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| 2. |
- Abul-Kasim, Kasim, et al.
(author)
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Optimization of Radiation Exposure and Image Quality of the Cone-beam O-arm Intraoperative Imaging System in Spinal Surgery.
- 2012
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In: Journal of Spinal Disorders and Techniques. - 1539-2465. ; 25:1, s. 52-58
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Journal article (peer-reviewed)abstract
- STUDY DESIGN: Retrospective study. OBJECTIVES: To optimize the radiation doses and image quality for the cone-beam O-arm surgical imaging system in spinal surgery. SUMMARY OF BACKGROUND: Neurovascular compromise has been reported after screw misplacement during thoracic pedicle screw insertion. The use of O-arm with or without navigation system during spinal surgery has been shown to lower the rate of screw misplacement. The main drawback of such imaging surgical systems is the high radiation exposure. METHODS: Chest phantom and cadaveric pig spine were examined on the O-arm with different scan settings: 2 were recommended by the O-arm manufacturer (120 kV/320 mAs, and 120 kV/128 mAs), and 3 low-dose settings (80 kV/80 mAs, 80 kV/40 mAs, and 60 kV/40 mAs). The radiation doses were estimated by Monte Carlo calculations. Objective evaluation of image quality included interobserver agreement in the measurement of pedicular width in chest phantom and assessment of screw placement in cadaveric pig spine. RESULTS: The effective dose/cm for 120 kV/320 mAs scan was 13, 26, and 69 times higher than those delivered with 80 kV/80 mAs, 80 kV/40 mAs, and 60 kV/40 mAs scans, respectively. Images with 60 kV/40 mAs were unreliable. Images with 80 kV/80 mAs were considered reliable with good interobserver agreement when measuring the pedicular width (random error 0.38 mm and intraclass correlation coefficient 0.979) and almost perfect agreement when evaluating the screw placement (κ value 0.86). CONCLUSIONS: The radiation doses of the O-arm system can be reduced 5 to 13 times without negative impact on image quality with regard to information required for spinal surgery.
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| 3. |
- Aho Fält, Tobias, et al.
(author)
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Simulated Dose Reduction for Abdominal CT With Filtered Back Projection Technique: Effect on Liver Lesion Detection and Characterization
- 2019
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In: American Journal of Roentgenology: diagnostic imaging and related sciences. - 0361-803X. ; 212:1, s. 84-93
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Journal article (peer-reviewed)abstract
- OBJECTIVE. Previous studies have shown the possibility to reduce radiation dose in abdominal CT by 25–50% without negatively affecting detection of liver lesions. How radiation dose reduction affects characterization of liver metastases is not as well known. The objective of this study was to investigate how different levels of simulated dose reduction affect the detection and characterization of liver lesions, primarily hypovascular metastases. A secondary objective was to analyze the relationship between the lesion size and contrast-to-noise ratio (CNR) and the detection rate.MATERIALS AND METHODS. Thirty-nine patients (19 with metastases and 20 without) were retrospectively selected. The following radiation dose levels (DLs) were simulated: 100% (reference level), 75%, 50%, and 25%. Five readers were asked to mark liver lesions and rate the probability of malignancy on a 5-grade Likert scale. Noninferiority analysis using the jackknife free-response ROC (JAFROC) method was performed as well as direct comparison of detection rates and grades.RESULTS. JAFROC analysis showed noninferior detection and characterization of metastases at DL75 as compared with DL100. However, the number of benign lesions and false-positive localizations rated as “suspected malignancy” was significantly higher at DL75.CONCLUSION. Radiation dose can be reduced by 25% without negatively affecting diagnosis of hypovascular liver metastases. Characterization of benign lesions, however, is impaired at DL75, which may lead to unnecessary follow-up examinations. Finally, increased image noise seems to affect the detection of small lesions to a degree that cannot be explained solely by the reduction in CNR.
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| 6. |
- Aurumskjöld, Marie-Louise, et al.
