Niska-hartiaoireisen asiakkaan ohjautuminen fysioterapian akuuttivastaanottoon : menetelmä terveyskeskuksen ajanvaraukseen

Opinnäytetyön tarkoituksena oli kehittää ohjeistus Kaarinan terveyskeskuksen ajanvarauksen työvälineeksi, jonka avulla hoidon tarpeen arviointi niska-hartiaoireisen asiakkaan kohdalla helpottuu. Ohjeistuksena toimiva prosessikaavio koottiin teoriatiedon ja haastattelujen pohjalta. Prosessikaaviolla ohjataan asiakas joko fysioterapeutin akuuttivastaanottoaikoihin tai lääkärille. Prosessikaavion tavoitteena oli selkeyttää ja yhtenäistää ajanvarauksen työtä hyödyntämällä mahdollisimman tehokkaasti jo olemassa olevia resursseja ohjaamalla fysioterapiasta hyötyvät asiakkaat suoraan fysioterapeutin luokse ja lääkärin hoitoa tarvitsevat lääkärin luokse. Näin saavutetaan kustannussäästöjä ja vähennetään asiakkaan hoitokäyntejä. Opinnäytetyö toteutettiin kehittämistutkimuksena, jonka tuloksena on syntynyt opinnäytetyöraportti ja prosessikaavio niska-hartiaseutuoireisen asiakkaan hoidon tarpeen arviointiin. Aineistonkeruu tapahtui avoimena haastatteluna, webropol-kyselynä sekä alan kirjallisuuteen ja näyttöön perustuvaan tietoon yhdistettynä. Tietoperusta perustuu niskakivun Käypä hoito-suositukseen ja tutkittuun tietoon perustuvaan tutkimusnäyttöön. Prosessikaavion materiaali koostettiin kartoittamalla teoriatiedon perusteella niska-hartiakivun oireet eli ”red flagsit”, jotka vaativat lääkärin hoitoa. Valmis prosessikaavio pohjautuu haastattelun ja tutkitun tiedon analysoinnissa koottuihin kriteereihin. Lisäksi opinnäytetyössä on selvitetty fysioterapeuttien ja lääkäreiden työnjakoa, fysioterapeuttien laajennettuja tehtävän kuvia ja fysioterapeutin suoravastaanottoa. Opinnäytetyön lopputuloksena syntynyt prosessikaavio tulee toimimaan hoidon tarpeen arvioinnin välineenä myös fysioterapeutin suoravastaanotolle. Jatkossa Kaarinan terveyskeskukseen tullaan perustamaan fysioterapeutin suoravastaanotto TULE-vaivoihin.The aim of this Bachelor’s thesis was to plan and produce instructions to the for the personnel of Kaarina Health Centre reception so the needs assessment for treatment for a client with neck pain will be easier. The process diagram that serves as a guide is compiled based on theoretical knowledge and interviews. The process diagram allows the client to be guided either to the physiotherapist's acute reception time or to the doctor. The aim of the process diagram is to clarify and harmonize the work of staff scheduling appointments by making the best use of the resources already available by guiding clients who benefit from physiotherapy direct to physiotherapist and those who needs medical care directed to a doctor. This results in cost savings and reduces customer visits. This Bachelor’s thesis project was carried out as a development study that led to the thesis report and process diagram for the needs assessment to treat a client with neck pain. The data collection was conducted as an open interview, a Webropol questionnaire, and a combination of literature and evidence-based information. The thesis database is based on the Current Care Guideline and the evidence-based survey screen. The process diagram material was compiled by mapping the theoretical knowledge of the neck-shoulder pain symptoms so called “red flags” that require medical treatment. The completed process diagram is based on the criteria of interviews and analyzed data. In addition, the thesis has clarified the division of labor between physiotherapists and doctors, extended scope of practice (intervention) in physiotherapy and physiotherapist's direct access. The process diagram resulting from the thesis will also serve as a tool for needs assessment for treatment for the physiotherapist's direct access. In the future, a physiotherapist's direct access will be set up in the Kaarina Health Centre to receive direct medical attention for musculoskeletal disorders

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Motion modeling from 4D MR images of liver simulating phantom

