Early-stage design strategies

Decisions made at early stages of the design are of the utmost importance for the energy-efficiency of buildings. Wrong decisions and design failures related to a building’s general layout, shape, façade transparency or orientation can increase the operational energy tremendously. These failures can be avoided in advance through simple changes in the design. Using extensive parametric energy simulations by DesignBuilder, this paper investigates the impact of geometric factors for the energy-efficiency of high-rise office buildings in three climates contexts: Amsterdam (Temperate), Sydney (Sub-tropical) and Singapore (Tropical). The investigation is carried out on 12 plan shapes, 7 plan depths, 4 building orientations and discrete values for window-to-wall ratio. Among selected options, each sub-section determines the most efficient solution for different design measures and climates. The optimal design solution is the one that minimizes, on an annual basis, the sum of the energy use for heating, cooling, electric lighting and fans. The results indicate that, the general building design is an important issue to consider for high-rise buildings: they can influence the energy use up to 32%. For most of the geometric factors, the greatest difference between the optimal and the worst solution occurs in the sub-tropical climate, while the tropical climate is the one that shows the smallest difference. In case of the plan depth, special attention should be paid in a temperate climate, as the total energy use can increase more than other climates. Regarding energy performance, the following building geometry factors have the highest to lowest influence: building orientation, plan shape, plan depth, and window-to-wall ratio

Axially rigid steerable needle with compliant active tip control

Steerable instruments allow for precise access to deeply-seated targets while sparing sensitive tissues and avoiding anatomical structures. In this study we present a novel omnidirectional steerable instrument for prostate high-dose-rate (HDR) brachytherapy (BT). The instrument utilizes a needle with internal compliant mechanism, which enables distal tip steering through proximal instrument bending while retaining high axial and flexural rigidity. Finite element analysis evaluated the design and the prototype was validated in experiments involving tissue simulants and ex-vivo bovine tissue. Ultrasound (US) images were used to provide visualization and shape-reconstruction of the instrument during the insertions. In the experiments lateral tip steering up to 20 mm was found. Manually controlled active needle tip steering in inhomogeneous tissue simulants and ex-vivo tissue resulted in mean targeting errors of 1.4 mm and 2 mm in 3D position, respectively. The experiments show that steering response of the instrument is history-independent. The results indicate that the endpoint accuracy of the steerable instrument is similar to that of the conventional rigid HDR BT needle while adding the ability to steer along curved paths. Due to the design of the steerable needle sufficient axial and flexural rigidity is preserved to enable puncturing and path control within various heterogeneous tissues. The developed instrument has the potential to overcome problems currently unavoidable with conventional instruments, such as pubic arch interference in HDR BT, without major changes to the clinical workflow

Case studies of high-rise buildings

Tall buildings are being designed and built across a wide range of cities. A poorly designed tall building can tremendously increase the building’s appetite for energy. Therefore, this paper aims to determine the design strategies that help a high-rise office building to be more energy efficient. For this purpose, a comparative study on twelve case buildings in three climate groups (temperate, sub-tropical & tropical) was performed. The exterior envelope, building form and orientation, service core placement, plan layout, and special design elements like atria and sky gardens were the subject of investigation. The effectiveness of different design strategies for reducing the cooling, heating, ventilation and electric lighting energy were analysed. Finally, lessons from these buildings were defined for the three climates. Furthermore, a comparison of building energy performance data with international benchmarks confirmed that in temperate and sub-tropical climates sustainable design strategies for high-rise buildings were performing well, as a result leading to lower energy consumption. However, for the tropics the design of high-rise buildings needs higher concern

Time-Action Analysis of Catheter Manipulation During Navigation Tasks in Bifurcations

