Improving the Timing Resolution of Positron Emission Tomography Detectors Using Boosted Learning -- A Residual Physics Approach

Artificial intelligence (AI) is entering medical imaging, mainly enhancing image reconstruction. Nevertheless, improvements throughout the entire processing, from signal detection to computation, potentially offer significant benefits. This work presents a novel and versatile approach to detector optimization using machine learning (ML) and residual physics. We apply the concept to positron emission tomography (PET), intending to improve the coincidence time resolution (CTR). PET visualizes metabolic processes in the body by detecting photons with scintillation detectors. Improved CTR performance offers the advantage of reducing radioactive dose exposure for patients. Modern PET detectors with sophisticated concepts and read-out topologies represent complex physical and electronic systems requiring dedicated calibration techniques. Traditional methods primarily depend on analytical formulations successfully describing the main detector characteristics. However, when accounting for higher-order effects, additional complexities arise matching theoretical models to experimental reality. Our work addresses this challenge by combining traditional calibration with AI and residual physics, presenting a highly promising approach. We present a residual physics-based strategy using gradient tree boosting and physics-guided data generation. The explainable AI framework SHapley Additive exPlanations (SHAP) was used to identify known physical effects with learned patterns. In addition, the models were tested against basic physical laws. We were able to improve the CTR significantly (more than 20%) for clinically relevant detectors of 19 mm height, reaching CTRs of 185 ps (450-550 keV)

The influence of a positive empathetic interaction on conditioned pain modulation and manipulation induced analgesia in people with lateral epicondylalgia

Objective: Conditioned pain modulation (CPM) and manipulation induced analgesia (MIA) are two forms of endogenous analgesia. Many forms of analgesia can be influenced by the nature of the patient clinician interaction. The aim of this study was to evaluate the influence of an empathetic and supportive interaction on CPM and MIA in people with Lateral Epicondylalgia (LE). Methods: In a double-blind, randomised, controlled trial, 68 participants with LE were assigned to two groups: the empathetic and neutral interaction groups. The interactions were carried out by a trained, professional role play actor, playing the part of a research assistant (RA). The RA actor spent 15min prior to CPM and MIA assessment interacting with the participants in an empathetic or neutral manner. Immediately after the interaction, a blinded assessor measured pressure pain threshold (PPT) at the symptomatic elbow and ipsilateral wrist during CPM and MIA testing. Linear mixed models were used to evaluate differences in CPM and MIA responses between the interaction groups. Results: There was a significant difference in CARE scores between the groups (p\u3c0.001), indicating that the intervention group experienced a more empathic interaction. Both groups showed a significant increase in PPT measures, indicative of a CPM and MIA analgesic response (p\u3c0.001), however the analgesic responses were greater in the group that had experienced a supportive, empathetic interaction (post CPM, wrist: p\u3c0.001; elbow: p=0.001), (post MIA wrist: p=\u3c0.001; elbow: p=0.001). Discussion: A single session of empathetic interaction positively influenced both CPM and MIA responses in people with LE

A Finely Segmented Semi-Monolithic Detector tailored for High Resolution PET

Preclinical research and organ-dedicated applications require high-resolution positron emission tomography (PET) detectors to visualize small structures and understand biological processes at a finer level of detail. Current commercial systems often employ finely pixelated or monolithic scintillators, each with its limitations. We present a semi-monolithic detector, tailored for high-resolution PET applications, and merging concepts of monolithic and pixelated crystals. The detector features slabs measuring (24 x 10 x 1) sq. mm, coupled to a 12 x 12 readout channel photosensor with 4 mm pitch. The slabs are grouped in two arrays of 44 slabs each to achieve a higher optical photon density. We employ a fan beam collimator for fast calibration to train machine-learning-based positioning models for all three dimensions, including slab identification and depth-of-interaction (DOI), utilizing gradient tree boosting (GTB). Energy calculation was based on a position-dependent energy calibration. Using an analytical timing calibration, time skews were corrected for coincidence timing resolution (CTR) estimation. Leveraging machine-learning-based calibration in all three dimensions, we achieved high detector spatial resolution: down to 1.18 mm full width at half maximum (FWHM) detector spatial resolution and 0.75 mm mean absolute error (MAE) in the planar-monolithic direction along the slabs, and 2.14 mm FWHM and 1.03 mm MAE for depth-of-interaction (DOI) at an energy window of (435-585) keV. Correct slab interaction identification exceeded 80%, alongside an energy resolution of 13.8% and a CTR of 450 ps FWHM. Therewith, the introduced finely segmented, high-resolution slab detector demonstrates an appealing performance suitable for high-resolution PET applications. The current benchtop-based detector calibration routine allows these detectors to be used in PET systems.Comment: 14 pages, 11 figures, IEEE NSS MIC RTSD 202

Mindfulness and skills-based eHealth intervention to reduce distress in cancer-affected patients in the Reduct trial: Intervention protocol of the make it training optimized.