Background and purpose A novel method of retrospective liver modeling was developed based on four-dimensional magnetic resonance (4D-MR) images. The 4D-MR images will be utilized in generation of the subject-specific deformable liver model to be used in radiotherapy planning (RTP). The purpose of this study was to test and validate the developed 4D-magnetic resonance imaging (MRI) method with extensive phantom tests. We also aimed to build a motion model with image registration methods from liver simulating phantom images. Materials and methods A deformable phantom was constructed by combining deformable tissue-equivalent material and a programmable 4D CIRS-platform. The phantom was imaged in 1.5 T MRI scanner with T2-weighted 4D SSFSE and T1-weighted Ax dual-echo Dixon SPGR sequences, and in computed tomography (CT). In addition, geometric distortion of the 4D sequence was measured with a GRADE phantom. The motion model was developed; the phases of the 4D-MRI were used as surrogate data, and displacement vector fields (DVF's) were used as a motion measurement. The motion model and the developed 4D-MRI method were evaluated and validated with extensive tests. Result The 4D-MRI method enabled an accuracy of 2 mm using our deformable phantom compared to the 4D-CT. Results showed a mean accuracy of <2 mm between coordinates and DVF's measured from the 4D images. Three-dimensional geometric accuracy results with the GRADE phantom were: 0.9-mm mean and 2.5 mm maximum distortion within a 100 mm distance, and 2.2 mm mean, 5.2 mm maximum distortion within a 150 mm distance from the isocenter. Conclusions The 4D-MRI method was validated with phantom tests as a necessary step before patient studies. The subject-specific motion model was generated and will be utilized in the generation of the deformable liver model of patients to be used in RTP.Background and purpose A novel method of retrospective liver modeling was developed based on four-dimensional magnetic resonance (4D-MR) images. The 4D-MR images will be utilized in generation of the subject-specific deformable liver model to be used in radiotherapy planning (RTP). The purpose of this study was to test and validate the developed 4D-magnetic resonance imaging (MRI) method with extensive phantom tests. We also aimed to build a motion model with image registration methods from liver simulating phantom images. Materials and methods A deformable phantom was constructed by combining deformable tissue-equivalent material and a programmable 4D CIRS-platform. The phantom was imaged in 1.5 T MRI scanner with T2-weighted 4D SSFSE and T1-weighted Ax dual-echo Dixon SPGR sequences, and in computed tomography (CT). In addition, geometric distortion of the 4D sequence was measured with a GRADE phantom. The motion model was developed; the phases of the 4D-MRI were used as surrogate data, and displacement vector fields (DVF's) were used as a motion measurement. The motion model and the developed 4D-MRI method were evaluated and validated with extensive tests. Result The 4D-MRI method enabled an accuracy of 2 mm using our deformable phantom compared to the 4D-CT. Results showed a mean accuracy ofPeer reviewe

Gold seed fiducials in analysis of linear and rotational displacement of the prostate bed

Background and purpose This study aimed to investigate the magnitude of interfraction prostate bed motion during radiotherapy using both the implanted gold seed fiducials and the soft tissue registration and to define reasonable planning target volume (PTV) margins for different localization methods. Material and methods Thirteen prostatectomized prostate cancer patients, after implanting four gold seed fiducials into their prostate bed, were imaged daily using a pretreatment cone-beam computed tomography (CBCT). Linear and the rotational prostate bed motion (PBM) was measured for 466 CBCTs. Results The linear PBM mean and standard deviation values in millimeters are 0.0±0.5, 0.7±2.1 and 0.8±1.6 in the LR, SI and AP axes, respectively. In 20% of the fractions the rotation of the prostate bed in sagittal plane exceeds ±6° and in 5% it exceeds ±10° from the position on the planning CT. In the transversal and coronal planes 1% and 2% of it exceeds ±6°. The PTV margins are 2.4, 6.5 and 6.6mm in the LR, SI and AP axes, respectively, if imaging is performed for the first three treatment fractions. Conclusion The linear PBM is largest in the SI and AP axis, whereas the rotation is largest in the sagittal plane. Bone localization during the first three treatment fractions can reduce PTV margins by 52%, 18% and 10% in the LR, SI and AP axes, respectively, whereas in daily CBCT the use of the gold seed fiducials seems profitable. Keywords: Prostate bed motion, Gold seed fiducials, Rotation of the prostate bed, Margin, Prostate cancerPeer reviewe

Dosimetric Comparison and Evaluation of 4 Stereotactic Body Radiotherapy Techniques for the Treatment of Prostate Cancer

