When dealing with the action of ionizing radiation in biological targets, biophysical modelling can be of great help to elucidate the mechanisms that lead from the initial radiation insult to an observable biological endpoint. Furthermore, models can provide predictions in those scenarios where the experimental data are scanty or absent.
Far from being exhaustive, this lecture will present and discuss examples of modelling approaches related to the induction of chromosome aberrations and cell death, which are strictly inter-related because some aberration types, such as dicentric chromosomes, have a high probability of leading to clonogenic cell death. Both endpoints are relevant for cancer therapy: although the death of tumour cells is the main objective, chromosome aberrations in normal cells can be regarded as indicators of normal tissue damage.
In discussing the various approaches, the attention will be focused on the different model assumptions and parameters, the comparisons with experimental data, and the possible implications in terms of biophysical mechanisms and/or applications for cancer therapy. In this framework, a two-parameter model developed in Pavia (called BIANCA, BIophysical ANalysis of Cell death and chromosome Aberrations [1,2]) will be presented, as well as its recent application to produce a radiobiological database that, following interface to a radiation transport code (e.g. FLUKA) or a TPS, can predict cell death and chromosome damage by hadrontherapy beams.

[1] Carante MP and Ballarini F. Calculating Variations in Biological Effectiveness for a 62 MeV Proton Beam.. Front. Oncol. 2016;6:76.
[2] Ballarini F and Carante MP. Chromosome aberrations and cell death by ionizing radiation: evolution of a biophysical model. Radiat. Phys. Chem. 2016;128C:18-25.

Acknowledgements: this work was partially supported by INFN (projects “ETHICS” and “MC-INFN”)

Medical physicists spend a lot of time "doing QA", but we often look at the results as just pass or fail. This non-quantitative methodology is often our way of meeting professional standards such as task group reports from the American Association of Physicists in Medicine or other professional societies. However, there is little data to show the impact of following these prescriptive guidelines. By setting quantitative quality metrics we can scientifically measure the impact of our work and quantify improvements. The easiest approach is to take routine work that is already being performed and make it the study for improvement. For example, institutions that use an incident learning system could quantify reported incidents before and after a practice change. To begin, a prospective plan of study must be created and a metric created; the additional work is minimal and the benefit can be significant. Essentially, this is applying the scientific method to the routine QA we currently do each and every day. In addition to evaluating the impact of our work, it can help justify our contributions to hospital administrators and regulators, provide data for change of practice, or substantiate need for new and improved equipment. Transitioning from a non-quantitative methodology into a scientific, qualitative one is a process every scientist should be excited about doing.

Traditional assessment of image quality in computed tomography (CT) makes use of subjective metrics, such as bar patterns for spatial resolution and low contrast test objects for noise or contrast resolution. This presentation discusses the need to adopt more modern, quantitative metrics for CT image quality assessment, as recommended in ICRU Report 87. The MTF(f) can be measured in several ways to characterize spatial resolution, and the MTF(f) can also be used to compute the spatial resolution in the z-dimension, replacing the section thickness measurement in that dimension. The 3D noise power spectrum, NPS(f), is recommended to characterize the image noise in the CT images. The use of a relatively simple phantom which combines dosimetry and image quality assessment allows the characterization of noise at a consistent dose level across CT scanner platforms and over time. It is concluded that better quantification of image quality will allow physicists and others to more accurately characterize the image quality performance of CT scanners, and this will in turn allow comparisons across CT platforms and for constancy testing on the same system over time.

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Clinical Engineering/Health Technology Management (CE/HTM) is spending more time trying to get medical device manufacturers to provide support for inhouse servicing than ever before. Many manufacturers and even healthcare institutions seem to minimize the value or even the existence of CE/HTM programs. It is important to note that these programs operate to save hospitals and healthcare money and also serve to provide quick and necessary support for healthcare technology in the clinical setting. They are now being challenged by many of their commercial partners. Almost every other acquisition of medical equipment now requires the need to negotiate support for inhouse services and is met with a balance of success and failure. It appears manufacturers are designing equipment without considering the customer’s option to service it. These customers include medium to large hospitals that have the capacity, economies of scale, and know-how to create and sustain CE/HTM departments. At the same time, there are many companies that provide good support for inhouse servicing. Their examples of appropriate support strategies may serve as a baseline for most other companies to make their products serviceable and to ensure CE/HTM is qualified and properly equipped to perform the required service. This paper highlights most of the issues surrounding the notion of Supportability in the CE/HTM world. These issues affect independent service organizations (ISOs) in a similar way. There are efforts to manage the supportability issue and ideas on how certain barriers might be dealt with. The paper attempts to recognize these and the rationale behind certain behaviors. There are standards and regulations, or an absence of them, that either help or hinder the issue.