Endovascular intervention is a form of minimally invasive intervention that allows catheters to be placed in practically any location of the vascular tree. However, to provide access to all these remote locations, an extensive array of catheters is needed. A specific catheter is choose based on experience, without any objective indication of its suitability during the actual procedure (Bakker, N. H., Tanase, D., Reekers, J. A., and Grimbergen, C. A., 2002, "Evaluation of Vascular and Interventional Procedures with Time-Action Analysis: A Pilot Study," J. Vasc. Intervent. Radiol., 13(5), pp. 483-488). The aim of this study is to evaluate several catheters using time-action analysis during a navigation task in bifurcations of various geometries. The relation between the geometry of bifurcations, the catheters, and the time taken to perform specific actions is investigated. Nine novices manipulated five widely used selective catheters with a 0.035" guidewire in a model. In the model, four bifurcations of various diameters and angles were selected. Each bifurcation was cannulated six times with two different yet suitable catheters. The participants had no direct vision of the model but navigated the instruments using the images that were captured by a camera and displayed on a screen. All images presented to the participant were recorded and used for detailed time-action analysis of the various actions to cannulate a branch (e.g., catheter or guidewire retracted, rotated, and advanced). On average, the participants needed 28.3 s to cannulate a branch. When the ratio between the diameter of the main and side branch was high, the average time per task increased significantly, as did the number of attempts to navigate into a branch. However, neither the choice between the two suitable catheters for each bifurcation, nor the angles of the bifurcation made a significant difference in navigation time. Time-action analysis enabled objective measurement of the time spent on various actions to cannulate a branch. The results revealed that most time was spent on retracting and rotating the catheter. This was comparable for all catheters and branches, showing that all the instruments were manipulated in a similar way and presented the same difficulties

Optimal point of insertion of the needle in neuraxial blockade using a midline approach: Study in a geometrical model

Performance of neuraxial blockade using a midline approach can be technically difficult. It is therefore important to optimize factors that are under the influence of the clinician performing the procedure. One of these factors might be the chosen point of insertion of the needle. Surprisingly few data exist on where between the tips of two adjacent spinous processes the needle should be introduced. A geometrical model was adopted to gain more insight into this issue. Spinous processes were represented by parallelograms. The length, the steepness relative to the skin, and the distance between the parallelograms were varied. The influence of the chosen point of insertion of the needle on the range of angles at which the epidural and subarachnoid space could be reached was studied. The optimal point of insertion was defined as the point where this range is the widest. The geometrical model clearly demonstrated, that the range of angles at which the epidural or subarachnoid space can be reached, is dependent on the point of insertion between the tips of the adjacent spinous processes. The steeper the spinous processes run, the more cranial the point of insertion should be. Assuming that the model is representative for patients, the performance of neuraxial blockade using a midline approach might be improved by choosing the optimal point of insertion

Visual force feedback in laparoscopic training

Background - To improve endoscopic surgical skills, an increasing number of surgical residents practice on box or virtual reality (VR) trainers. Current training is focused mainly on hand–eye coordination. Training methods that focus on applying the right amount of force are not yet available. Methods - The aim of this project is to develop a low-cost training system that measures the interaction force between tissue and instruments and displays a visual representation of the applied forces inside the camera image. This visual representation continuously informs the subject about the magnitude and the direction of applied forces. To show the potential of the developed training system, a pilot study was conducted in which six novices performed a needledriving task in a box trainer with visual feedback of the force, and six novices performed the same task without visual feedback of the force. All subjects performed the training task five times and were subsequently tested in a post-test without visual feedback. Results - The subjects who received visual feedback during training exerted on average 1.3 N (STD 0.6 N) to drive the needle through the tissue during the post-test. This value was considerably higher for the group that received no feedback (2.6 N, STD 0.9 N). The maximum interaction force during the post-test was noticeably lower for the feedback group (4.1 N, STD 1.1 N) compared with that of the control group (8.0 N, STD 3.3 N). Conclusions - The force-sensing training system provides us with the unique possibility to objectively assess tissuehandling skills in a laboratory setting. The real-time visualization of applied forces during training may facilitate acquisition of tissue-handling skills in complex laparoscopic tasks and could stimulate proficiency gain curves of trainees. However, larger randomized trials that also include other tasks are necessary to determine whether training with visual feedback about forces reduces the interaction force during laparoscopic surgery.Biomechanical EngineeringMechanical, Maritime and Materials Engineerin

Dosimetric benefits and preclinical performance of steerable needles in HDR prostate brachytherapy