Purpose:The aim of this study was to compare dosimetric characteristics, monitor unit, and delivery efficiency of 4 different stereotactic body radiotherapy techniques for the treatment of prostate cancer.Methods:This study included 8 patients with localized prostate cancer. Dosimetric assets of 4 delivery techniques for stereotactic body radiotherapy were evaluated: robotic CyberKnife, noncoplanar intensity-modulated radiotherapy, and 2 intensity-modulated arc therapy techniques (RapidArc and Elekta volumetric-modulated arc therapy). All the plans had equal treatment margins and a prescription dose of 35 Gy in 5 fractions.Results:Statistically significant differences were observed in homogeneity index and mean doses of bladder wall and penile bulb, all of which were highest with CyberKnife. No significant differences were observed in the mean doses of rectum, with values of 15.2 2.6, 13.3 +/- 2.6, 13.1 +/- 2.8, and 13.8 +/- 1.6 Gy with CyberKnife, RapidArc, volumetric-modulated arc therapy, and noncoplanar intensity-modulated radiotherapy, respectively. The highest dose conformity was realized with RapidArc. The dose coverage of the planning target volume was lowest with noncoplanar intensity-modulated radiotherapy. Treatment times and number of monitor units were largest with CyberKnife (on average 34.0 +/- 5.0 minutes and 8704 +/- 1449 monitor units) and least with intensity-modulated arc therapy techniques (on average 5.1 +/- 1.1 minutes and 2270 +/- 497 monitor units).Conclusion:Compared to CyberKnife, the RapidArc, volumetric-modulated arc therapy, and noncoplanar intensity-modulated radiotherapy produced treatment plans with similar dosimetric quality, with RapidArc achieving the highest dose conformity. Overall, the dosimetric differences between the studied techniques were marginal, and thus, the choice of the technique should rather focus on the delivery accuracies and dose delivery times.Peer reviewe

Quantitative accuracy of Lu-177 SPECT reconstruction using different compensation methods : phantom and patient studies

Background: In targeted radionuclide therapy (TRT), accurate quantification using SPECT/CT images is important for optimizing radiation dose delivered to both the tumour and healthy tissue. Quantitative SPECT images are regularly reconstructed using the ordered subset expectation maximization (OSEM) algorithm with various compensation methods such as attenuation (A), scatter (S) and detector and collimator response (R). In this study, different combinations of the compensation methods are applied during OSEM reconstruction and the effect on the Lu-177 quantification accuracy is studied in an anthropomorphic torso phantom. In addition, the phantom results are reflected to (177) Lu-DOTA-Tyr3-octreotate (Lu-177-DOTATATE)-treated patient data and kidney absorbed dose estimates. Methods: The torso phantom was imaged with nine various sized (0.4-104.4 cm(3)) spherical inserts, filled with known Lu-177 activity ranging from 0.5 to 105.5 MBq. Images were reconstructed using OSEM algorithm using A, AR and ARS compensation method combinations. The compensation method combinations were compared by calculating the concentration recovery coefficient (cRC) for each insert. In addition, ten Lu-177-DOTATATE-treated patient's post-therapy dosimetry acquisitions were reconstructed, and the absorbed dose to kidneys was estimated. Results: cRC values depend on the insert size for all compensation methods. AR and ARS produced significantly higher cRC values than attenuation correction alone. There were no cRC value differences between the methods for the smallest 1-cm-diameter insert, cRC being 0.18. However, the collimator and detector response compensation method (R) made the 1.3-cm-diameter insert clearly visible and improved cRC estimate from 0.19 to 0.43. ARS produced slightly higher cRC values for small- and medium-sized inserts than AR. On the patient data, a similar trend could be seen. AR and ARS produced higher kidney activities than using attenuation correction alone; the total absorbed doses to the right and left kidneys were on average 15 and 20 % higher for AR and 19 and 25 % higher for ARS, respectively. The effective half-life decay estimated from time-activity curves however showed no notable difference between the compensation methods. Conclusions: The highest cRC values were achieved by applying ARS compensation during reconstruction. The results were notably higher than those using attenuation correction alone. Similarly, higher activity estimates and thus higher absorbed dose estimates were found in patient data when all compensation methods were applied. ARS improved cRC especially in small-sized sources, and it thus might aid tumour dosimetry for Lu-177 PRRT treatments.Peer reviewe