Policy statements describing the role of the Medical Physicist include the duty of teaching medical and healthcare professionals at both universities and hospitals. In the case of ionising radiations this is often a legal obligation of the Medical Physicist; in Europe this legal obligation is in fact enshrined in EU directives (2013/59/EURATOM, Article 83(2)(h)). Unfortunately little educational research has been carried out by Medical Physicists regarding their role in the education of medical and healthcare professionals with the result that sometimes learning outcomes are far removed from the day-to-day clinical learning needs of these professions. In 2005, the EFOMP council set up a Special Interest Group (SIG) to develop this aspect of the role of the Medical Physicist. This session will explain the background to the project, summarise the research achievements of the SIG and explain a curriculum model developed by the SIG involving a multi-stakeholder consensus based approach. This model is structured enough for systematic curriculum development yet generic enough to be applicable to all medical and health care professions whilst being easily modifiable to national and local needs. Finally we will describe the research results of a practical application of the model for the development of physics learning outcomes as part of a continuous professional development programme for MRI radiographers.

Artificial intelligence is seeing a renewed interest in medical imaging thanks to advanced algorithms and increased computational power. Applications include automated detection of abnormalities as well as highly specialized tasks, e.g. early prediction of treatment outcome or searching for apparently hidden correlations between the radiological phenotype of a tumor and its molecular subtype or genotypic classification. Machine learning methods used in the pioneering era of artificial intelligence are increasingly being replaced by more advanced approaches, especially deep learning algorithms.
On the other hand, the full potential of artificial intelligence can only be expressed when a vast amount of data are used. This is necessary either to train a machine-learning algorithm with a large training set of annotated data or to look for hidden correlations in data banks, typically obtained in a large multi-institution cooperation. Management of big data poses the challenging problem of data quality, an aspect that deserves major efforts in order to exploit the full capability of deep learning algorithms. Issues such as prospective standardization and data homogeneity are of special importance in medical imaging. Depending on the imaging modality, these aspects may assume a complexity that can be regarded as the major limiting factor in medical imaging data mining. For example, modern magnetic resonance imaging offers an enormous portfolio of different morphological, functional and quantitative investigations, whose acquisition parameters may vary significantly from site to site. Data heterogeneity is among the major threats to the potential of data mining based on artificial intelligence methods, and requires huge organizational efforts to the researchers involved in the development of machine-learning methods in medical imaging.
In this talk, basic concepts of artificial intelligence and data mining as well as examples of diverse applications in medical imaging will be introduced.

Dosimetry audit plays an important role in the development and safety of radiotherapy. National and large scale audits are able to set, maintain and improve standards, as well as having the potential to identify issues which may cause harm to patients. They can support implementation of complex techniques and can facilitate awareness and understanding of any issues which may exist by benchmarking centres with similar equipment. Undertaking regular external audit motivates centres to modernise and develop techniques and provides assurance, not only that radiotherapy is planned and delivered accurately, but that the patient dose delivered is as prescribed. This lecture will give an overview of different types of dosimetry audit, highlighting their advantages and disadvantages. A summary of audit results will be given, with an overview of methodologies employed and lessons learnt. Recent and forthcoming more complex audits will be considered, including future needs such as proton therapy and other advanced techniques such as 4D radiotherapy delivery and verification, stereotactic radiotherapy and MR linacs. The work of the main quality assurance and auditing bodies will be discussed, including how they are working together to streamline audit.

Dose reference levels (DRLs) have proven to be an effective tool for optimisation of protection in medical exposures of patients. The new Euroepan Union ‘Basic Safety Standards’ states that ‘Member States shall ensure the establishment, regular review and use of diagnostic reference levels for radiodiagnostic examinations, having regard to the recommended European diagnostic reference levels where available, and when appropriate, for interventional radiology procedures, and the availability of guidance for this purpose’. Clinical indications dictate the main parameters that affect patient dose from CT such as scanning length, collimation and number of phases. Therefore DRLs should be specified for a given clinical indication. Although many national radiation protection authorities have established DRLs for anatomical areas only a few have defined a limited number of DRLs for different clinical indications, so far.
The European Commission (EC) launched the ‘European study on clinical diagnostic reference levels for x-ray medical imaging’ (acronym: EUCLID) project to provide up-to-date clinical DRLs. The main objectives of the project are to a) conduct a European survey to collect data needed for the establishment of DRLs for the most important, from the radiation protection perspective, x-ray imaging tasks in Europe and b) specify up-to-date DRLs for these clinical tasks. Moreover, a workshop will be organized to disseminate and discuss the results of this project with Member States and the relevant national, European and international stakeholders and to identify the need for further national and local actions on establishing, updating and using DRLs.