Introduction Cancer-affected patients experience high distress due to various burdens. One way to expand psycho-oncological support is through digital interventions. This protocol describes the development and structure of a web-based psycho-oncological intervention, the Make It Training optimized. This intervention is currently evaluated in the Reduct trial, a multicenter randomized controlled trial. Methods The Make It Training optimized was developed in six steps: A patient need and demand assessment, development and acceptability analysis of a prototype, the formation of a patient advisory council, the revision of the training, implementation into a web app, and the development of a motivation and evaluation plan. Results Through a process of establishing cancer-affected patients' needs, prototype testing, and patient involvement, the Make It Training optimized was developed by a multidisciplinary team and implemented in a web app. It consists of 16 interactive self-guided modules which can be completed within 16 weeks. Discussion Intervention protocols can increase transparency and increase the likelihood of developing effective web-based interventions. This protocol describes the process and results of developing a patient-oriented intervention. Future research should focus on the further personalization of web-based psycho-oncological interventions and the potential benefits of combining multiple psychotherapeutic approaches

Pilot field testing of the chronic pain classification for ICD-11: the results of ecological coding

Background: A task force of the International Association for the Study of Pain (IASP) has developed a classification of chronic pain for the ICD-11 consisting of seven major categories. The objective was to test whether the proposed categories were exhaustive and mutually exclusive. In addition, the perceived utility of the diagnoses and the raters’ subjective diagnostic certainty were to be assessed. Methods: Five independent pain centers in three continents coded 507 consecutive patients. The raters received the definitions for the main diagnostic categories of the proposed classification and were asked to allocate diagnostic categories to each patient. In addition, they were asked to indicate how useful they judged the diagnosis to be from 0 (not at all) to 3 (completely) and how confident they were in their category allocation. Results: The two largest groups of patients were coded as either chronic primary pain or chronic secondary musculoskeletal pain. Of the 507 patients coded, 3.0% had chronic pain not fitting any of the proposed categories (97% exhaustiveness), 20.1% received more than one diagnosis. After adjusting for double coding due to technical reasons, 2.0% of cases remained (98% uniqueness). The mean perceived utility was 1.9 ± 1.0, the mean diagnostic confidence was 2.0 ± 1.0. Conclusions: The categories proved exhaustive with few cases being classified as unspecified chronic pain, and they showed themselves to be mutually exclusive. The categories were regarded as useful with particularly high ratings for the newly introduced categories (chronic cancer-related pain among others). The confidence in allocating the diagnoses was good although no training regarding the ICD-11 categories had been possible at this stage of the development

Guide - User Co-Production in Standardisation

Research within the H2020 PROGRESSIVE project has identified good practices in user co-production strategies and methodologies. Early findings from research in the PROGRESSIVE project were shared with relevant stakeholders outside the consortium for consultation and review. The outcomes of that initial investigation highlighted the need to focus on the objectives, processes, and methods used in user and older people co-production. This guide adapts these insights and makes them relevant specifically for standardisation in ICT for active and healthy ageing. This guide was approved by representatives of the PROGRESSIVE project on 22 February 2018. The consortium has requested comments from interested stakeholders in an enquiry from 1 March to 30 April 2018. The PROGRESSIVE guide was approved on 5 June 2018

A Policy-into-Practice Intervention to Increase the Uptake of Evidence-Based Management of Low Back Pain in Primary Care: A Prospective Cohort Study

BACKGROUND: Persistent non-specific low back pain (nsLBP) is poorly understood by the general community, by educators, researchers and health professionals, making effective care problematic. This study evaluated the effectiveness of a policy-into-practice intervention developed for primary care physicians (PCPs). METHODS: To encourage PCPs to adopt practical evidence-based approaches and facilitate time-efficient, integrated management of patients with nsLBP, we developed an interdisciplinary evidence-based, practical pain education program (gPEP) based on a contemporary biopsychosocial framework. One hundred and twenty six PCPs from primary care settings in Western Australia were recruited. PCPs participated in a 6.5-hour gPEP. Self-report measures recorded at baseline and at 2 months post-intervention included PCPs' attitudes, beliefs (modified Health Care Providers Pain and Impairment Relationship Scale (HC-PAIRS), evidence-based clinical practices (knowledge and skills regarding nsLBP management: 5-point Likert scale with 1  =  nil and 5  =  excellent) and practice behaviours (recommendations based on a patient vignette; 5-point Likert scale). RESULTS: Ninety one PCPs participated (attendance rate of 72%; post-intervention response rate 88%). PCP-responders adopted more positive, guideline-consistent beliefs, evidenced by clinically significant HC-PAIRS score differences (mean change  =  -5.6±8.2, p<0.0001; 95% confidence interval: -7.6 to -3.6) and significant positive shifts on all measures of clinical knowledge and skills (p<0.0001 for all questions). Self management strategies were recommended more frequently post-intervention. The majority of responders who were guideline-inconsistent for work and bed rest recommendations (82% and 62% respectively) at pre-intervention, gave guideline-consistent responses at post-intervention. CONCLUSION: An interprofessional pain education program set within a framework that aligns health policy and practice, encourages PCPs to adopt more self-reported evidence-based attitudes, beliefs and clinical behaviours in their management of patients with nsLBP. However, further research is required to determine cost effectiveness of this approach when compared with other modes of educational delivery and to examine PCP behaviours in actual clinical practice

eAdmin: Interoperability for administrative data: Basis for mobility and borderless health services

This presentation was given by Stephan Schug at the Med-e-tel 2005 Conference in Luxembourg on April 6th, 2005.Trans-National Interoperability in eHealth: Facing the Challenges and Overcoming the Barriers. Presents a coherent picture of interoperability in eHealth, with examples across the various types of services, and analyses of the challenges and roadblocks to eHealth implementation, identifying the gaps, and concretely recommending the way ahead. Our approach will be trans-national because our aim is that the various systems now being developed in the different countries and regions can communicate with each other; so that the solutions offered will also have a broad trans-national market for applications; that the European citizen, patient, health practitioner may receive and provide services across national borders. The presentations will link the broad topics such as technical standards and semantics with certification, accreditation, organisation, reimbursement and even cultural differences. The underlying philosophy is that unless the problems are viewed holistically and the approaches coordinated openly and trans-nationally, there will be little progress in this exciting and challenging arena.Chaired by TM-Alliance (a European Space Agency, World Health Organization, International Telecommunication Union, and European Commission partnership)