Prostate cancer patients with an enlarged prostate and/or excessive pubic arch interference (PAI) are generally considered non-eligible for high-dose-rate (HDR) brachytherapy (BT). Steerable needles have been developed to make these patients eligible again. This study aims to validate the dosimetric impact and performance of steerable needles within the conventional clinical setting. HDR BT treatment plans were generated, needle implantations were performed in a prostate phantom, with prostate volume &gt; 55 cm3 and excessive PAI of 10 mm, and pre- and post-implant dosimetry were compared considering the dosimetric constraints: prostate V100 &gt; 95 % (13.50 Gy), urethra D0.1cm3 &lt; 115 % (15.53 Gy) and rectum D1cm3 &lt; 75 % (10.13 Gy). The inclusion of steerable needles resulted in a notable enhancement of the dose distribution and prostate V100 compared to treatment plans exclusively employing rigid needles to address PAI. Furthermore, the steerable needle plan demonstrated better agreement between pre- and post-implant dosimetry (prostate V100: 96.24 % vs. 93.74 %) compared to the rigid needle plans (79.13 % vs. 72.86 % and 87.70 % vs. 81.76 %), with no major changes in the clinical workflow and no changes in the clinical set-up. The steerable needle approach allows for more flexibility in needle positioning, ensuring a highly conformal dose distribution, and hence, HDR BT is a feasible treatment option again for prostate cancer patients with an enlarged prostate and/or excessive PAI.</p

Dosimetric benefits and preclinical performance of steerable needles in HDR prostate brachytherapy

Prostate cancer patients with an enlarged prostate and/or excessive pubic arch interference (PAI) are generally considered non-eligible for high-dose-rate (HDR) brachytherapy (BT). Steerable needles have been developed to make these patients eligible again. This study aims to validate the dosimetric impact and performance of steerable needles within the conventional clinical setting. HDR BT treatment plans were generated, needle implantations were performed in a prostate phantom, with prostate volume &gt; 55 cm3 and excessive PAI of 10 mm, and pre- and post-implant dosimetry were compared considering the dosimetric constraints: prostate V100 &gt; 95 % (13.50 Gy), urethra D0.1cm3 &lt; 115 % (15.53 Gy) and rectum D1cm3 &lt; 75 % (10.13 Gy). The inclusion of steerable needles resulted in a notable enhancement of the dose distribution and prostate V100 compared to treatment plans exclusively employing rigid needles to address PAI. Furthermore, the steerable needle plan demonstrated better agreement between pre- and post-implant dosimetry (prostate V100: 96.24 % vs. 93.74 %) compared to the rigid needle plans (79.13 % vs. 72.86 % and 87.70 % vs. 81.76 %), with no major changes in the clinical workflow and no changes in the clinical set-up. The steerable needle approach allows for more flexibility in needle positioning, ensuring a highly conformal dose distribution, and hence, HDR BT is a feasible treatment option again for prostate cancer patients with an enlarged prostate and/or excessive PAI.</p

Dosimetric evaluation of off-axis fields and angular transmission for the 1.5 T MR-linac

Objective. GPU-oriented Monte Carlo dose (GPUMCD) is a fast dose calculation algorithm used for treatment planning on the Unity MR-linac. Treatments for the MR-linac must be calculated quickly and accurately, and must account for two important MR-linac aspects: off-axis positions and angular transmission through the cryostat, couch and MR-coils. Therefore, the aim of this research is to quantify the system-related errors for GPUMCD calculations over the range of clinically-relevant field configurations and gantry angles. Approach. Dose profiles (crossline, inline and PDD) were measured and calculated for varying field sizes, off-axis positions and depths. Eleven different (off-axis) positions were included. The angular transmission was investigated by measuring and calculating the transmission for multiple angles, taking the cryostat, couch and coils into account. Main results. Differences between absolute point doses were found to be within 1.7% for field sizes 2 × 2 cm2 and larger. The relative dose profiles in the crossline, inline and PDD direction illustrated maximum mean dose differences of 0.9pp, 0.8pp and 0.7pp of D max in the central region for field sizes 2 × 2 cm2 and larger. The 1 × 1 cm2 field size showed larger dosimetric errors for absolute point doses and relative dose profiles. The maximum mean DTA in the penumbra was 0.7 mm. The mean difference in angular transmission ranged from −0.33% ± 0.60% to 0.27% ± 0.91% using three treatment machines. Additionally, 77.1%-93.7% of the datapoints remained within 1% transmission difference. The largest transmission differences were present at the edges of the table. Significance. This research showed that the GPUMCD algorithm provides reliable dose calculations with a low uncertainty for field sizes 2 × 2 cm2 and larger, focusing on off-axis fields and angular transmission