(author)
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Evaluation of an iterative model-based reconstruction of pediatric abdominal CT with regard to image quality and radiation dose
- 2018
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In: Acta Radiologica. - : SAGE Publications. - 1600-0455 .- 0284-1851. ; 59:6, s. 740-747
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Journal article (peer-reviewed)abstract
- BackgroundIn pediatric patients, computed tomography (CT) is important in the medical chain of diagnosing and monitoring various diseases. Because children are more radiosensitive than adults, they require minimal radiation exposure. One way to achieve this goal is to implement new technical solutions, like iterative reconstruction.PurposeTo evaluate the potential of a new, iterative, model-based method for reconstructing (IMR) pediatric abdominal CT at a low radiation dose and determine whether it maintains or improves image quality, compared to the current reconstruction method.Material and MethodsForty pediatric patients underwent abdominal CT. Twenty patients were examined with the standard dose settings and 20 patients were examined with a 32% lower radiation dose. Images from the standard examination were reconstructed with a hybrid iterative reconstruction method (iDose4), and images from the low-dose examinations were reconstructed with both iDose4 and IMR. Image quality was evaluated subjectively by three observers, according to modified EU image quality criteria, and evaluated objectively based on the noise observed in liver images.ResultsVisual grading characteristics analyses showed no difference in image quality between the standard dose examination reconstructed with iDose4 and the low dose examination reconstructed with IMR. IMR showed lower image noise in the liver compared to iDose4 images. Inter- and intra-observer variance was low: the intraclass coefficient was 0.66 (95% confidence interval = 0.60–0.71) for the three observers.ConclusionIMR provided image quality equivalent or superior to the standard iDose4 method for evaluating pediatric abdominal CT, even with a 32% dose reduction.
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| 8. |
- Aurumskjöld, Marie-Louise, et al.
(author)
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Improvements to image quality using hybrid and model-based iterative reconstructions: a phantom study.
- 2017
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In: Acta radiologica (Stockholm, Sweden : 1987). - : SAGE Publications. - 1600-0455 .- 0284-1851. ; 58:1, s. 53-61
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Journal article (peer-reviewed)abstract
- The number of computed tomography (CT) examinations is increasing and leading to an increase in total patient exposure. It is therefore important to optimize CT scan imaging conditions in order to reduce the radiation dose. The introduction of iterative reconstruction methods has enabled an improvement in image quality and a reduction in radiation dose.
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| 9. |
- Aurumskjöld, Marie-Louise, et al.
(author)
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MODEL-BASED ITERATIVE RECONSTRUCTION ENABLES THE EVALUATION OF THIN-SLICE COMPUTED TOMOGRAPHY IMAGES WITHOUT DEGRADING IMAGE QUALITY OR INCREASING RADIATION DOSE.
- 2016
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In: Radiation Protection Dosimetry. - : Oxford University Press (OUP). - 1742-3406 .- 0144-8420. ; 169:1-4, s. 100-106
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Journal article (peer-reviewed)abstract
- Computed tomography (CT) is one of the most important modalities in a radiological department. This technique not only produces images that enable radiological reports with high diagnostic confidence, but it may also provide an elevated radiation dose to the patient. The radiation dose can be reduced by using advanced image reconstruction algorithms. This study was performed on a Brilliance iCT, equipped with iDose(4) iterative reconstruction and an iterative model-based reconstruction (IMR) method. The purpose was to investigate the effect of reduced slice thickness combined with an IMR method on image quality compared with standard slice thickness with iDose(4) reconstruction. The results of objective and subjective image quality evaluations showed that a thinner slice combined with IMR can improve the image quality and reduce partial volume artefacts compared with the standard slice thickness with iDose(4). In conclusion, IMR enables reduction of the slice thickness while maintaining or even improving image quality versus iDose(4).
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| 10. |
- Aurumskjöld, Marie-Louise, et al.