The development of modern cell testing technology made possible a whole series of new and unexpected applications of the cell mechanics expanding its scope to limits that couldn’t be dreamed of a couple of decades ago. However, the interpretation of cell mechanics could be confusing due to different principles adopted used when measuring cell mechanics and different and mutually incompatible cell mechanics models. The aim of the lecture is to facilitate the understanding of the field to non-experts. We overview a suite of different cell mechanics experiments with the focus on their principles, practices, and results. Along with the experiments, different cell mechanics models are summarized. The application experts will present experimental tools, discuss loading protocols, and evaluation of mechanical measurement results. Examples of interpretation of typical cell mechanical measurements are provided and new prospects of cell mechanics research are outlined.

The shape of the dose-response relationship for radiation-induced health effects at low doses and low dose rates is a critical knowledge for establishing radiation protection system and risk assessment. The uncertainty in low-dose region comes from the lack of sufficiently large cohorts combined with the lack of understanding the underlying mechanisms. In present, five basic model options on low dose response tend to be considered following exposure of the whole body or of individual tissues: i) linear-no-threshold, ii) upwardly curving with no threshold, iii) linear or upwardly curving above a given threshold dose, iv) supra-linear (hypersensitivity), or (v) complex bi-modal relationship taking into account potential hormesis at low doses (Sources and Effects of Ionizing Radiation. Vol. II Effects. UNSCEAR 2000 Report to the General Assembly with Scientific Annexes, United Nations, New York; ICRP Publication 103. The 2007 Recommendations of the International Commission on Radiological Protection. Annals of the ICRP 37 (2-4), Elsevier Science Ltd, Oxford; Tubiana Int. J. Radiation Oncology Biol. Phys. 63(2), 317–319, 2005).
The lecture will overview recent findings about processes in cells, cell tissues and living organisms following low dose exposure to ionizing radiation. Current understanding of bystander effects, adaptive response, genomic instability and the role of immune system will be summarized. The implications of the current knowledge for medical diagnostics and treatment will be discussed.

The tutorial will briefly lead through history of X-ray imaging devices (celluloid, image storage foils, image intensifier). Then the most important technologies of today are described ending with the Flat-Panel Detector (FPD). Quality measures like Modulation Transfer Function MTF and Detective Quantum Efficiency DQE are explained. Finally new trends are reported: dual energy detectors and direct conversion detectors.

The classical steps of biosignal analysis are: preprocessing, feature extraction, annotation and visualization. Sometimes classification tasks are included. The lecture will explain important methods of biosignal analysis using the example of signals measured with multichannel catheters inside the human atria. Signal sections with activity will be separated from signals without activity, ventricular far fields will be identified and compensated, the local activation time (LOT) will be detected, complex fractionated atrial electrograms (CFAE) will be classified, the cycle length (CL) and the dominant frequency (DF) and the conduction velocity (CV) will be reconstructed. The detection of the instantaneous phase, phase maps and phase singularities is a speciality of atrial signals, aiming at reliable rotor identification.

Repair of DNA damage is a necessary prerequisite for life. Biochemical pathways responsible for DNA damage signaling and repair thus attracted extensive attention in previous years. However, less understood remain spatio-temporal aspects of DNA damage response upon action of different radiation types. In present lecture, we will focus on induction, repair and misrepair of DNA double strand breaks (DSB) as the most serious DNA damages induced by ionizing radiation; we will discuss how physical parameters of ionizing radiation, like frequently studied linear energy transfer (LET), influence microdosimetric characteristics of DSB damage, with important consequences on DSB repair and misrepair. We are going to show that although LET represents an important determinant of microdosimetric characteristics of DSB damage, even particles with similar LET can dramatically differ in spatio-temporal distribution of DSBs and, consequently, biological effects. Moreover, we will explain how different types of ionizing radiation interacts with chromatin domains of different structure. This also has to be taken into consideration when biological effects of individual radiation types are compared. In this context, we will introduce primary DSB clusters, which especially appear due to highly localized energy deposition and chromatin fragmentation after high-LET irradiation, and secondary DSB clusters, which arise as a byproduct of DSB repair processes after irradiation of all types. Both primary and secondary DSB clusters can result to formation of chromosomal aberrations, the process that is further dependent on cell nuclei organization and chromatin structure of higher-order. We will explain how these findings together support the “breakage-first” and “position-first” hypotheses of the mechanism of chromosomal aberrations formation, respectively. To summarize, relationships between physical characteristics of different radiation types, higher-order chromatin structure, DSB induction and repair, DSB misrepair, and cell killing by radiation will be discussed.

