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OBJECTIVES: The beneficial effects of ozone therapy consist mainly of the promotion of blood circulation: peripheral and central ischemia, immunomodulatory effect, energy boost, regenerative and reparative properties, and correction of chronic oxidative stress. Ozone therapy increases interest in new neuroprotective strategies that may represent therapeutic targets for minimizing the effects of oxidative stress. METHOD(S): The overview examines the latest literature in neurological pathologies treated with ozone therapy as well as our own experience with ozone therapy. The effectiveness of treatments is connected to the ability of ozone therapy to reactivate the antioxidant system to address oxidative stress for chronic neurodegenerative diseases, strokes, and other pathologies. Application options include large and small autohemotherapy, intramuscular application, intra-articular, intradiscal, paravertebral and epidural, non-invasive rectal, transdermal, mucosal, or ozonated oils and ointments. The combination of different types of ozone therapy stimulates the benefits of the effects of ozone. RESULT(S): Clinical studies on O2-O3 therapy have been shown to be efficient in the treatment of neurological degenerative disorders, multiple sclerosis, cardiovascular, peripheral vascular, orthopedic, gastrointestinal and genitourinary pathologies, fibromyalgia, skin diseases/wound healing, diabetes/ulcers, infectious diseases, and lung diseases, including the pandemic disease caused by the COVID-19 coronavirus. CONCLUSION(S): Ozone therapy is a relatively fast administration of ozone gas. When the correct dose is administered, no side effects occur. Further clinical and experimental studies will be needed to determine the optimal administration schedule and to evaluate the combination of ozone therapy with other therapies to increase the effectiveness of treatment.Copyright © 2021 Neuroendocrinology Letters.
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The proceedings contain 158 papers. The topics discussed include: use of cumulative sum in the assessment of diagnostic competency of cytopathology fellows;what's up in Whatsapp - telecytopathology experience connecting rural districts of Punjab to a tertiary care center in India;ballistic gel model for ultrasound-guided fine needle aspiration: a cost-effective method for simulation training;science, medicine, and cytology: a pilot program of the ASC diversity equity and inclusion (DEI) committee;comparison of low-cost phantoms for ultrasound guided fine needle aspiration biopsy teaching;deep learning algorithm for malignant pleural fluids cytology;application of international system for reporting serous fluid cytology (ISRSFC) in effusion samples - a prospective study;evaluation of 'crowd wisdom' in biliary brush cytology;characterization of the cellular composition of malignant pleural effusion specimens for clinical applications: preliminary study;and diagnostic criteria for COVID-19 pneumonia in broncho-alveolar lavage specimens.
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PurposeThis paper aims to examine the parallel and serial multiple mediating effects of job insecurity (JIS) and occupational self-efficacy (OSE) in the association between servant leadership and work engagement (WENG).Design/methodology/approachData collected from 296 flight attendants in Korea were tapped to assess the study hypotheses. The linkages were tested via structural equation modeling. The phantom variable was used to estimate the parallel and serial indirect impacts of JIS and OSE.FindingsServant leadership fosters OSE and WENG, while it alleviates JIS. Both JIS and OSE parallelly mediate the effect of servant leadership on WENG. Contrary to what has been hypothesized, the findings lend no credence to the serial multiple mediating impact.Practical implicationsManagement should pay utmost attention to the promotion of employees to supervisory positions based on "stringent selection and hiring of people.” Flight attendants high on WENG should have job security. This is important because such employees exhibit good performance at work. Management should also organize training programs that would enhance flight attendants' OSE.Originality/valueThis paper contributes to the relevant knowledge base by relating servant leadership to flight attendants' WENG through JIS and OSE. Because of the number of rising disengaged service workers across the globe, this study also gauges the factors influencing flight attendants' WENG and reports whether servant leadership, JIS and OSE influence their WENG at the same time. Unlike the preponderance of the empirical pieces, this study contributes to the literature by assessing the indirect effect of servant leadership on WENG via JIS and OSE as the parallel and serial multiple mediators using the phantom variable.
