| 1. |
- Bäck-Pettersson, Siv, 1946, et al.
(författare)
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FOU-kompetensförsörjningsprogram för sjuksköterskor i Fyrbodal
- 2012
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Sammanfattning Betydelsen av FoU-kompetensförsörjningsprogrammet som varit en medveten och strategisk satsning inom FoU-området kan sammanfattas på följande sätt: Deltagarnas behållning och föreskriven akademisk utveckling har haft en närmast hundraprocentig måluppfyllelse och gett kliniskt verksamma sjuksköterskor en bra start på sin akademiska karriär. Programmet illustrerar ett effektivt sätt att stimulera sjuksköterskors livslånga lärande genom att bygga upp förmågan att genomföra och tillämpa omvårdnadsforskning i klinisk praktik. Programmet har också bidragit till utvecklingen av kompetenta handledare för studenter under utbildning. Flertalet av deltagarna har utvecklat både en önskan om och kompetens för att ta på sig ledande uppdrag såväl inom den egna verksamheten som i gränsöverskridande projekt både inom Fyrbodal och nationellt. Programmet har medverkat till att bryta revirtänkande och kan bidra till en mer öppen och gränsöverskridande kultur inom Fyrbodalområdets hälso- och sjukvård. Det har även medverkat till att deltagarna skaffat sig en helhetssyn på och förståelse för olika vårdverksamheter. Programmets design kan användas för att utveckla såväl professionell som vetenskaplig kompetens och kan med fördel användas inom andra yrkesgrupper med medellång vårdutbildning, eller för en tvärprofessionell grupp.
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| 2. |
- Bäck-Pettersson, Siv, 1946, et al.
(författare)
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Nurses´Experiences of participation in a research and development programme
- 2013
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 22:7-8, s. 1103-1111
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectives. To describe clinical nurses’ experience of participating in a Research and Development (R&D) programme and its influence on their research interest and ability to conduct and apply nursing research. Background. To stimulate nurses’ research interest and to overcome barriers for building research capacity in nursing, there is a need for sustainable research programmes. A two-year programme was designed for nurses, to take part in both an academic education for master and research seminars and workshops to conduct a research project from idea to publication. Design. A qualitative approach using using focus group interviews. Methods. Registered nurses (n = 12) with a bachelor’s degree in nursing, participated. Data were collected in focus group interviews, after one year and when the programme ended. Content analysis was used to analyse the data. Results. The findings consist of two themes: being a traveller in the world of nursing research, which included three categories, and experiencing professional growth as a result of nursing research training, in both cases focusing on the experience of students involved in a cohesive programme which included four categories: discovering new dimensions of clinical nursing practice; selected and confirmed; supported by professional others; development of professional self-concept. Conclusions. To support early career researchers, there is a need for strong leadership, an organisational and supportive infrastructure underpinning research capability building in nurses. In this context, research strategies, programmes and collaboration between leaders of academia and clinical institutions appear to be essential. Relevance to clinical practice. The R&D programme illustrates an effective way of stimulating nurses’ lifelong learning by building the capacity to conduct and apply nursing research in clinical practice. The structure of the programme can be used as a model in other contexts.
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| 3. |
- Ceberg, Sofie, et al.
(författare)
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Evaluation of breathing interplay effects during VMAT by using 3D gel measurements
- 2013
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Ingår i: 7th International Conference on 3D Radiation Dosimetry (IC3DDose). - : IOP Publishing. - 1742-6588 .- 1742-6596. ; 444, s. 012098-012098
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Konferensbidrag (refereegranskat)abstract
- Respiratory motion during dynamic radiotherapy may affect the absorbed dose distribution both by dose-reducing smoothing and by more complicated interplay effects. In this study we present a novel method to determine the relative importance of these two effects. For the two dynamic deliveries studied in this work, the expected target dose reduction due to the smoothing effect was estimated by measurements convolved by the motion function. Remaining absorbed dose differences were attributed to interplay effects between the motion of the gel phantom and the movement of the modulating MLC leaves during modulated arc radiotherapy. The total dosimetric effect due to breathing motion and dynamic MLC motion during VMAT delivery resulted in an average of about 4% target dose reduction. Comparing with only the smoothing effect, the average difference was decreased to around 1%, and the remaining distribution was attributed to interplay effects. Although the interplay effects were small compared to the smoothing effect, the standard deviations of 1.4-2.3% (1SD) were larger than the narrow distribution for repeated stationary measurement with a standard deviation between 0.5-0.9% (1SD).