Nuclear medicine has always had numerous weapons to treat cancerous disease thanks to radiopharmaceuticals that bind β particles to molecules of interest. Recently, this arsenal has been enriched by new radiopharmaceuticals such as radium-223 chloride or lutetium-177 labelled with peptides. In these procedures, treatment dosage are rarely administrated according to tumours or organ at risks absorbed doses as opposed to external radiotherapy procedures. Indeed, posology is more often dictated by a single activity administrated to all patients. In some cases, administrated activities are normalized to patient surface area or patient body weight which is not as optimal as a personalized injected activity derived from absorbed doses estimations.
This situation was justified by the difficulty to put exhibit correlation between absorbed doses and patient outcomes. However, this situation is evolving and recent literature show that correlations exist as long as dosimetry is implemented the proper way. One could argue hybrid SPECT/CT cameras availability helped a lot. Indeed, quantitative bias corrections are easier to implement in 3D imaging than in planar whole-body imaging.
Moreover, scientific community is pushing strongly towards standardization of acquisition/reconstruction procedures as well as data management in order to achieve dosimetry results reproducibility.
This is especially true in the context of multi-center trials needed for the development and validation of new radio-therapeutic approaches.
In addition, the calculation workflow related to absorbed doses calculations up to result reporting needs to be standardized.
This is especially true as dosimetric calculations result from several chained intensive computing operations and involve several meta-data related to patient radiopharmaceutical injection to name a few.
This talk aims at presenting various issues associated with the implementation of a traceability in the context of dosimetry procedures in molecular radiotherapy, with emphasis on some solutions implemented in various clinical trials for which the author performed dosimetric calculations.

With the advances of MRI and its applications to functional imaging, a new field of research and clinical applications has arisen, designated fMRI (functional Magnetic Resonance Imaging). Because it harmless, mechanically non-invasive and it does not imply the injection of any contrasts into the body, fMRI has largely replaced PET studies for regular brain studies, being the imaging modality of choice in neurosciences. Also it has the advantage of MRI being a very complete and versatile imaging tool that can produce very high quality anatomical images as well as white matter fibre tracts with the technique known as Diffusion Tensor Tractography. All these combined produce a wealth of information on the brain which can be used both for neuroscience research and for clinical applications. More recently a new area has emerged with the production of EEG electrodes compatible with MRI, leading to the technique of simultaneous acquisition of EEG and fMRI, with great applications to Epilepsy in particular. fMRI is one of those areas where Medical Physics and Biomedical Engineering mix constantly to produce an exciting field of research with a lot of potential.

Center for Advanced Preclinical Imaging (CAPI), First Faculty of Medicine, Charles University (Prague) – member of Czech-BioImaging (a national research infrastructure for biological and medical imaging), invites you to a Hands-On Workshop on preclinical in-vivo imaging of small laboratory animals.
CAPI is equipped with following preclinical imaging modalities:
Magnetic Particle Imaging (MPI) – MPI scanner (Bruker)
Optical Imaging (OI) – Xtreme In Vivo (Bruker)
Magnetic Resonance (MRI) – ICON (Bruker)
CT-PET/SPECT imaging – Albira (Bruker)
Ultrasound – Photoacoustic imaging (US – PA) – Vevo LAZR X (VisialSonics)
High resolution spectral X-ray scanner (Advacam)

The workshop will be focused on the following topics:
a) Animal-handling, anesthesia, contrast agent application, animal monitoring system
b) multimodal imaging
c) comparing X-radiography using different detection systems (CCD, flat panel and WidePix detectors)

The workshop will be held within CAPI in Prague, i.e. Salmovská 3, 120 00 Praha 2, Czech Republic, http://www.capi.lf1.cuni.cz on Monday 4. 6. 2018 from 14.00 to 18.00.

PARTRAC [1] is a biophysical simulation tool for modelling radiation effects on subcellular and cellular scales. Starting from cross section databases, it simulates the stochastic nature of individual energy deposition and transport events for photons, electrons, protons and light ions over a wide energy range occurring naturally or in medical and technical applications. Subsequently, the formation of reactive species, their diffusion and mutual reactions are modelled. Induction of damage to cellular DNA is simulated taking into account both direct energy deposits and attacks of reactive species. To this end, multi-scale models of DNA and chromatin structures are implemented, ranging from the double-helix wrapped around histones, over formation of chromatin fibres, loops and domains, to chromosomes in territories of the spherical or ellipsoidal nucleus. In the next module, DNA damage response through non-homologous end-joining of double-strand breaks is followed, explicitly considering both temporal and spatial aspects by modelling enzymatic processing and mobility of DNA termini. Correct rejoining, misrejoining and the formation of chromosome aberrations are distinguished including specific structural abnormalities like dicentrics. Work in progress aims at extending PARTRAC to the endpoint of cell killing. The processes represented, methods used, and benchmarking against data will be discussed. Recent results will be presented on ion-induced DNA damage [2] and induction of dicentrics after ion microbeam irradiation [3]. Future development of PARTRAC will be discussed, too.
[1] Friedland, Dingfelder, Kundrát, Jacob (2011) Track structures, DNA targets and radiation effects in the biophysical Monte Carlo simulation code PARTRAC. Mutation Research 711:28-40.
[2] Friedland et al. (2017) Comprehensive track-structure based evaluation of DNA damage by light ions from radiotherapy-relevant energies down to stopping. Scientific Reports 7:45161.
[3] Friedland et al. (2018) Modelling studies on dicentrics induction after sub-micrometer focused ion beam grid irradiation. Radiation Protection Dosimetry, submitted.