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BACKGROUND: To assess the clinical feasibility of a virtual mirror therapy system in a pilot sample of patients with phantom pain. METHODS: Our Mixed reality system for Managing Phantom Pain (Mr. MAPP) mirrors the preserved limb to visualize the amputated limb virtually and perform exercises. Seven patients with limb loss and phantom pain agreed to participate and received the system for 1-month home use. Outcome measures were collected at baseline and 1 month. RESULTS: Four (of seven recruited) participants completed the study, which was temporarily suspended due to COVID-19 restrictions. At 1 month, in-game data showed a positive trend, but pain scores showed no clear trends. Functioning scores improved for 1 participant. CONCLUSIONS: Mr. MAPP is feasible and has the potential to improve pain and function in patients with phantom pain. TRIAL REGISTRATION: Clinical Trials Registration, NCT04529083.
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Purpose This paper aims to examine the parallel and serial multiple mediating effects of job insecurity (JIS) and occupational self-efficacy (OSE) in the association between servant leadership and work engagement (WENG). Design/methodology/approach Data collected from 296 flight attendants in Korea were tapped to assess the study hypotheses. The linkages were tested via structural equation modeling. The phantom variable was used to estimate the parallel and serial indirect impacts of JIS and OSE. Findings Servant leadership fosters OSE and WENG, while it alleviates JIS. Both JIS and OSE parallelly mediate the effect of servant leadership on WENG. Contrary to what has been hypothesized, the findings lend no credence to the serial multiple mediating impact. Practical implications Management should pay utmost attention to the promotion of employees to supervisory positions based on "stringent selection and hiring of people." Flight attendants high on WENG should have job security. This is important because such employees exhibit good performance at work. Management should also organize training programs that would enhance flight attendants' OSE. Originality/value This paper contributes to the relevant knowledge base by relating servant leadership to flight attendants' WENG through JIS and OSE. Because of the number of rising disengaged service workers across the globe, this study also gauges the factors influencing flight attendants' WENG and reports whether servant leadership, JIS and OSE influence their WENG at the same time. Unlike the preponderance of the empirical pieces, this study contributes to the literature by assessing the indirect effect of servant leadership on WENG via JIS and OSE as the parallel and serial multiple mediators using the phantom variable.
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Many published studies use deep learning models to predict COVID-19 from chest x-ray (CXR) images, often reporting high performances. However, the models do not generalize well on independent external testing. Common limitations include the lack of medical imaging data and disease labels, leading to training on small datasets or drawing classes from different institutions. To address these concerns, we de signed an external validation study of deep learning classifiers for COVID-19 in CXR images including XCAT phantoms as well. We hypothesize that a simulated CXR image dataset obtained from the XCAT phantom allows for better control of the dataset including pixel-level ground truth. This setup allows for multiple advantages: First, we can validate the publicly available models using simulated chest x-rays. Secondly, we can also address clinically relevant questions with this setup such as effect of dose levels and size of COVID-19 pneumonia in performance of deep learning classifier. We design a study to address these concerns on this work. For the first part, we validate the performance of a publicly available model from the University of Waterloo trained on a large clinical dataset by testing on another large BIMCV-RSNA clinical dataset as well as simulated XCAT CXRs. We also trained an in-house classification model on the same BIMCV-RSNA dataset and validate the model on both an internal test set (AUC 0.71) and the simulated set CVIT-COVID (AUC 0.69) and COVIDx CXR-2 (Waterloo) (AUC 0.62). For the second part, we further investigate the role of clinically relevant factors such as dose levels in CXR and size of COVID-19 pneumonia in performance of deep learning-based classifiers using XCAT phantoms. As the virtual imaging trial approach allows generating images of varied dose and COVID-19 pneumonia sizes, our setup allows us to investigate the role of different features. The results show promise of using the virtual image trial approach to validate deep learning models and better control of study design to address clinically significant factors.