(author)
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Model based iterative reconstruction IMR gives possibility to evaluate thinner slice thicknesses than conventional iterative reconstruction iDose(4) - a phantom study
- 2015
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In: Medical Imaging 2015: Physics of Medical Imaging. - : SPIE. - 1996-756X .- 0277-786X. ; 9412, s. 94124-94124
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Conference paper (peer-reviewed)abstract
- Computed tomography (CT) is one of the most important modalities in a radiological department, which produces images with high diagnostic confidence, but in some cases contributes to a high radiation dose to the patient. The radiation dose can be reduced by the use of advanced image reconstruction algorithms. This study was done on a Philips Brilliance iCT with iterative reconstruction iDose(4) and model-based iterative reconstruction IMR. The purpose was to investigate the effect on the image quality with thin slice images reconstructed with IMR, compared to standard slice thickness reconstructed with iDose(4). Objective measurements of noise and contrast-to-noise ratio were performed using an image quality phantom, an anthropomorphic phantom and clinical cases. Subjective evaluations of low-contrast resolution were performed by observers using an image quality phantom. IMR gives strong noise reduction and enhanced low-contrast and thereby enable selection of thinner slice thickness. Objective evaluation of image noise shows that thin slices reconstructed with IMR provides lower noise than thicker slice images reconstructed with iDose(4). With IMR the slice thickness is of less importance for the noise. With thinner slices the partial volume artefacts becomes less pronounced. In conclusion, we have shown that IMR enables reduction of the slice thickness and at the same time maintain or even reduce the noise level compared to iDose(4) reconstruction with standard slice thickness. This will subsequently result in an improvement of image quality for images reconstructed with IMR.
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| 12. |
- Bebbington, Natalie A., et al.
(author)
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A Nordic survey of CT doses in hybrid PET/CT and SPECT/CT examinations
- 2019
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In: EJNMMI Physics. - : Springer Science and Business Media LLC. - 2197-7364. ; 6:1
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Journal article (peer-reviewed)abstract
- Background: Computed tomography (CT) scans are routinely performed in positron emission tomography (PET) and single photon emission computed tomography (SPECT) examinations globally, yet few surveys have been conducted to gather national diagnostic reference level (NDRL) data for CT radiation doses in positron emission tomography/computed tomography (PET/CT) and single photon emission computed tomography/computed tomography (SPECT/CT). In this first Nordic-wide study of CT doses in hybrid imaging, Nordic NDRL CT doses are suggested for PET/CT and SPECT/CT examinations specific to the clinical purpose of CT, and the scope for optimisation is evaluated. Data on hybrid imaging CT exposures and clinical purpose of CT were gathered for 5 PET/CT and 8 SPECT/CT examinations via designed booklet. For each included dataset for a given facility and scanner type, the computed tomography dose index by volume (CTDIvol) and dose length product (DLP) was interpolated for a 75-kg person (referred to as CTDIvol,75kg and DLP75kg). Suggested NDRL (75th percentile) and achievable doses (50th percentile) were determined for CTDIvol,75kg and DLP75kg according to clinical purpose of CT. Differences in maximum and minimum doses (derived for a 75-kg patient) between facilities were also calculated for each examination and clinical purpose. Results: Data were processed from 83 scanners from 43 facilities. Data were sufficient to suggest Nordic NDRL CT doses for the following: PET/CT oncology (localisation/characterisation, 15 systems); infection/inflammation (localisation/characterisation, 13 systems); brain (attenuation correction (AC) only, 11 systems); cardiac PET/CT and SPECT/CT (AC only, 30 systems); SPECT/CT lung (localisation/characterisation, 12 systems); bone (localisation/characterisation, 30 systems); and parathyroid (localisation/characterisation, 13 systems). Great variations in dose were seen for all aforementioned examinations. Greatest differences in DLP75kg for each examination, specific to clinical purpose, were as follows: SPECT/CT lung AC only (27.4); PET/CT and SPECT/CT cardiac AC only (19.6); infection/inflammation AC only (18.1); PET/CT brain localisation/characterisation (16.8); SPECT/CT bone localisation/characterisation (10.0); PET/CT oncology AC only (9.0); and SPECT/CT parathyroid localisation/characterisation (7.8). Conclusions: Suggested Nordic NDRL CT doses are presented according to clinical purpose of CT for PET/CT oncology, infection/inflammation, brain, PET/CT and SPECT/CT cardiac, and SPECT/CT lung, bone, and parathyroid. The large variation in doses suggests great scope for optimisation in all 8 examinations.