Monte Carlo simulations, modelling particle interactions with matter, are a very useful tool to design and improve novel radiation detectors. Geant4 (www.geant4.org) is a free, open-source Monte Carlo Toolkit, with applications spanning from High Energy Physics to medical physics and space science. It is used at the Centre For Medical Radiation Physics (CMRP), University of Wollongong, to improve the design of new silicon detectors for radiotherapy Quality Assurance and radiation protection. Geant4 is also used to characterise the response of the novel detectors in radiation fields of interest, supporting the experimental characterisation of the devices.
The talk will be dedicated to the description of a Geant4-based study aimed to improve the design of Silicon-On-Insulator (SOI) microdosimeters for Quality Assurance in proton, carbon ion and Boron Neutron Capture therapies. Since the 90’s, the CMRP is developing SOI microdosimeters as alternative to conventional tissue equivalent proportional counters (TEPCs), which have several limitations such as high voltage operation, large size of assembly which reduces spatial resolution and an inability to measure an array of cells.
In particular, Geant4 has been used to develop a methodology to convert microdosimetry measurements in silicon to tissue and to optimize the dimensions of the silicon sensitive volumes of the device. It has also been used to predict the detector response when irradiated in proton (e.g. MGH, Boston, US and IThemba Labs, Cape Town, South Africa) and carbon ion therapy (e.g. HIMAC, NIRS, Chiba, Japan) facilities. The use of Geant4 in microdosimetry has been validated with respect to experimental measurements.

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Nowadays, additive manufacturing otherwise known as three-dimensional (3D) printing is fully implemented into the production of hard tissue replacements. Department of Biomedical Engineering and Measurement together with CEIT Biomedical Engineering company designed and produced more then 35 implants made of titanium alloy using additive technologies, which were subsequently implanted by Slovak and foreign surgeons. 3D printing of PEEK, bioceramic and magnesium alloys implants is recently tested to offer alternative materials to titanium for cranioplasties or biodegradable impalnts. 3D bioprinting is being applied to regenerative medicine to address the need for tissues and organs suitable for transplantation. Compared with non-biological printing, 3D bioprinting involves additional complexities, such as the choice of materials, cell types, growth and differentiation factors, and technical challenges related to the sensitivities of living cells and the construction of tissues. The 3D bioplotter (Envisiontec, Germany) was used to prepare tubular structures made of biodegradable PLA + PHB polymer for substitutes of human urethra. Tubular structures were tested from geometrical point of view to assure required precision, repeatability and possibility to print porous structures for application of epithelial and muscle cells and their growth. Several studies on PEEK spinal implants manufactured by 3D printing were accomplished, where mechanical testing, simulations and testing of biocompatibility were implemented. Presented research covers selected case studies of patient specific implants made by additive manufacturing and research in medical 3D printing and 3D bioprinting.

The Geant4-DNA (http://geant4-dna.org) extension to the Geant4 (http://geant4.org) general purpose Monte Carlo toolkit aims to provide an open access platform capable of simulating ionising radiation induced early biological damage at the sub-cellular scale. This extension is entirely included in Geant4 and can be used to simulate step-by-step physical interactions of particles (electrons, protons, alpha particles including their charge states, and a few ions) down to very low energies in liquid water and select biological materials, thanks to a variety of physics models. In this lecture, we will present the functionalities of Geant4-DNA for the simulation of track structures. Example applications will be shown using our freely accessible Geant4 Virtual Machine.