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Purpose or Objective Early assessment of neutron contamination in IMRT applications was based on delivery techniques [1,2]. Recently these delivery techniques have been optimized and made more efficient with respect to the number of MU required for a certain dose. In fact, the number of MU for many IMRT or VMAT treatments required for a certain fraction dose are now comparable to those required for 3D-conformal techniques. Furthermore, with the Covid-19 pandemic, a new hypofractionated breast treatment protocol was introduced in our department, based on the “Fast Forward” protocol [3,5]. The implementation of higher daily doses demands for stricter constraints. This study was initiated in order to determine a strategy in minimising the out-of-field dose in clinical practice taking into account the risks and benefits related to different treatment techniques and photon energies. Materials and Methods To simulate realistic clinical conditions, an anthropomorphic phantom was used with a right breast prosthesis. The phantom was scanned and appropriate structures (body, breast, lung and PTV) were delineated. Plans were created using Field in Field (FiF), IMRT and VMAT techniques with different energies. The mean dose of the PTV was normalised to the prescribed fraction dose (5.2Gy) in all treatment plans. Surface scanning was used to position the phantom for treatment. Different detectors types were used for measurements (see Table 1). The measurements were performed at 3 positions: one in the lung and two on the surface at 10 cm and 20 cm respectively from isocentre. Results Figures 1 and 2 illustrate the out-of-field dose measurements associated with a specific configuration of delivery technique and beam energy. Application of 15MV, for all delivery techniques combined, produced more neutrons compared to the other energies used in this study, the neutron contribution to the total contamination was up to 13% for 15 MV at 20 cm from isocentre. FiF neutron contribution were comparable to IMRT even if it required the least MU. In terms of photon scatter contribution, VMAT showed the highest doses. The neutron contamination for 10 MV and 10 MV FFF was similar. Considering a treatment fraction of 5.2 Gy delivered in 15MV IMRT mode, a neutron contamination of 5mGy was observed, which can be considered comparable to a CBCT acquisition for patient positioning [4]. Conclusion As IMRT provides better dose homogeneity and OAR sparing it can be preferred over FiF considering comparable contributions in out-of-field dose contamination. For some complex cases, such as irradiating regional lymph nodes for a breast treatment, VMAT can be considered, as the small increase in out-of-field dose might be balanced against an optimal target coverage / OAR sparing. As expected, some neutron contribution can be observed for the higher energies, however, the low levels of it to the total contamination dose as observed in this study might warrant their use in favour of improved target coverage and skin sparing. Appendix (Figure Presented)(Table Presented)
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Background & Aim: The COVID-19 pandemic changed the approach to aerosol mitigation in dentistry, although there is limited evidence and notable inconsistency among measures implemented in different countries. The aim of this study was to investigate aerosol mitigation by different high and low volume suction devices (HVE/LVE) during two distinct aerosol generating procedures (AGPs): a full mouth ultrasonic scaling (USS) and an anterior crown preparation with a high speed handpiece. Methods: Two different sensor set ups were optimized;a single sensor in a funnel positioned above the mouth and a two-sensor set up with sensors positioned at the patient's nose and chin. The particulate sensors (Plantower PMS5003) quantified aerosol concentration, expressed as the number of >0.3 μm particles/0.1 L of air. Defined dental procedures were carried out on a dental phantom head. Aerosol generation was measured throughout the procedures. Efficacy of different suction devices was assessed. Statistical analysis was performed using the mean normalized area under the curve of five independent experiments. Results: The high speed handpiece generated 3.4 times more aerosol/ min than ultrasonics when measured with the single sensor funnel device, and comparable amount of aerosol when measured with the two-sensor set up. HVE devices, that are moved around the mouth, provided consistent reduction of aerosol - to background levels - when carrying out ultrasonic scaling or crown preparation. We evaluated both HVE and LVE 'static' devices that are placed in the patient's mouth in a predetermined position for the duration of the procedure. These 'static' devices offered reduction of aerosol but with consistent 'spikes' recorded during procedures when aerosol escaped. Conclusions: In this simulated test system, either HVE or LVE 'static' devices provide inconsistent reduction of aerosols when conducting ultrasonic instrumentation. By contrast, an appropriately used HVE could reduce detectable aerosol to background levels during ultrasonic instrumentation in this test system.
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Background: The diagnosis of osteoporosis is still one of the most critical topics for orthopedic surgeons worldwide. One research direction is to use existing clinical imaging data for accurate measurements of bone mineral density (BMD) without additional radiation. Methods: A novel phantom-less quantitative computed tomography (PL-QCT) system was developed to measure BMD and diagnose osteoporosis, as our previous study reported. Compared with traditional phantom-less QCT, this tool can conduct an automatic selection of body tissues and complete the BMD calibration with high efficacy and precision. The function has great advantages in big data screening and thus expands the scope of use of this novel PL-QCT. In this study, we utilized lung cancer or COVID-19 screening low-dose computed tomography (LDCT) of 649 patients for BMD calibration by the novel PL-QCT, and we made the BMD changes with age based on this PL-QCT. Results: The results show that the novel PL-QCT can predict osteoporosis with relatively high accuracy and precision using LDCT, and the AUC values range from 0.68 to 0.88 with DXA results as diagnosis reference. The relationship between PL-QCT BMD with age is close to the real trend population (from â¼160 mg/cc in less than 30 years old to â¼70 mg/cc in greater than 80 years old for both female and male groups). Additionally, the calculation results of Pearson's r-values for correlation between CT values with BMD in different CT devices were 0.85-0.99. Conclusion: To our knowledge, it is the first time for automatic PL-QCT to evaluate the performance against dual-energy X-ray absorptiometry (DXA) in LDCT images. The results indicate that it may be a promising tool for individuals screened for low-dose chest computed tomography.
