluation of findings and treatment in fractures of the facial skull].

A special form is presented by means of which clinical findings and therapy of fractures of the visceral cranium are documented in such a way that the data can be fed into a computer and be evaluated. Like similar forms for cheilognathopalatoschisis and tumors of the jaw and face area the present form is meant for a special field or specific problems and is not to replace the traditional case history.

Diagnosis, Computer-Assisted↗
PubMed1979

[A computer-controlled monitoring and therapy system for shock compensation in severe burns (author's transl)].

A computer-controlled control loop for the automatic diagnosis of shock and infusion therapy is reported. External information (off-line) and vital parameters measured with serial devices (on-line) are used by the computer for the automatic control of infusion pumps. By this method the critical shock phase could be prevented in five seriously burned patients. The construction of the system also permits its use in other shock conditions.

Blood Pressure↗
PubMedDate not supplied

Investigating the potential of three-dimensional treatment planning.

3-D treatment planning has received a great deal of attention in the radiation therapy community over the last several years. This new technology makes use of the continuous improvements in computer hardware and graphics capabilities, along with major improvements in treatment planning software, to provide a fully three dimensional simulation of the patient, radiation beams, and dose distributions which are used for radiation therapy of various cancers. With these capabilities, the physician and treatment planner may now optimize the radiation beams used to treat the patient much more effectively than in the past, when only a limited description of the patient, beams, and doses was available. This paper describes several of the new capabilities of these 3-D planning systems, some research studies which are currently being performed to evaluate the usefulness of the new technology, and finally some of the costs associated with its implementation.

Computer Simulation↗
PubMedDate not supplied

[Computerized planning of radiotherapy].

The hypophysis was studied by MR tomography in 148 patients with the most prevalent diseases of the hypothalamohypophyseal system and in 13 ones with primary hypothyrosis. The findings evidence a great variety of changes in the MRT picture in the examinees. The method permits a reliable diagnosis of hypophyseal macroadenoma and of an 'empty' sella turcica. Qualitative and quantitative criteria for MRT diagnosis of these conditions are suggested. The diagnostic value of MRT for the detection of macroadenomas is still to be researched. The method was effectively used for a dynamic follow-up of the hypophyseal status in the course of pathogenetic therapy; the formation of an 'empty' sella turcica is possible against the background of dopamine agonist therapy and substitution therapy of primary hypothyrosis.

Adolescent↗
PubMed1992

[Conformal technics by the movement of bars in pendular fields. 1. Prototype realization and the possible applications].

The growing interest for conformal radiotherapy originates from the need of giving the prescribed dose to the target volume, by sparing, at the same time, surrounding healthy tissues and organs. More dose to the target volume with respect to the healthy tissues always increases the curative possibilities of the treatment. However, the development of conformal techniques implies an increased complexity of the treatment and the solution of many technical and dosimetric problems. In our Institute we are developing new conformal techniques, based on the use of moving bars driven by a computer-controlled system in arc therapy. This paper refers to the conclusion of the preliminary part of our work: a movement (translating or rotating) of bars in arc therapy seems to have good chances to tailor dose distribution in a relatively simple way. We realized two mechanical systems driven by computer for translating and rotating movements of a bar. The two techniques have been tested by TLD and film dosimetry on acrylic phantoms. We present the results of these tests, and describe technical problems and the clinical possibilities of this method.

Equipment Design↗
PubMed1992

True three-dimensional dose computations for megavoltage x-ray therapy: a role for the superposition principle.

The objective of radiation therapy is to concentrate a prescribed radiation dose accurately within a target volume in the patient. Major advances in imaging technology have greatly improved our ability to plan radiation treatments in three dimensions (3D) and to verify the treatment geometrically, but there is a concomitant need to improve dosimetric accuracy. It has been recommended that radiation doses should be computed with an accuracy of 3% within the target volume and in radiosensitive normal tissues. We review the rationale behind this recommendation, and describe a new generation of 3D dose algorithms which are capable of achieving this goal. A true 3D dose calculation tracks primary and scattered radiations in 3D space while accounting for tissue inhomogeneities. In the past, dose distributions have been computed in a 2D transverse slice with the assumption that the anatomy of the patient dose not change abruptly in nearby slices. We demonstrate the importance of computing 3D scatter contributions to dose from photons and electrons correctly, and show the magnitude of dose errors caused by using traditional 2D methods. The Monte Carlo technique is the most general and rigorous approach since individual primary and secondary particle tracks are simulated. However, this approach is too time-consuming for clinical treatment planning. We review an approach that is based on the superposition principle and achieves a reasonable compromise between the speed of computation and accuracy in dose. In this approach, dose deposition is separated into two steps. Firstly, the attenuation of incident photons interacting in the absorber is computed to determine the total energy released in the material (TERMA). This quantity is treated as an impulse at each irradiated point. Secondly, the transport of energy by scattered photons and electrons is described by a point dose spread kernel. The dose distribution is the superposition of the kernels, weighted by the magnitude of the TERMA impulse for all interaction sites. In this review, we demonstrate the capabilities of the superposition method, particularly for situations of charged particle disequilibrium, and we report on the progress made by several research groups in adapting this method to clinical treatment planning. In the future, the superposition method will have a significant role in dose optimization for conformal irradiation techniques because of its close correspondence to image reconstruction by filtered back-projection.