Physical therapy or physiotherapy aims to remediate impairments and to improve functioning. The main phases of physiotherapy are: functional assessment, setting up the therapeutic plan and physical intervention. The rehabilitation is more effective if the patient is motivated. The following electronic devices were developed at the Department of Measurement and Information Systems, Budapest University of Technology and Economics to aid rehabilitation: passive marker based analyzer of movement (PAM), a smart Nine-Hole Peg Tester and an input position and rotation sensor to Huple®, a special hemisphere-like tool for the habilitation of children with birth injuries.
PAM is a 2D analyzer, able to determine the x-y coordinates of passive markers moving basically in a plane. Finger tapping, tremor of the face, hand- and arm tremor and balance were tested. The recordings make possible the objective evaluation of patients’ actual state, an important feedback for their therapy.
The Nine-Hole Peg Test requires the tested person to pick nine pegs up from the holder and place them in the holes in the board in arbitrary order and then remove the pegs. The smart Nine-Hole Peg Tester features light emitting diodes, thus guided tests with different difficulties can be performed. Patients can use the smart device without supervision. Certain patients enjoyed the guided tests and were keen on improving their results. This increased the efficiency of their rehabilitation.
Gézengúz Foundation for Children with Birth Injuries uses the patented hemisphere-like tool, Huple®, to improve the balance ability of children with disability. Attaching an integrated 3D orientation sensor, x-IMU to Huple® allows the objective assessment of the actual movement control of the child sitting in it. An interface was developed to Huple® thus children can control simple PC games by tilting the hemisphere. As a result, they are motivated, they playfully improve their balancing ability.

There is a bewildering range of devices now available to assist functional movement for those with physical impairments. Many of the devices on the market have limited evidence of efficacy, making the selection of the appropriate device for a given patient difficult. The clinical studies of efficacy which have been published, generally focus on parameters which can easily be measured in the lab or clinic, sometimes combined with self-report or interview feedback from the user. Very few studies report objective data on how, where and when the devices are actually used in everyday life. The lecture will first discuss why capturing data on real world usage of assistive devices is of potentially significant value to researchers, manufacturers and clinicians. A number of case studies will then be presented, focusing on real world monitoring of prostheses, walking aids and wheelchairs. Finally, a discussion of how such approaches could be used to better evidence the effectiveness of assistive devices, as well as some of the challenges such technologies raise, will be presented.

The development of models of human physiology was facilitated by a new generation of simulation environments using Modelica language. Fundamental innovation of Modelica language is the possibility to describe individual parts of the model as a system of equations directly describing the behavior of that part and not the algorithm of solving of these equations (see http://physiome.cz/modelica.pdf).
This tutorial gives an introduction to the Modelica language, the OpenModelica environment, and an overview of modeling and simulation in a number of application areas.
The tutorial will show acausal approach of modeling physiological system using Physiolibrary, an open-source library for biomedical modeling, which allows presenting complex models composed from different domains in comprehensible and maintainable form. Together with participants, models will be constructed of cardiovascular system, chemical reactions, body thermal transfer, osmotic phenomenon and integrative approach. Attendees should bring their own computers to participate in the hands-on sections of the tutorial.
Based on participants previous knowledge, tutorial may be extended to introduction of model-based dynamic optimization with OpenModelica including goal functions, constraints, convergence and other advanced features of OpenModelica. Bring your laptop for exercises.
First part of tutorial will introduce acausal and object oriented Modelica language using an open-source tool OpenModelica (www.openmodelica.org) and a commercial tool Dymola. Attendees can install the open-source OpenModelica tool in advance before the tutorial.
The second part of the tutorial will consist of hands-on sections that will demonstrate building selected models of 1) cardiovascular system dynamics – using hydraulic domain. 2) common biochemical reactions – using chemical domain. 3) body thermal transfers with blood flow using thermal domain 4) liquid volume of the penetrating solution in intracellular space, extracellular space, interstitial space, blood plasma or cerebrospinal fluid using osmotic domain 5) integrative approach which connects these domains together.

To the implantable cardiac devices belong now the pacemakers, implantable defibrillators and subcutaneous defibrillators. The aim of this tutorial is to show the possibilities of the recent programmable features within these devices and their using in practice. The troubleshooting part of the tutorial provides the overview of most common issues to solve in the clinical practice, like supporting/elimination of own patient rhythm, individual need of pacing, environment and electromagnetic disturbance. The technical standardization requirement will also be covered.
For dual chamber pacemakers, the timing of ventricular pacing, realized by AV delay parameter, is fundamental. It can be either fix or dynamic, incorporated the specific algo-rithms for AV delay extension. As the ventricular filling phase influences the patient hemo-dynamics, and an abundance of ventricular paced beats should be avoided, this parameter is critical.
For implantable defibrillators, the optimization of tachycardia detection process is of primary importance. False-positive shocks are quite often in the praxis. Therefore the trends of patient rhythm should be evaluated during ambulatory follow-ups and detection settings adjusted appropriately. Detection zones, sensing threshold, duration, morphological algo-rithms – all these parameters will be discussed in details. The similar situation is for subcuta-neous defibrillators, where however the settings have no so many options.
All implantable cardiac devices settings should be individualized. This educational course helps to better understanding of advanced settings.