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Introduction. COVID radiotherapy requires performance of all radiotherapy (RT) procedures during one site visit due to the infectious nature of the disease. The aim of the study was to develop methods of estimating the delivered dose based on electronic portal image device (EPID) signal during treatment. Material and methods. Electronic portal image device signal was measured as a function of the phantom dose. The dose in 14 COVID patients was estimated for two X6MV beams. Results. The method allows to estimate dose in phantom with uncertainty of 12%. In this case, a systematic error was reported. Therefore, coefficients for clinical data were calculated and used to determine the dose in patients. The mean difference between the dose calculated and the dose measured for the 14 patients was 1%, but the uncertainty of this method was estimated as ±6% Conclusions. The proposed method may be useful in clinical practice as in vivo method. However, due to high uncertainty, it should be dedicated to the detection of “big” errors.
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Research studies of artificial intelligence models in medical imaging have been hampered by poor generalization. This problem has been especially concerning over the last year with numerous applications of deep learning for COVID-19 diagnosis. Virtual imaging trials (VITs) could provide a solution for objective evaluation of these models. In this work utilizing the VITs, we created the CVIT-COVID dataset including 180 virtually imaged computed tomography (CT) images from simulated COVID-19 and normal phantom models under different COVID-19 morphology and imaging properties. We evaluated the performance of an open-source, deep-learning model from the University of Waterloo trained with multi-institutional data and an in-house model trained with the open clinical dataset called MosMed. We further validated the model's performance against open clinical data of 305 CT images to understand virtual vs. real clinical data performance. The open-source model was published with nearly perfect performance on the original Waterloo dataset but showed a consistent performance drop in external testing on another clinical dataset (AUC=0.77) and our simulated CVIT-COVID dataset (AUC=0.55). The in-house model achieved an AUC of 0.87 while testing on the internal test set (MosMed test set). However, performance dropped to an AUC of 0.65 and 0.69 when evaluated on clinical and our simulated CVIT-COVID dataset. The VIT framework offered control over imaging conditions, allowing us to show there was no change in performance as CT exposure was changed from 28.5 to 57 mAs. The VIT framework also provided voxel-level ground truth, revealing that performance of in-house model was much higher at AUC=0.87 for diffuse COVID-19 infection size <2.65% lung volume versus AUC=0.52 for focal disease with <2.65% volume. The virtual imaging framework enabled these uniquely rigorous analyses of model performance, which would be impracticable with real patients. © 2022 SPIE.
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Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic had not only developed as a key challenge to public health all around the world but also instigated physical and mental constraints on the health care professionals especially on the education of dental students with the sudden switch from traditional teaching methods to e-learning platforms thereby shutting all means of clinical experiences. Aim: To assess the effects of lockdown on clinical practice among undergraduate dental students in Tamil Nadu, India. Materials and Methods: A cross-sectional observational study was done among undergraduate dental students in Tamil Nadu, India, from June 1, 2021 to July 1, 2021, using convenience sampling method to yield a total of 510 responses for a self-administered online questionnaire that aimed at evaluating the consequence of lockdown on clinical practice. Statistical Package for the Social Sciences (SPSS) version 19.0 was used to analyse the data. Results: A total of 510 responses (mean age: 21.72±2.2827 years;323 female and 187 male) were analysed in the present study. Majority of the students felt that COVID-19 lockdown had a negative impact on clinical exposure. Inspite of following infection control measures, only 35.1% of students felt imperative to practice during pandemic. With over 82.7% of patient flow reduced due to fear of disease spread. 85.1% revealed being stressed in completing clinical quota in a short duration. Further questions on prospects in improvising their clinical knowledge;showed 45% recommending e-workshops, 29.4% opting for video demonstration followed by 22.2% on exposure to Objective Structured Clinical Examination (OSCE) to compensate for the loss of clinical practice. Conclusion: New teaching protocols have to be adopted taking into account the changing aspects of the pandemic to improve their wellbeing, overcome mental stress and to enhance the sustainability of dental education. Focus on video demonstrations, lectures provoking their clinical reasoning, simulations on phantom heads and conducting workshops enhancing preclinical skills as well as following appropriate safety protocols must be implemented.