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| 4. |
- Ceberg, Sofie, et al.
(författare)
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Modelling the dynamic dose response of an nMAG polymer gel dosimeter.
- 2012
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Ingår i: Physics in Medicine and Biology. - : IOP Publishing. - 1361-6560 .- 0031-9155. ; 57:15, s. 4845-4853
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Tidskriftsartikel (refereegranskat)abstract
- Gel dosimetry measures the absorbed radiation dose with high spatial resolution in 3D. However, recently published data show that the response of metacrylic-based polymer gels depends on the segmented delivery pattern, which could potentially be a considerable disadvantage for measurements of modern dynamic radiotherapy techniques. The aim of this study is to design a dynamic compartment model for the response of a gel dosimeter, exposed to an arbitrary irradiation pattern (segmented delivery and intensity modulation), in order to evaluate the associated effects on absorbed dose measurements. The model is based on the separation of the protons affecting the magnetic resonance signal (i.e. the R2 value) into six compartments, described by a set of differential equations. The model is used to calculate R2 values for a number of different segmented delivery patterns between 0-4 Gy over 1-33 fractions. Very good agreement is found between calculated and measured R2 values, with an average difference of 0.3 ± 1.1% (1 SD). The model is also used to predict the behaviour of a gel dosimeter exposed to irradiation according to typical IMRT, VMAT and respiratory gating scenarios. The calculated R2 values are approximately independent of the segmented delivery, given that the same total dose is delivered during the same total time. It is concluded that this study helps to improve the theoretical understanding of the dependence of metacrylic-based polymer gel response to segmented radiation delivery.
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| 5. |
- Ceberg, Sofie, et al.
(författare)
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Radiotherapy delivery during motion
- 2010
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Ingår i: Journal of Physics: Conference Series. - : IOP Publishing. - 1742-6588 .- 1742-6596. ; 250
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Tidskriftsartikel (refereegranskat)abstract
- This paper discusses the 3D dosimetric consequences of radiotherapy delivery during two kinds of motion, (i) the respiratory motion by the patient and (ii) the motion by the gantry while rotating around the patient. Respiratory motion primarily compromises treatments in the thorax and abdomen regions. Several strategies to reduce respiratory motion effects have been developed or are under development. The organ motion could for instance be measured and incorporated in the treatment planning, or adapted to by using respiratory gating and tumour-tracking delivery techniques. Gantry motion is involved in various forms of intensity-modulated arc-therapy techniques. The purpose is to increase the modulation by simultaneously varying the MLC positions, the rotation speed of the gantry, and the dose rate during the treatment. The advantage of these techniques is the increased possibility to deliver a high absorbed dose to the target volume while minimizing the dose to normal tissues. However, the dosimetric uncertainties associated with motion, small fields and steep dose gradients, has to be evaluated in detail, and this requires adequate true 3D dose-verification tools.
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| 6. |
- Ceberg, Sofie, et al.
(författare)
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RapidArc treatment verification in 3D using polymer gel dosimetry and Monte Carlo simulation.