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| 13. |
- Begano, Dino, et al.
(author)
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TO USE OR NOT USE PATIENT SHIELDING ON PREGNANT WOMEN UNDERGOING CT PULMONARY ANGIOGRAPHY : A PHANTOM STUDY
- 2020
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In: Radiation Protection Dosimetry. - : Oxford University Press (OUP). - 1742-3406 .- 0144-8420. ; 189:4, s. 458-465
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Journal article (peer-reviewed)abstract
- Pregnancy increases the risk of pulmonary embolism. Computed tomography pulmonary angiography (CTPA) is used for diagnosis. CT generates ionising radiation, and thus, abdominal shielding may be used. This phantom study investigated the effects of patient shielding and scan length reduction on the fetal and maternal ionising radiation dose from CTPA. The absorbed dose to the fetus was measured using thermoluminescent dosemeters. Estimated effective doses to the pregnant patient were based on the dose-length products. Shielding increased both the effective dose to the patient by 47% and the mean absorbed dose to the fetus (0.10 vs. 0.12 mGy; p < 0.001) compared with unshielded standard CTPA, as it affected the automatic exposure control. Shielded short CTPA marginally lowered only the mean fetal absorbed dose (0.03 vs. 0.02 mGy; p = 0.018). Shortening the scan reduced the fetal absorbed dose most effectively by 70% (0.10 vs. 0.03 mGy; p = 0.006), compared with the standard unshielded scan. Shielding modestly reduces fetal radiation dose but may compromise automatic exposure control, possibly increasing the maternal and fetal radiation dose. Shortening the scan is beneficial, assuming anatomical coverage is secured.
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| 14. |
- Box, Marcus
(author)
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New Venture, Survival, Growth : Continuance, Termination and Growth of Business Firms and Business Populations in Sweden During the 20th Century
- 2005
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Doctoral thesis (other academic/artistic)abstract
- This dissertation focuses on the formation, growth and discontinuance of business populations and firms in Sweden during the 20th century. It addresses some key issues in the domain of economic and social sciences, and in particular entrepreneurship and small business research: if and when firms grow, stagnate and decline, as well as how long firms survive and when they are likely to disband. Previous research has primarily analyzed these questions from a short time frame. Further, an individual or firm-oriented focus is commonly assumed. In that, alternative or complementary explanations to the growth and survival of firms may be disregarded. In contrast to much previous research, this dissertation assumes a micro-to-macro, longitudinal and demographic population approach. The period of investigation is over one hundred years. In addressing the growth and survival of firms, it takes into account the impact of firm-specific structural factors (such as firm age and size), generation (cohort) effects, as well as the influence of macroeconomic, exogenous factors. Further, the relationship between managerial/ownership succession and firm performance is also addressed. Both cross-sectional and longitudinal databases are employed in the dissertation. Its main empirical material consists of unique longitudinal data on new business firms, traced at the firm level from their birth to their termination. More specifically, seven birth cohorts – generations – of approximately 2,200 firms founded in 1899, 1909, 1912, 1921, 1930, 1942 and 1950 are included. The main findings show that ownership/management succession in firms had a quite weak correlation with firm performance and survival. At least at an aggregate level, and with some exceptions, it is debatable if the loss and replacement of owner-managers in small and in larger firms have any observable effects on firm performance. Furthermore, macroeconomic phenomena influence the conditions of individual firms as well as populations/aggregates of businesses. Both the growth and termination of firms and firm populations are found to be related to real economic (environmental) conditions; e.g. favorable macroeconomic conditions implied that firms grew in size. At the same time, under certain circumstances, the influence of structural variables (firm age and size) – as suggested in much previous research – is found to be of importance. As concerns firm growth, as well as firm termination, the economic environment and structural factors interact. These findings challenges individual or firm-level research that mainly focus on personal traits and behaviors in explaining firm success and failure. Other previous assumptions are also challenged when taking a longer time perspective into consideration. For decades, organization and business research have acknowledged a liability of newness and of size for business firms. While this might be true under some conditions, this liability of newness is falsified in the study: the termination behavior of some firm generations did not correspond with these assumptions. Thus, the perspectives and methodology applied in the dissertation complement earlier approaches in entrepreneurship and small business research.