Image Processing, Computer-Assisted↗
PubMed1992

Decision analysis as a quality-assurance screening tool.

BACKGROUND: The purpose of this pilot study was to examine whether the technique of decision analysis, including sensitivity analysis, could be used in a clinical quality-assurance program. METHODS: This research was performed in a family practice residency clinical practice. A computerized decision analysis model was developed for selection of initial drug therapy for hypertension. The medical records of 52 resident-managed patients with hypertension were then reviewed. The residents' drug prescribing was evaluated by faculty reviewers and also by the decision analysis model, including a sensitivity analysis. RESULTS: Faculty reviewers rated the residents' drug choices as "most appropriate" or "acceptable" in 59.6% of cases. There was good agreement between faculty reviewers and the computerized decision analysis model. For example, in those cases in which the resident chose the computer model's first-choice drug, faculty deemed the management as "most appropriate" or "acceptable" 93.3% of the time. When residents selected the computer model's third or fourth choice, faculty judged the residents' therapy as "inappropriate" or "an alternate drug would have been more desirable" in 61.9% of cases. CONCLUSION: The results suggest that computerized decision analysis techniques may be a useful adjunct to other clinical quality-assurance procedures in residency training programs.

Adult↗
PubMedDate not supplied

Kinetics and dynamics of acute rejection after heterotopic heart transplantation.

Right cervical, heterotopic heart transplantation was performed in 18 mongrel dogs. Study design was based on three different groups (n = 3 x 6). Standard immunosuppression consisted of triple drug therapy in all dogs. Groups II and III received high dose steroids during acute rejection. In group III the native hearts of previous recipients (groups I and II) were used as donors for heterotopic transplantation ("domino" principle). The hearts were examined by daily transmural biventricular biopsies and graded according to Billingham classification. Cytoimmunologic monitoring (n = 345; activation index from peripheral and coronary sinus blood) and fast Fourier transformation ECG (n = 80; area under the curve; surface recordings) served as daily noninvasive methods. Optionally antimyosin scintigraphy (n = 25; single photon emission computed tomography; heart-to-lung ratio) was performed and immunohistologically confirmed by peroxidase staining of the antibody (n = 61). Kinetics of rejection was not uniform in group I (onset after 5.7 days) and biphasic in group II (clear rejection-free interval: 6.8 days). Group III developed a continuously persisting rejection, despite repeated high-dose steroids, with an early onset (3.2 days). The invasive data, consisting of 587 punch biopsies, showed no significant difference between right and left ventricular rejection. Clearly focal rejection appeared in 51.5% of the cases, with subendocardial involvement in 54%. Cytoimmunologic monitoring significantly (p less than 0.001) correlated with daily biopsies in groups I and II. The activation index from coronary sinus blood was two times higher than in peripheral blood. Fast Fourier transform ECG identified the onset of rejection with great accuracy (p less than 0.01). The heart-to-lung ratio of antimyosin scintigraphy corresponded exactly to the various stages of rejection (p less than 0.001). High-dose steroids led to a clear reduction of the ratio in 26% cases. Peroxidase staining showed typical locations of the antibody, depending on the grade of rejection (p less than 0.001). Considering the results of pathology in this transplantation model, relying on endomyocardial biopsy alone in a clinical setting may not seem advisable. Although the results of this study must be confirmed clinically, the simultaneous use of cytoimmunologic monitoring and fast Fourier transformation ECG may prove to be valuable to day-to-day monitoring for acute rejection in the early postoperative course. If both methods indicate the onset of an acute rejection, antimyosin scintigraphy and endomyocardial biopsy, respectively, should be performed to confirm and grade the suspected diagnosis.

Animals↗
PubMedDate not supplied

Rapid prototyping of interactive software for automated instrumentation in rehabilitative therapy.

Rapid prototyping is a quick, efficient way to evaluate new electrical instruments. A hardware interface between a computer and an instrument can be simulated in software. The authors demonstrate the technique of rapid prototyping by developing interfaces for two therapeutic strength-testing devices and an electromagnetic tracker/digitizer. The LabVIEW rapid prototyping software tool was used to create "virtual instruments," which combine to form interfaces. The functions and connections of each virtual instrument are described.