- 2010
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Ingår i: Physics in Medicine and Biology. - : IOP Publishing. - 1361-6560 .- 0031-9155. ; 55:17, s. 4885-4898
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to verify the advanced inhomogeneous dose distribution produced by a volumetric arc therapy technique (RapidArc) using 3D gel measurements and Monte Carlo (MC) simulations. The TPS (treatment planning system)-calculated dose distribution was compared with gel measurements and MC simulations, thus investigating any discrepancy between the planned dose delivery and the actual delivery. Additionally, the reproducibility of the delivery was investigated using repeated gel measurements. A prostate treatment plan was delivered to a 1.3 liter nPAG gel phantom using one single arc rotation and a target dose of 3.3 Gy. Magnetic resonance imaging of the gel was carried out using a 1.5 T scanner. The MC dose distributions were calculated using the VIMC-Arc code. The relative absorbed dose differences were calculated voxel-by-voxel, within the volume enclosed by the 90% isodose surface (VOI(90)), for the TPS versus gel and TPS versus MC. The differences between the verification methods, MC versus gel, and between two repeated gel measurements were investigated in the same way. For all volume comparisons, the mean value was within 1% and the standard deviation of the differences was within 2.5% (1SD). A 3D gamma analysis between the dose matrices were carried out using gamma criteria 3%/3 mm and 5%/5 mm (% dose difference and mm distance to agreement) within the volume enclosed by the 50% isodose surface (VOI(50)) and the 90% isodose surface (VOI(90)), respectively. All comparisons resulted in very high pass rates. More than 95% of the TPS points were within 3%/3 mm of both the gel measurement and MC simulation, both inside VOI(50) and VOI(90). Additionally, the repeated gel measurements showed excellent consistency, indicating reproducible delivery. Using MC simulations and gel measurements, this verification study successfully demonstrated that the RapidArc plan was both accurately calculated and delivered as planned.
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| 7. |
- Ceberg, Sofie, et al.
(författare)
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Tumor-tracking radiotherapy of moving targets; verification using 3D polymer gel, 2D ion-chamber array and biplanar diode array
- 2010
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Ingår i: Journal of Physics: Conference Series. - : IOP Publishing. - 1742-6588 .- 1742-6596. ; 250:1, s. 235-239
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to carry out a dosimetric verification of a dynamic multileaf collimator (DMLC)-based tumor-tracking delivery during respiratory-like motion. The advantage of tumor-tracking radiation delivery is the ability to allow a tighter margin around the target by continuously following and adapting the dose delivery to its motion. However, there are geometric and dosimetric uncertainties associated with beam delivery system constraints and output variations, and several investigations have to be accomplished before a clinical integration of this tracking technique. Two types of delivery were investigated in this study I) a single beam perpendicular to a target with a one dimensional motion parallel to the MLC moving direction, and II) an intensity modulated arc delivery (RapidArc®) with a target motion diagonal to the MLC moving direction. The feasibility study (I) was made using an 2D ionisation chamber array and a true 3D polymer gel. The arc delivery (II) was verified using polymer gel and a biplanar diode array. Good agreement in absorbed dose was found between delivery to a static target and to a moving target with DMLC tracking using all three detector systems. However, due to the limited spatial resolution of the 2D array a detailed comparison was not possible. The RapidArc® plan delivery was successfully verified using the biplanar diode array and true 3D polymer gel, and both detector systems could verify that the DMLC-based tumor-tracking delivery system has a very good ability to account for respiratory target motion.
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| 8. |
- Jönsson, Mattias, et al.
(författare)
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Technical evaluation of different motion-monitoring systems for respiratory gating in radiation therapy
- 2013
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Ingår i: Medical Physics in the Baltic States. - 1822-5721. ; , s. 38-41
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Konferensbidrag (refereegranskat)abstract
- The purpose of this work was to evaluate three motion-monitoring systems: Sentinel (TM), Catalyst (TM) (both C-RAD) and Real-time Position Management (RPM (TM)) system (Varian Medical Systems Inc) for respiratory gating in radiotherapy. To measure the systems. latency, an in-house built circuit with a microcontroller operating a piston was used. The trigger pulse was sent from the gating systems to the accelerator within 300 mu s. However, the response time of the accelerator could be over 300 ms
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| 9. |
- Nordström, Fredrik, et al.