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| 15. |
- Carlsson, Marcus, et al.
(author)
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A note on variable susceptibility, the herd-immunity threshold and modeling of infectious diseases
- 2023
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In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 18
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Journal article (peer-reviewed)abstract
- The unfolding of the COVID-19 pandemic has been very difficult to predict using mathematical models for infectious diseases. While it has been demonstrated that variations in susceptibility have a damping effect on key quantities such as the incidence peak, the herd-immunity threshold and the final size of the pandemic, this complex phenomenon is almost impossible to measure or quantify, and it remains unclear how to incorporate it for modeling and prediction. In this work we show that, from a modeling perspective, variability in susceptibility on an individual level is equivalent with a fraction θ of the population having an “artificial” sterilizing immunity. We also derive novel formulas for the herd-immunity threshold and the final size of the pandemic, and show that these values are substantially lower than predicted by the classical formulas, in the presence of variable susceptibility. In the particular case of SARS-CoV-2, there is by now undoubtedly variable susceptibility due to waning immunity from both vaccines and previous infections, and our findings may be used to greatly simplify models. If such variations were also present prior to the first wave, as indicated by a number of studies, these findings can help explain why the magnitude of the initial waves of SARS-CoV-2 was relatively low, compared to what one may have expected based on standard models.
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| 16. |
- Carlsson, Marcus, et al.
(author)
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COVID-19 Modeling Outcome versus Reality in Sweden
- 2022
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In: Viruses. - : MDPI AG. - 1999-4915. ; 14:8
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Journal article (peer-reviewed)abstract
- It has been very difficult to predict the development of the COVID-19 pandemic based on mathematical models for the spread of infectious diseases, and due to major non-pharmacological interventions (NPIs), it is still unclear to what extent the models would have fit reality in a “do nothing” scenario. To shed light on this question, the case of Sweden during the time frame from autumn 2020 to spring 2021 is particularly interesting, since the NPIs were relatively minor and only marginally updated. We found that state of the art models are significantly overestimating the spread, unless we assume that social interactions significantly decrease continuously throughout the time frame, in a way that does not correlate well with Google-mobility data nor updates to the NPIs or public holidays. This leads to the question of whether modern SEIR-type mathematical models are unsuitable for modeling the spread of SARS-CoV-2 in the human population, or whether some particular feature of SARS-CoV-2 dampened the spread. We show that, by assuming a certain level of pre-immunity to SARS-CoV-2, we obtain an almost perfect data-fit, and discuss what factors could cause pre-immunity in the mathematical models. In this scenario, a form of herd-immunity under the given restrictions was reached twice (first against the Wuhan-strain and then against the alpha-strain), and the ultimate decline in cases was due to depletion of susceptibles rather than the vaccination campaign.
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| 22. |
- Giussani, Augusto, et al.
