[Standardised in-hospital mortality decreasing over time]. / Gestandaardiseerde ziekenhuissterfte daalt in de tijd.

OBJECTIVE: To study the changes in standardised in-hospital mortality in the period 2005 to 2010. DESIGN: Retrospective, descriptive study. METHOD: Data from the National Medical Registration (LMR) for the period 2005 to 2010 were used to calculate a time-series of the standardised in-hospital mortality rate. Predicted mortality was calculated for 50 principle diagnosis groups using logistic regression models with 8 explanatory variables. This was used, in combination with actual in-hospital mortality, to calculate the Time-Series Standardised Hospital Mortality Ratio (TSHMR). RESULTS: The TSHMR decreased significantly each year in the period 2005 to 2010. The greatest decrease was from 2009 to 2010, which was partly due to a registration effect. Total age- and sex-standardised mortality in the population also decreased in the period 2005 to 2010, mortality out of hospital decreasing less than in-hospital mortality. Standardised hospital mortality decreased significantly in all adult age categories (≥ 25 years of age). The TSHMR fell most sharply in the diagnosis groups 'gastrointestinal haemorrhage' and 'deficiencies and other anaemias'. The diagnosis groups 'heart valve disorders' and 'aspiration pneumonia due to food or vomitus' showed the smallest decrease in TSHMR, and this decrease was not significant. CONCLUSION: The decrease in standardised in-hospital mortality shows that the risk of dying in hospital has decreased substantially in the past few years. The size of the decrease in TSHMR differed per diagnosis group. There can be many reasons for this decrease in in-hospital mortality, including improved quality of care; however, it may also be due to, for instance, changes in hospital admission and discharge policies.

Limits on the spatial resolution of monolithic scintillators read out by APD arrays.

Cramér-Rao theory can be used to derive the lower bound on the spatial resolution achievable with position-sensitive scintillation detectors as a function of the detector geometry and the pertinent physical properties of the scintillator, the photosensor and the readout electronics. Knowledge of the Cramér-Rao lower bound (CRLB) can for example be used to optimize the detector design and to test the performance of the method used to derive position information from the detector signals. Here, this approach is demonstrated for monolithic scintillator detectors for positron emission tomography. Two detector geometries are investigated: a 20 × 10 × 10 mm(3) and a 20 × 10 × 20 mm(3) monolithic LYSO:Ce(3+) crystal read out by one or two Hamamatsu S8550SPL avalanche photodiode (APD) arrays, respectively. The results indicate that in these detectors the CRLB is primarily determined by the APD excess noise factor and the number of scintillation photons detected. Furthermore, it is shown that the use of a k-nearest neighbor (k-NN) algorithm for position estimation allows the experimentally obtained spatial resolution to closely approach the CRLB. The approach outlined in this work can in principle be applied to any scintillation detector in which position information is encoded in the distribution of the scintillation light over multiple photosensor elements.

Model of the point spread function of monolithic scintillator PET detectors for perpendicular incidence.

PURPOSE: Previously, we demonstrated the potential of positron emission tomography detectors consisting of monolithic scintillation crystals read out by arrays of solid-state light sensors. We reported detector spatial resolutions of 1.1-1.3 mm full width at half maximum (FWHM) with no degradation for angles of incidence up to 30 degrees, energy resolutions of approximately 11% FWHM, and timing resolutions of approximately 2 ns FWHM, using monolithic LYSO:Ce3+ crystals coupled to avalanche photodiode (APD) arrays. Here we develop, validate, and demonstrate a simple model of the detector point spread function (PSF) of such monolithic scintillator detectors. METHODS: A PSF model was developed that essentially consists of two convolved components, one accounting for the spatial distribution of the energy deposited by annihilation photons within the crystal, and the other for the influences of statistical signal fluctuations and electronic noise. The model was validated through comparison with spatial resolution measurements on a detector consisting of an LYSO:Ce3+ crystal read out by two APD arrays. RESULTS: The model is shown to describe the measured detector spatial response well at the noise levels found in the experiments. In addition, it is demonstrated how the model can be used to correct the measured spatial response for the influence of the finite diameter of the annihilation photon beam used in the experiments, thus obtaining an estimate of the intrinsic detector PSF. CONCLUSIONS: Despite its simplicity, the proposed model is an accurate tool for analyzing the detector PSF of monolithic scintillator detectors and can be used to estimate the intrinsic detector PSF from the measured one.