Equipment Design↗
PubMed1975

[The effectiveness of treatment for breast cancer patients].

The study of late results of treatment in 1166 patients with breast cancer permitted to find the percentage of a 5-year survival to be equal to 55.58, 37.93% of patients survived for 10 years, 28.25% -- for 15 years. In the first stage a 5-year survival was 87.20%, while in the second and third -- 57.7% and 31.56% of patients survived for 5 years, accordingly. The modern methods of radiotherapy (radiosurgical method, interstitial gamma therapy with Au-198 granules, distance grammatherapy on the machine LUCH) enhanced the efficacy of therapeutic measures in patients with widespread breast cancer. A complex diagnosis -- cytology, non-contrast mammography and mathematical analysis by means of a computer contributes to recognition of early forms of breast cancer.

Adenocarcinoma↗
PubMed1978

Enlarged acid-base and blood gas calculations by electronical data computing in the blood gas laboratory.

A rapid anaysis of parameters of the acid-base equilibrium and blood gases during open heart surgery and emergency therapy is absolutely necessary. Computing of the several parameters of the acid-base status by slide rules or nomograms is time consuming and can be shortened by computer applications. The central blood gas laboratory consists of a blood gas analyzer for PO2, PCO2 and pH, an electronic desktop calculator, a four color X-Y-plotter and two data lines to the cardiac surgery unit and to the intensive care unit. The time needed for computing and feedback of the parameters could be decreased to one quarter. In addition to numerical data printout, a graphical representation of the several parameters is possible on a X-Y-plotter and includes the Rahn-Fenn-O2-CO2-Diagram with venous admixture, ventilation perfusion ratio, alveolar dead space ventilation and the standard and actual oxygen dissociation curve as well as the pH/HCO3- Acid-Base nomogram. Furthermore, a computer diagnosis of the actual disturbances can be plotted.

Acid-Base Equilibrium↗
PubMed1977

[Electronic data processing in the clinical nuclear medicine].

Computer techniques as introduced into clinical nuclear-medicine 12 years ago, were first exclusively used for scintigraphic purposes. Through the development of a comprehensive pilot system for nuclear medical data processing on the basis of two Siemens Process control computers it could be demonstrated, that besides of scintigraphy there are also other important fields for computer application, e.g. in function diagnostics and therapy planning.

Bayes Theorem↗
PubMed1977

[Quantitative fluorometry at the ocular fundus (author's transl)].

Description of a videodensitometric method for the quantitative evaluation of fluorescence angiography photographs using the Quantimet 720 image analysis computer system. The clinical value of the new method is demonstrated in a case of central serous retinopathy. With the aid of these measurements the activity of leakage points can be assessed more exactly than by mere subjective inspection of the gained pictures, thus allowing a better control of the effects of a chosen therapy.

Computers↗
PubMed1978

Computer assisted monitoring in intensive medicine.

Intensive Medicine is always associated with the problem of handling the mass and assuring the quality of information on vital signs, fluid and blood balance, laboratory data, physiological calculations, etc., required in patient care. A computer based monitoring system for intensive care was introduced in 1973 at the Academic Hospital in Leuven. The basic software was developed at the Peter Bent Brigham Hospital of the Harvard Medical School and the medical division of the Hewlett Packard Company; the computer used was a H.P. 2100 central processor with 32K of core memory. Initially, the program allowed mainly acquisition, storage and retrieval of bedside monitored and manual data of cardiac and circulatory function. Very soon however, the software was extended and modified by the division of "Medical Informatics" in order to meet new or different requirements. In the present situation our vision on the use of computer-assisted monitoring has changed and our present program has been extended as follows : 1. On-line collection and retrieval of bedside monitored data including heart rate, arterial blood pressure (systolic-diastolic-mean) left atrial pressure, central venous pressure, pulmonary artery pressure, intracranial pressure. Trend analysis of those data, with calculation of mean values, standard variation and corresponding t-tests. 2. Computer assistance in performing time consuming calculations on off-line data such as : -- clearance-values (renal function), -- temperature-correction of blood-gasvalues, -- hour-to-hour fluid balance, including calculation of in-sensible losses, -- blood-balance. 3. Data transmission of laboratory results as soon as available in the central laboratory through a direct link between laboratory and I.T.U. 4. Computer assisted E.C.G. analysis. The three first objectives are realised, on-line E.C.G.-analysis is being developed. The same computer serves the remotely located medical and coronary care units and one bed in the emergency department. An assessment of computer assistance in intensive therapy, on nursing labor and on quality of patient care is made.

Clinical Laboratory Techniques↗