(author)
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A Compartmental Model for Biokinetics and Dosimetry of 18F-Choline in Prostate Cancer Patients
- 2012
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In: Journal of Nuclear Medicine. - : Society of Nuclear Medicine. - 0161-5505 .- 2159-662X. ; 53:6, s. 985-993
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Journal article (peer-reviewed)abstract
- PET with F-18-choline (F-18-FCH) is used in the diagnosis of prostate cancer and its recurrences. In this work, biodistribution data from a recent study conducted at Skane University Hospital Malmo were used for the development of a biokinetic and dosimetric model. Methods: The biodistribution of F-18-FCH was followed for 10 patients using PET up to 4 h after administration. Activity concentrations in blood and urine samples were also determined. A compartmental model structure was developed, and values of the model parameters were obtained for each single patient and for a reference patient using a population kinetic approach. Radiation doses to the organs were determined using computational (voxel) phantoms for the determination of the S factors. Results: The model structure consists of a central exchange compartment (blood), 2 compartments each for the liver and kidneys, 1 for spleen, 1 for urinary bladder, and 1 generic compartment accounting for the remaining material. The model can successfully describe the individual patients' data. The parameters showing the greatest interindividual variations are the blood volume (the clearance process is rapid, and early blood data are not available for several patients) and the transfer out from liver (the physical half-life of F-18 is too short to follow this long-term process with the necessary accuracy). The organs receiving the highest doses are the kidneys (reference patient, 0.079 mGy/MBq; individual values, 0.033-0.105 mGy/MBq) and the liver (reference patient, 0.062 mGy/MBq; individual values, 0.036-0.082 mGy/MBq). The dose to the urinary bladder wall of the reference patient varies between 0.017 and 0.030 mGy/MBq, depending on the assumptions on bladder voiding. Conclusion: The model gives a satisfactory description of the biodistribution of F-18-FCH and realistic estimates of the radiation dose received by the patients.
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| 25. |
- Haller, Paul M., et al.
(author)
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Biomarker-based prediction of fatal and non-fatal cardiovascular outcomes in individuals with diabetes mellitus
- 2023
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In: European Journal of Preventive Cardiology. - 2047-4873 .- 2047-4881. ; 30:12, s. 1218-1226
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Journal article (peer-reviewed)abstract
- AIMS: The role of biomarkers in predicting cardiovascular outcomes in high-risk individuals is not well established. We aimed to investigate benefits of adding biomarkers to cardiovascular risk assessment in individuals with and without diabetes. 'METHODS AND RESULTS: We used individual-level data of 95 292 individuals of the European population harmonized in the Biomarker for Cardiovascular Risk Assessment across Europe consortium and investigated the prognostic ability of high-sensitivity cardiac troponin I (hs-cTnI), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), and high-sensitivity C-reactive protein (hs-CRP). Cox-regression models were used to determine adjusted hazard ratios of diabetes and log-transformed biomarkers for fatal and non-fatal cardiovascular events. Models were compared using the likelihood ratio test. Stratification by specific biomarker cut-offs was performed for crude time-to-event analysis using Kaplan-Meier plots. Overall, 6090 (6.4%) individuals had diabetes at baseline, median follow-up was 9.9 years. Adjusting for classical risk factors and biomarkers, diabetes [HR 2.11 (95% CI 1.92, 2.32)], and all biomarkers (HR per interquartile range hs-cTnI 1.08 [95% CI 1.04, 1.12]; NT-proBNP 1.44 [95% CI 1.37, 1.53]; hs-CRP 1.27 [95% CI 1.21, 1.33]) were independently associated with cardiovascular events. Specific cut-offs for each biomarker identified a high-risk group of individuals with diabetes losing a median of 15.5 years of life compared to diabetics without elevated biomarkers. Addition of biomarkers to the Cox-model significantly improved the prediction of outcomes (likelihood ratio test for nested models P < 0.001), accompanied by an increase in the c-index (increase to 0.81).CONCLUSION: Biomarkers improve cardiovascular risk prediction in individuals with and without diabetes and facilitate the identification of individuals with diabetes at highest risk for cardiovascular events.
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