Optical simulation of monolithic scintillator detectors using GATE/GEANT4.

Much research is being conducted on position-sensitive scintillation detectors for medical imaging, particularly for emission tomography. Monte Carlo simulations play an essential role in many of these research activities. As the scintillation process, the transport of scintillation photons through the crystal(s), and the conversion of these photons into electronic signals each have a major influence on the detector performance; all of these processes may need to be incorporated in the model to obtain accurate results. In this work the optical and scintillation models of the GEANT4 simulation toolkit are validated by comparing simulations and measurements on monolithic scintillator detectors for high-resolution positron emission tomography (PET). We have furthermore made the GEANT4 optical models available within the user-friendly GATE simulation platform (as of version 3.0). It is shown how the necessary optical input parameters can be determined with sufficient accuracy. The results show that the optical physics models of GATE/GEANT4 enable accurate prediction of the spatial and energy resolution of monolithic scintillator PET detectors.

Monolithic scintillator PET detectors with intrinsic depth-of-interaction correction.

We developed positron emission tomography (PET) detectors based on monolithic scintillation crystals and position-sensitive light sensors. Intrinsic depth-of-interaction (DOI) correction is achieved by deriving the entry points of annihilation photons on the front surface of the crystal from the light sensor signals. Here we characterize the next generation of these detectors, consisting of a 20 mm thick rectangular or trapezoidal LYSO:Ce crystal read out on the front and the back (double-sided readout, DSR) by Hamamatsu S8550SPL avalanche photodiode (APD) arrays optimized for DSR. The full width at half maximum (FWHM) of the detector point-spread function (PSF) obtained with a rectangular crystal at normal incidence equals approximately 1.05 mm at the detector centre, after correction for the approximately 0.9 mm diameter test beam of annihilation photons. Resolution losses of several tenths of a mm occur near the crystal edges. Furthermore, trapezoidal crystals perform almost equally well as rectangular ones, while improving system sensitivity. Due to the highly accurate DOI correction of all detectors, the spatial resolution remains essentially constant for angles of incidence of up to at least 30 degrees . Energy resolutions of approximately 11% FWHM are measured, with a fraction of events of up to 75% in the full-energy peak. The coincidence timing resolution is estimated to be 2.8 ns FWHM. The good spatial, energy and timing resolutions, together with the excellent DOI correction and high detection efficiency of our detectors, are expected to facilitate high and uniform PET system resolution.

GATE: a simulation toolkit for PET and SPECT.

Monte Carlo simulation is an essential tool in emission tomography that can assist in the design of new medical imaging devices, the optimization of acquisition protocols and the development or assessment of image reconstruction algorithms and correction techniques. GATE, the Geant4 Application for Tomographic Emission, encapsulates the Geant4 libraries to achieve a modular, versatile, scripted simulation toolkit adapted to the field of nuclear medicine. In particular, GATE allows the description of time-dependent phenomena such as source or detector movement, and source decay kinetics. This feature makes it possible to simulate time curves under realistic acquisition conditions and to test dynamic reconstruction algorithms. This paper gives a detailed description of the design and development of GATE by the OpenGATE collaboration, whose continuing objective is to improve, document and validate GATE by simulating commercially available imaging systems for PET and SPECT. Large effort is also invested in the ability and the flexibility to model novel detection systems or systems still under design. A public release of GATE licensed under the GNU Lesser General Public License can be downloaded at http:/www-lphe.epfl.ch/GATE/. Two benchmarks developed for PET and SPECT to test the installation of GATE and to serve as a tutorial for the users are presented. Extensive validation of the GATE simulation platform has been started, comparing simulations and measurements on commercially available acquisition systems. References to those results are listed. The future prospects towards the gridification of GATE and its extension to other domains such as dosimetry are also discussed.