(författare)
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3D geometric gel dosimetry verification of intraprostatic fiducial guided hypofractionated radiotherapy of prostate cancer
- 2010
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Ingår i: Journal of Physics: Conference Series. - : IOP Publishing. - 1742-6596. ; 250, s. 287-291
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Konferensbidrag (refereegranskat)abstract
- This pre-study is aimed to investigate the feasibility of a normoxic polyacrylamide gel (nPAG) dosimeter with implanted gold fiducials to evaluate the geometric precision, including setup correction strategies, in the delivery of hypofractionated treatments. For this purpose a phantom consisting of three parts was constructed: (1) the patient simulating volume, providing realistic scatter conditions and weight, (2) a bottle containing the active dosimetric volume and (3) the gold fiducials and the fiducial support structure. A 6.1 Gy prostate IMRT treatment was delivered to the phantom using the sliding-window technique. The phantom was positioned prior to the treatment using the implanted fiducials and kV on-board imaging. An overlay of the 95% isosurface of the TPS calculated dose distribution and the measured dose distribution using gel showed good agreement. The clinical target volume (CTV) was well centred inside the 95% isodose surface of the measured volume. It was shown for the evaluated case that the use of on-board imaging and integrated setup correction tools could be used to compensate for a deliberately introduced offset in CTV position. The study showed that MRI based nPAG gel dosimetry can be used to verify setup correction procedures using implanted gold fiducials.
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| 10. |
- Nordström, Fredrik, et al.
(författare)
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4D dosimetry and its applications to pre-treatment quality control and real-time in vivo dosimetry of VMAT treatments
- 2013
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Ingår i: 7th International Conference on 3D Radiation Dosimetry (IC3DDose). - : IOP Publishing. - 1742-6596 .- 1742-6588. ; 444, s. 012021-012021
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Konferensbidrag (refereegranskat)abstract
- In this study, a 4D dosimetry concept was developed. This concept included a method for calculation of 3D reference absorbed dose matrices at every control point of the delivery using a clinical treatment planning system (TPS). Further, the gamma evaluation method was extended to incorporate the 4th dimension of the TPS calculated dose distributions. The applications of the 4D dosimetry concept on pre-treatment quality control and real-time in vivo dosimetry were investigated.
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| 11. |
- Nordström, Fredrik, et al.
(författare)
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Control chart analysis of data from a multicenter monitor unit verification study.
- 2012
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Ingår i: Radiotherapy and Oncology. - : Elsevier BV. - 1879-0887 .- 0167-8140. ; 102:3, s. 364-370
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: This study aims to investigate the process of monitor unit verification using control charts. Control charts is a key tool within statistical process control (SPC), through which process characteristics can be visualized, usually chronologically with statistically determined limits. MATERIAL AND METHODS: Our group has developed a monitor unit verification software that has been adopted at several Swedish institutions for pre-treatment verification of radiotherapy treatments. Deviations between point dose calculations using the treatment planning systems and using the independent monitor unit verification software from 9219 treatment plans and five different institutions were included in this multicenter study. The process of monitor unit verification was divided into subprocesses. Each subprocess was analyzed using probability plots and control charts. RESULTS: Differences in control chart parameters for the investigated subprocesses were found between different treatment sites and different institutions, as well as between different treatment techniques. 19 of 37 subprocesses met the clinical specification (±5%), i.e. process capability index was equal to or above one. CONCLUSIONS: Control charts were found to be a useful tool for continuous analysis of data from the monitor unit verification software for patient specific quality control, as well as for comparisons between different institutions and treatment sites. The derived control chart limits were in agreement with AAPM TG114 guidelines on action levels.
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| 12. |
- Nordström, Fredrik, et al.
(författare)
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Ensuring the integrity of treatment parameters throughout the radiotherapy process.
- 2012
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Ingår i: Radiotherapy and Oncology. - : Elsevier BV. - 1879-0887 .- 0167-8140. ; 103:3, s. 299-304
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: Ensuring data integrity in radiotherapy is of major importance and a complex task. The aim of this study was to compare three different combinations of treatment planning and record and verify systems with respect to data integrity. MATERIALS AND METHODS: A software for comparison of treatment parameters in DICOM-RT files was developed using the MATLAB R2010a (MathWorks Inc.) environment. One hundred treatment plans were analyzed for each system combination. In the first step of the analysis, all parameters were compared and a normal condition for each system combination was identified. The second step focused on the discovery of potential special cause deviations, e.g. by applying tolerance levels. RESULTS: In total, 15% and 0.37% of all comparisons failed to meet the defined integrity demands in step 1 and step 2 of the analysis, respectively. Differences in the data integrity level between the systems were observed, ranging on average from 3.1 to 11.9 discrepancies per beam for the different RV-TPS combinations. CONCLUSIONS: The proposed method can be used to increase the safety for individual patients by ensuring that the intended treatment is delivered. The system combination with the highest level of data integrity was found to be the one which shares a single database.
