Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

The structure and properties of non-linear optical crystals

SIGLEAvailable from British Library Document Supply Centre-DSC:D190968 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Polychromatic cone­-beam phase­-contrast tomography

A method is presented for quantitative phase-contrast tomography using unfiltered radiation from a small polychromatic source. The three-dimensional distribution of complex refractive index in a monomorphous object is reconstructed given a single projection image per view angle. The reconstruction algorithm is achromatic and stable with respect to high-spatial-frequency noise, in contrast to conventional tomography. The density distribution in a test sample was accurately reconstructed from polychromatic phase-contrast data collected with a point-projection x-ray microscope

Quantitative phase-contrast tomography using polychromatic radiation

We discuss theoretical, experimental and numerical aspects of several new techniques for quantitative phase-contrast tomography using, for example, unfiltered radiation from a polychromatic X-ray microfocus source. The proposed algorithms allow one to reconstruct the three-dimensional distribution of complex refractive index in a sample consisting of one or more constituent materials, given one or more projection images per view angle. If the sample is weakly absorbing or consists predominantly of a single material, these reconstruction algorithms can be simplified and fewer projections may be required for an unambiguous quantitative reconstruction of the spatial distribution of the refractive index. In the case of weakly absorbing samples, the reconstruction algorithm is shown to be achromatic and stable with respect to high-spatial-frequency noise, in contrast to conventional tomography. A variation of the algorithm exploits the natural combination of binary tomography with a phase-retrieval method that makes explicit use of the single-material nature of the sample. Such consistent use of a priori knowledge dramatically reduces the number of required projections, implying significantly reduced dose and scanning time when compared to most alternative phase-contrast tomography methods. Experimental demonstrations are also given, using data from a point-projection X-ray microscope. The refractive index distribution, in test samples of both a polymer fibre scaffold and an adult mouse, is accurately reconstructed from polychromatic phase-contrast data. Applications of the new techniques to rapid non-destructive testing in materials science and biomedical imaging are considered

Applications of phase-contrast X-ray microscopy in an SEM

We have developed a new approach to SEM-based X-ray projection microscopy which utilises phase contrast to enhance the quality and information content of images. The development of SEMs based on highbrightness field emission guns and highly sensitive CCD cameras enables us to produce an extremely fine microfocus source with sufficient flux for imaging. By combining this fine source with an appropriate imaging geometry, phase contrast arising from Fresnel diffraction at edges and boundaries within the sample leads to images with greatly enhanced edge detail. We have also developed phase-retrieval algorithms for quantitative determination of the projected phase shift in the object-plane from either a single image or multiple images acquired at different energies or magnifications. These developments have been realised in an instrument, dubbed the X-ray ultramicroscope (XuM), which has enabled us to acquired images down to ~200 nm resolution. Examples of applications of the XuM are described here including the use of phase-retrieval algorithms and microtomography