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Background: Phantom pain and stump pain in amputees have negative physical and psychological impacts. These effects may influence the quality of life (QoL) of lower limb amputees. Objective: To explore QoL of lower limb amputees treated at Ramathibodi pain clinic. Materials and Methods: All lower limb amputees treated at Ramathibodi pain clinic in 2020 were invited to answer questionnaires, including demographic data, the Short Form-36 Health Survey (SF-36), and the Hospital Anxiety and Depression Scale (HADS). Participants were recruited to join a focus group discussion and individual interviews. Qualitative data were collected, and then analyzed using content analysis and inductive thematic analysis. Results: Twenty-two participants were recruited. Average SF-36 score was 49.17±10.07. Physical component summary was 23.36±15.27 and mental component summary was 68.02±16.45. HADS were 5.91±3.69 and 5.23±3.42 for anxiety and depression, respectively. Eight participants were selected for focus group discussion and individual interviews. Five themes emerged, including biopsychosocial effects of amputation, pain among amputees, concepts of encouragement in life, gaps between patients and multidisciplinary team staff, and effects of the COVID-19 pandemic. Conclusion: Lower limb amputees had low QoL. Amputation was found to restrict patients' physical function, and good pain management was reported to be crucial to help amputees cope and accept their condition. Positive self-esteem and social support also played a significant role. Inadequate communication was found to be the main deficit requiring attention. Lockdown policies during the COVID-19 pandemic affected QoL but pain intensity was maintained with management via telemedicine.
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Introduction: It is suitable for a patient to wear a respirator or face mask during any radiological investigation during Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) pandemic. Some face masks may have nanoparticles, or antimicrobial coating, which may comprise metal to help shape the mask according to user face shape. This kind of ferromagnetic substances can cause artefacts in the image. Aim: To detect and compare the artefacts while using different types of respirators and surgical masks in the Magnetic Resonance Imaging (MRI) phantom images. Materials and Methods: This was a prospective cross-sectional study which was conducted from July 2021-September 2021. Two Not resistant to oil-based aerosols with 95% efficiency to airborne particles (N95) respirators and two types of three-ply surgical disposable masks with a metal and plastic nose holder were used. The N95 respirators were of Halo N95 Filtering Facepiece 2 Particulate Matter (FFP2) PM 2.5 and Suchi N95 S-7400, while the surgical masks were from Venus 3 ply V-1010 with a metal nose holder and the Thea Tex Filtra 3 ply with plastic nose holder. A polymethyl methacrylate plastic phantom was used with 1.5 Tesla (Siemens Magnetom Avanto) MRI scanner for imaging. Results: When exposed to the metal detector both N95 respirators and one of the surgical masks with a metal nose clip showed strong ferromagnetic attraction. Both respirators and a surgical mask with a metal nasal holder showed magnetic susceptibility artefacts. The signal loss is caused by dephasing of spins from metal strip on the image. Conclusion: All the patients must have a recognised MR safe masks prior to an MRI investigation. When this is not possible to follow, metallic components from the face mask should be removed before the patient's arrival at the MR room. After removing the metal strip from the mask, the paper tape may be applied across the nasal bridge region for adequate transmission control and to maintain the intended function of the mask. The mask with a plastic nasal holder was ideal to use in an MR environment since it doesn't have any distortion in the image.