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| 13. |
- Polistena, Andrea, et al.
(författare)
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Matrilysin Expression Related to Radiation and Microflora Changes in Murine Bowel.
- 2011
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Ingår i: The Journal of surgical research. - : Elsevier BV. - 1095-8673 .- 0022-4804. ; 167, s. 137-143
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Matrilysin (MMP-7) elevation after radiotherapy is shown in humans. Matrilysin regulates certain cytokines and the production of bactericidal proteins when the mucosa is exposed to bacterial antigens. We investigate the effect of irradiation on matrilysin and microflora in murine bowel, after modulation with antibiotics. METHODS: Animals were divided into two different groups a radiation group (72 animals) and sham radiation group (36 animals). Animals were divided into smaller groups of six according to radiation dose (19 or 38 Gy or sham). Seven days before radiotherapy ampicillin 500 mg/kg/d was administered intramuscularly, in the antibiotic groups. An exteriorized segment of ileum was subjected to single high dose radiation (19 or 38 Gy). Samples were collected 2, 24, and 48 h and analyzed for microflora, MIP-2, TGF-β, and MMP-7. RESULTS: The combination of antibiotics and irradiation leads to an early significant reduction of bacteria, down-regulates MIP-2, up-regulates TGF-β and elevation of MMP-7 to levels achieved by antibiotics or irradiation alone. Lactobacilli were reduced to non-existent levels after antibiotics. CONCLUSIONS: Pretreatment with Ampicillin before irradiation and laparotomy in a murine model leads to Matrilysin over-expression as achieved by radiotherapy alone. Microfloral regulation does not affect MMP-7 stimulation after surgical or radiological trauma. Radiotherapy overrides the effect of antibiotics leading to an up-regulation of MMP-7, TGF-β and MIP-2 expression between 24 h and 48 h.
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| 14. |
- Svensson, Henrik, et al.
(författare)
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An investigation of a potential multipurpose readout modality for two and three-dimensional dosimetry using optical computed tomography scanners
- 2011
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Ingår i: Medical Physics in the Baltic States. - 1822-5721. ; , s. 39-44
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Konferensbidrag (refereegranskat)abstract
- Radiochromic film, polymer gel and radiochromic plastic are three different kinds of dosimeters developed for radiation therapy and suitable for optical readout. In this study, different optical CT scanners are used to scan the dosimeters to find out if they could be used as multi-purpose scanners, i.e. for readout of the different kinds of dosimeters. Promising results are found but further development needs to be done before any of the scanners could be categorized as multi-purpose scanners.
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| 15. |
- Svensson, H., et al.
(författare)
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Feasibility study using MRI and two optical CT scanners for readout of polymer gel and Presage (TM)
- 2013
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Ingår i: 7th International Conference on 3D Radiation Dosimetry (IC3DDose). - : IOP Publishing. - 1742-6588 .- 1742-6596. ; 444, s. 012079-012079
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Konferensbidrag (refereegranskat)abstract
- The aim of this study was to compare the conventional combination of three-dimensional dosimeter (nPAG gel) and readout method (MRI) with other combinations of three-dimensional dosimeters (nPAG gel/Presage (TM)) and readout methods (optical CT scanners). In the first experiment, the dose readout of a gel irradiated with a four field-box technique was performed with both an Octopus IQ scanner and MRI. It was seen that the MRI readout agreed slightly better to the TPS. In another experiment, a gel and a Presage (TM) sample were irradiated with a VMAT field and read out using MRI and a fast laser scanner, respectively. A comparison between the TPS and the volumes revealed that the MRI/gel readout had closer resemblance to the TPS than the optical CT/Presage (TM) readout. There are clearly potential in the evaluated optical CT scanners, but more time has to be invested in the particular scanning scenario than was possible in this study.
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