The tutorial will introduce registration and analysis of the electrical activity of the brain associated with visual stimuli. In the first part, the principles of registration together with their clinical and experimental use (e.g. in brain computer interface) will be presented. In the second part, a live registration of sensory and cognitive potentials (ERPs) will be conducted among interested course participants. Registered data will be available on-line for a simple immediate ERP analysis. The tutorial should give an overview of ERP strengths and weaknesses for a future project build by the course participant.

Advances in radiotherapy have greatly improved our ability to deliver conformal tumor doses while minimizing the dose to adjacent organs at risk. However, there remains concern over stray radiation to normal tissues away from the treatment field as this radiation may induce second cancers, cardiac disease, and other late effects. This risk is becoming more relevant as patients live longer after treatment, providing an increased opportunity for late effects to manifest. In order to assess the potential risk to the patient, it is first necessary to know what radiation exposure the patient is subjected to. While the treatment planning system reports the dose in and near the treatment field, it does not provide reliable (if any) dosimetric information away from the field edge, and it does not provide any information on neutron doses. A serious challenge exists in that the assessment of stray x-ray and neutron doses can involve unique considerations. For example, when measuring the dose outside the treatment field, it is often important to consider the radiation energy spectrum, dose rate, and general shape of the dose distribution (particularly the percent depth dose), which are very different outside than inside the treatment field. Neutron dosimetry is also particularly challenging, and common errors in methodology can easily manifest as errors of several orders of magnitude. Calculation of the non-target dose (whether by Monte Carlo or analytical solutions) similarly requires unique consideration.
This presentation will highlight the recommendations from the recently published AAPM Task Group 158 report on non-target doses to provide guidance and strategies for physicists to measure and calculate x-ray and neutron doses away from the treatment field. This presentation will do this in the context of risks to the patient and clinical considerations.

Dedicated models of tissue responses to radiation depict the sigmoidal dose-effect relationship of tumor control and normal tissue complication probabilities (TCP and NTCP) in radiotherapy [1]. Refining simple tools like the logistic or Poisson models, current descriptive and mechanistic approaches account for non-uniform dose distributions, hierarchical tissue organization, and effects of fractionation. Cellular automaton models represent individual cells and underlying processes such as cell growth and loss or angiogenesis in stochastic terms. Descriptive and mechanistic models of diverse levels of complexity exist also for long-term health risks, namely for radiation-induced cancer and cardiovascular diseases.
Another class of models [2-4] represent the fact that cells respond to any stressor, including ionizing radiation, not as independent entities but in a highly coordinated manner within tissues. The bystander phenomenon clearly illustrates this: Cells directly hit by ionizing radiation emit signals to which neighbor cells react and exhibit similar responses as the hit cells, including DNA damage or cell kill. Ionizing radiation modulates existing signaling processes and their outcomes, e.g. the anticarcinogenic process removing transformed cells upon signaling with normal cells.
An overview of the above-mentioned models will be given, focusing on their mechanistic background and practical applications.

[1] Friedland, Kundrát (2014) Modeling of radiation effects in cells and tissues. In: Brahme (Ed.) Comprehensive Biomedical Physics, 9:105-142. Amsterdam: Elsevier.
[2] Kundrát, Friedland (2016) Enhanced release of primary signals may render intercellular signalling ineffective due to spatial aspects. Scientific Reports 6:33214.
[3] Kundrát, Friedland (2015) Mechanistic modelling of radiation-induced bystander effects. Radiation Protection Dosimetry 166:148-151.
[4] Kundrát et al (2012) Mechanistic modelling suggests that the size of preneoplastic lesions is limited by intercellular induction of apoptosis in oncogenically transformed cells. Carcinogenesis 33:253-259.

Today, biological cells and tissues are exposed to electric fields in order to induce certain biological effect - for instance, the electroporation of cell membranes. The exposure is, however, often unintentional coming from numberless electrical devices. In this tutorial we present basic methodology for modeling and understanding the electrical response of biological cell and tissue to harmonic and pulsed electric fields of various intensities and frequencies. The focus is on short-term electrical and thermal response of tissue to high intensity pulsed electric field used in electrochemotherapy and electro gene therapy. The methodology is based on basic concepts of electromagnetic theory.

TBA

Diabetes is one of the most challenging medical problems worldwide. The tutorial will review technologies, which are used to support diagnostics, monitoring and treatment of diabetes. It will cover the state of the art and recent developments in: (1) the intermittent and continuous glucose monitoring, (2) the glycated hemoglobin A1c monitoring and interpretation, (3) the subcutaneous insulin infusion using the conventional portable pumps, patch pumps and implantable pumps, (4) the alternative routes of insulin delivery, (5) decision support systems in the intensive insulin therapy, (6) the tele-homecare support of the diabetes treatment applying eHelath and mHealth systems, and (7) the artificial pancreas systems, including electromechanical, biological, bioartificial and biochemical solutions.