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Introduction & Objectives: Workshops with hands-on training using phantoms (anatomical models) are well-known methods for training clinicians and residents. However, during the Covid-19 pandemic it was not possible to attend workshops owing to the restrictions imposed by the lock-down. As a result, both the medical device industry and clinicians were not able to keep current with their skills. We introduce a novel method of education using augmented reality that virtually places the trainer (proctor) in the same room as the student during the procedure.(Figure Presented)A training simulation was created where a proctor trained a student in transperineal local anesthesia and biopsy using a prostate phantom. The hardware platform consisted of a headset containing see-through optic displays with an imbedded webcam. The image from the ultrasound machine was displayed in the optics of the headset, allowing the proctor to view the ultrasound image while looking at the phantom and his hands simultaneously (figure). A web-based software program was developed that displayed the ultrasound image and the video of the proctor’s hands (captured by the imbedded web cam) in a stacked format. These images were transmitted to the student (in a different room) who also wore a comparable headset. Both proctor and student had an ultrasound unit (BK Medical 5000 and 3000 with model 9048 probes) and prostate phantoms (SIM, Inc.). The proctor then demonstrated how to perform the local anesthesia and transperineal biopsy procedure, step by step, while the student observed these in his headset. After each step of the procedure the proctor changed the active feed so he could watch in his own headset the student performing that same step and further instruct him. s EAU22 – 37th Annual EAU Congress Eur Urol Suppl 2022;81(S 1):S1769 Results: The Remote Training Platform allowed the proctor to successfully demonstrate the prostate block and transperineal biopsy techniques to the student. The student was able to ask the proctor for instructions while the proctor was able to annotate additional information on the student’s ultrasound. Successful completion of both procedures was accomplished. Conclusions: The beta testing of this Remote Training Platform demonstrated that augmented reality combined with dedicated hardware and software could provided an efficient means of training physicians in new technology. Eliminating the need for the proctor to travel could increase the safety and efficiency for the introduction of new medical devices and resident education.
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Ischemia with No Obstructive Coronary Artery (INOCA) in angina patients increases the risk of major cardiac events, with a 1.5x increased mortality rate. There is a link between COVID-19 infection and impairment in the myocardial micro-vasculation which may cause an increase of INOCA patients. Fractional Flow Reserve (FFR), is the standard of care in cardiology but its diagnostic function is only related to Obstructive Coronary Artery disease (or epicardial) and it is ineffective with INOCA. The lack of effective and accurate tools for timely evaluation of coronary impairments creates a clinical unmet need. The PhysioCath catheter was developed within the Eurostars project FPCatheter, E!113577 aims to resolve this need a provide an effective tool to interventional cardiologists. The main project outcome is a catheter prototype equipped with a blood flow velocity sensor based on a thermo-convection principle, and a fiber optic pressure sensor (based on Fabry-Perot principle). While the use of Fabry-Perot type of sensor is already standard in the industry, the use of a thermo-convection sensor represents a progress with respect the state of the art. The sensor creates an overheat of 7°C above the physiological blood's temperature (considered as being within the safety limits), and it exchanges thermal power with the blood stream. The power is then measured and converted to velocity by means of a calibration curve. The project encompassed interviews with 14 clinical experts, the summary of the interviews indicated that the preferred form of the device is an over the wire microcatheter, with rapid exchange. Within the project then, it was developed a 3Fr microcatheter, with a rapid exchange section of 24cm. Both pressure sensor and flow velocity sensor were integrated in this embodiment. Finally, the PhysioCath prototype was evaluated in a bench test study. The test setup was composed by an anatomical silicone phantom of the aortic root and the coronaries (Elastrat, Geneva, Switzerland), perfused with a peristaltic pump (Harvard Apparatus, Holliston MA, US). The measurements performed by the flow velocity sensor were compared against and external doppler flow velocity sensor. While the pressure measurement was assessed for stability and presence of drift. The data processing revealed and extreme accuracy in the measurement of flow based indexes like CFR (±6% variability), accuracy of the blood flow velocity measurement (±10%), and extreme stability in the measurement of both pressure and flow velocity. In the second part of the project (that is currently ongoing), it will be studied the performance of the device within an animal setting. In conclusion, the PhysioCath device is a microcatheter integrating bot pressure measurement and blood flow velocity measurement. Its performance is of very high accuracy and stability, that represent a main step ahead with respect the current state of the art, based mainly on thermodilution.