Diffusion-weighted magnetic resonance imaging for evaluation of salivary gland function in head and neck cancer patients treated with intensity-modulated radiotherapy

Background and purposes: Permanent xerostomia as a result of radiation-induced salivary gland damage remains a common side effect of radiotherapy (RT) of the head and neck. The purpose of this study was to evaluate the usefulness of diffusion-weighted magnetic resonance imaging (DW-MRI) in assessing the post-RT salivary gland function in patients with head and neck cancer (HNC). Materials and methods: In this prospective study, 20 HNC patients scheduled for bilateral neck chemoradiotherapy (CRT) with weekly cisplatin went through diffusion-weighted magnetic resonance imaging (DW-MRI) and salivary gland scintigraphy (SGS) prior to and at a mean of six months after completing the treatment. The changes in apparent diffusion coefficient (ADC) before and after treatment were compared with ejection fraction (EF) measured with SGS and the radiation dose absorbed by the salivary glands. Results: As a result of gustatory stimulation with ascorbic acid, the ADC showed a biphasic response with an initial increase and subsequent decrease. This pattern was seen both before and after RT. Post-RT ADC increased as a function of RT dose absorbed by the salivary glands. A moderate statistical correlation between pre- and post-RT ADCs at rest and EF measured with SGS was found. Conclusions: DW-MRI seems a promising tool for detection of physiological and functional changes in major salivary glands after RT. (C) 2016 Elsevier Ireland Ltd. All rights reserved.Peer reviewe

Low vs. high radioiodine activity to ablate the thyroid after thyroidectomy for cancer : a randomized study

Peer reviewe

Dosimetric Comparison and Evaluation of 4 Stereotactic Body Radiotherapy Techniques for the Treatment of Prostate Cancer

Purpose: The aim of this study was to compare dosimetric characteristics, monitor unit, and delivery efficiency of 4 different stereotactic body radiotherapy techniques for the treatment of prostate cancer. Methods: This study included 8 patients with localized prostate cancer. Dosimetric assets of 4 delivery techniques for stereotactic body radiotherapy were evaluated: robotic CyberKnife, noncoplanar intensity-modulated radiotherapy, and 2 intensity-modulated arc therapy techniques (RapidArc and Elekta volumetric-modulated arc therapy). All the plans had equal treatment margins and a prescription dose of 35 Gy in 5 fractions. Results: Statistically significant differences were observed in homogeneity index and mean doses of bladder wall and penile bulb, all of which were highest with CyberKnife. No significant differences were observed in the mean doses of rectum, with values of 15.2+ 2.6, 13.3 +2.6, 13.1 +2.8, and 13.8 +1.6 Gy with CyberKnife, RapidArc, volumetric-modulated arc therapy, and noncoplanar intensity-modulated radiotherapy, respectively. The highest dose conformity was realized with RapidArc. The dose coverage of the planning target volume was lowest with noncoplanar intensity-modulated radiotherapy. Treatment times and number of monitor units were largest with CyberKnife (on average 34.0 + 5.0 minutes and 8704 + 1449 monitor units) and least with intensity-modulated arc therapy techniques (on average 5.1 + 1.1 minutes and 2270 + 497 monitor units).Conclusion: Compared to CyberKnife, the RapidArc, volumetric-modulated arc therapy, and noncoplanar intensity-modulated radiotherapy produced treatment plans with similar dosimetric quality, with RapidArc achieving the highest dose conformity. Overall, the dosimetric differences between the studied techniques were marginal, and thus, the choice of the technique should rather focus on the delivery accuracies and dose delivery times.</p

Radiation therapy for breast cancer and clonal chromosome translocations: a fluorescence in situ hybridization study

The frequency of chromosomal translocations was analyzed in skin fibroblast cell cultures derived from irradiated and nonirradiated skin biopsies from five cases of breast adenocarcinoma in women, who had undergone radiotherapy after surgery. The study was performed at the first annual check-up. Chromosomal in situ suppression (CISS) hybridization was performed using metaphase nonisotopic fluorescence in situ hybridization (FISH) with library probes specific for chromosomes 1, 2, 3, 4, 5, 7, 8, 13, 19, and 20. The results showed that the frequency of clonal translocations in metaphases obtained from irradiated areas was significantly higher than in metaphases from the nonirradiated tissue samples.Facultad de Ciencias Naturales y Muse