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Introduction: The current COVID-19 pandemic has fostered several accelerations in remote patient care such as video and telephone clinics, as well as multidisciplinary collaborations using online platforms with experts consulting the local teams from a distance. The next logical step would be to also offer remote-controlled interventions which the expert operator not on site, but in support of the local team. This is especially valuable for complex interventions when either patient or expert operator can not be present at the same place. Purpose: We aimed to demonstrate that an expert operator located at far distance (Austria) could directly interact with the remote magnetic navigation system in London (UK) whilst mapping a 3D phantom using an electroanatomical mapping system. Method: Two experienced operators of the magnetic navigation system were tasked with creating fast anatomic maps (FAM) of the atrial and ventricular chambers of a 3D phantom using remote magnetic navigation in combination with 3D electroanatomical mapping. One was located in the control room of the magnetic catheter lab (UK) and the second one was in Tirol, Austria and connected through a secure remote desktop connection (via high speed fibre optic cable). Using a solid tip magnetic catheter connected to a mechanical drive, all interactions with the system were carried out via the Odyssey platform. Acquisitions for right and left atrium, as well as right and left ventricles plus aorta was compared with regards to mapping duration, map completeness (as judged by the average distance of surface points from 3D CT scan reconstruction), total 3D map volume and need for additional radiation exposure during the mapping process. Results: Mapping time and map completeness when performed by the distant operator was not inferior to the local operator and both did not require any additional radiation exposure during the mapping process. Table 1 demonstrates the mean parameters for each chamber, respectively. Figure 1 depicts the matched data for chamber completeness as compared for the LA (green= local operator, pink= distant operator) using a contrast CT scan as the gold standard. Conclusion: Telerobotic 3D mapping of a 3D phantom from a distance was equally fast delivered from the control room as compared to an operator located 1200 km away without compromising on map completeness. This demonstrates the feasibility of telerobotic interventions and stress the need for remote collaboration which is especially valuable when travel of patients and/or physician experts is restricted.
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BACKGROUND: Fluoroscopic-guided lumbar procedures have increased in daily pain practice because the lumbar spine is one of the most common sources of pain. Interventional pain fellows must develop a minimum number of skills during their training in order to achieve the competences without neglecting radiological safety. However, medical training in fluoroscopic-guided interventions is being affected by the current coronavirus disease 2019 (COVID-19) situation. METHODS: The objective of this study was to evaluate the use of a phantom model for lumbar injection as a training strategy during the COVID-19 pandemic in fellows of interventional pain. The study was divided into theoretical and practical modules. The hands-on practice was performed in a lumbar model phantom where fellows were evaluated in four fluoroscopically guided approaches: intra-articular facet block (IAFB), medial branch block (MBB), transforaminal block (TFB), and interlaminar block (ILB) divided in 5 sessions. The aim was to make as many punctures as possible in every session. We measured total procedural performance (TPP), total needle hand time (TNH), and total radiation dose generated by the fluoroscopic machine (TRD) during each procedure. Additionally, a survey was applied to evaluate confidence and satisfaction before and after training. RESULTS: A total of 320 lumbar punctures were completed. The results were statistically significant in all approaches attempted (p < 0.01). The fellow's survey for satisfaction and confidence demonstrated a significant difference between pre and post-test (p < 0.01). CONCLUSIONS: The results of this study highlight the importance of adaptations and adoption of new educational models. The use of the phantom model for simulation could be a strategy for other emerging situations, like the COVID-19 pandemic. Including this practice in the interventional pain programs could lead to better results for the patient and operator radiology safety.
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COVID-19 , Pandemics , Fluoroscopy , Humans , Pain , SARS-CoV-2ABSTRACT
BACKGROUND: Deep brain stimulation (DBS) is a standard of care treatment for multiple neurologic disorders. Although 3-tesla (3T) magnetic resonance imaging (MRI) has become the gold-standard modality for structural and functional imaging, most centers refrain from 3T imaging in patients with DBS devices in place because of safety concerns. 3T MRI could be used not only for structural imaging, but also for functional MRI to study the effects of DBS on neurocircuitry and optimize programming. OBJECTIVE: To use an anthropomorphic phantom design to perform temperature and voltage safety testing on an activated DBS device during 3T imaging. METHODS: An anthropomorphic 3D-printed human phantom was constructed and used to perform temperature and voltage testing on a DBS device during 3T MRI. Based on the phantom assessment, a cohort study was conducted in which 6 human patients underwent MRI with their DBS device in an activated (ON) state. RESULTS: During the phantom study, temperature rises were under 2°C during all sequences, with the DBS in both the deactivated and activated states. Radiofrequency pulses from the MRI appeared to modulate the electrical discharge from the DBS, resulting in slight fluctuations of voltage amplitude. Six human subjects underwent MRI with their DBS in an activated state without any serious adverse events. One patient experienced stimulation-related side effects during T1-MPRAGE scanning with the DBS in an ON state because of radiofrequency-induced modulation of voltage amplitude. CONCLUSION: Following careful phantom-based safety testing, 3T structural and functional MRI can be safely performed in subjects with activated deep brain stimulators.