MRI uses signals generated by nuclear magnetic resonance (NMR) of hydrogen nuclei (protons) in water. The signal frequency depends on the strength of the magnetic field, typically 1.5 tesla (NMR frequency 64 MHz) or 3.0 T (NMR frequency 128 MHz. Three spatial-encoding methods are employed, all of which use the concept of the magnetic field gradient. By sending electrical current (hundreds of amperes) through a gradient coil, an extra magnetic field is produced, the strength of which varies linearly with position inside the scanner bore. The scanner includes three independent gradient coils, generating magnetic field gradients along the principal axes X, Y and Z. In frequency-encoding, the NMR signal is recorded while a field gradient is applied. Since the magnetic field varies with position along the gradient direction, the NMR resonant frequency (also called the Larmor frequency) is a function of position, so the detected signal contains a range of frequencies; analysing the frequency content generates a one-dimensional projection of the water-distribution within the patient. The technique called phase-encoding is employed in the second in-plane dimension; here, the gradient is pulsed on and off prior to measurement of the signal, altering the phase of the NMR signal as a function of position. Finally, the slice itself is defined using selective-excitation, in which the excitation 90-degree radiofrequency pulse is specially-shaped and is applied in the presence of a field gradient perpendicular to the slice plane (e.g. along Z for a transaxial X-Y slice). In order to generate data for an NxN image, the pulse sequence is usually applied N times, varying the phase-encode gradient amplitude with each repetition. A two-dimensional Fourier transform of the raw data matrix (the “k-space” data) yields the MR image, which can be encoded with the disease-dependent NMR parameters (T1, T2, diffusion etc.) to aid diagnosis.

Dual energy CT has been possible for some time now and has demonstrated considerable advantages in clinical diagnosis. DECT is achieved by ways that are unique to different CT platforms. DECT is considered as a first step towards achieving true “Spectral CT”. DECT has the potential to improve lesion detection and characterization, reduce artifacts and possible quantification of CT images. Advanced applications such as kidney stone classifications, gout detection, automatic bone removal, virtual non-contrast enhanced images and many others are routinely used clinically. In spite of these advantages, DECT is still aiming to gain wider acceptance in clinics.
This presentation will discuss the various ways dual energy CT is possible among the various CT platforms, along with the uniqueness of each method. Will also discuss the advantages and limitations of DECT and explore reasons that are holding DECT from being widely used.

Tutorial deals with numerical solving differential equations, specifically ordinary differential equations, ODE, where the variable is integrated typically in time, t, in environments of MATLAB and its free companion, OCTAVE.
Other inputs, which have to be specified: Initial conditions, the range of values of the integrated variable, and initial variable difference and initial output tolerance to be used as initial precision of the solution.
MATLAB contains several ODE solvers (integrators), "ode23, ode45, ode113, ode23tb" and others.
The solvers are MATLAB/ OCTAVE functions in libraries (under MS Windows, or Unix, respectively, can be found at):
C:\Program_Files\MATLAB\R2008a\toolbox\matlab\funfun\
/opt/matlab/toolbox/matlab/funfun
My demos can be accessed on web at: nemo.lf1.cuni.cz/mlab/ftp/tutorial, or onyx.lf1.cuni.cz/mlab/ftp/tutorial
Most current versions of MATLAB contain only solvers with adaptive, i. e. variable step size. They use Runge-Kutta methods, Adams method, and others. The simplest Euler method is not amongst them. We can plot the solution, obtain phase plots or using the event location property. In MATLAB libraries, there is no solver with the fixed step, to my knowledge.
Several years ago I have written my own ODE solver with the fixed step size, using Runge-Kutta and Euler methods. Then I also wrote my own version of "odeplot", which plots the solution, since at that time, when I was writing these, it was not available.
When simulating models of neurons by dynamic ODE, it is advantageous to solve complicated and nonlinear equations, like the Hodgkin-Huxley equations, and others, with the use of fixed time step and simultaneously plot the solutions and captured specific events (like action potentials, or synaptic potentials). With these techniques we can construct curve of firing frequency response of neurons to the level of DC current.

Routine assessment of imaging system sharpness has always been an important aspect of quality control (QC) protocols. This is especially relevant to mammography: the imaging of microcalcifications places strong constraints on system and detector sharpness. Prior to the transition to readily available DICOM image data, sharpness was assessed using line pair test objects. Now that digital image data are universally available, the presampling modulation transfer function (MTF) has quickly gained widespread acceptance as an objective measure of component or system sharpness, provided the appropriate image types are available. A similar situation exists in fluoroscopic imaging: the visualization of small (moving) vessels places constraints on parameters that influence system sharpness. X-ray image intensifiers (XRII) have been largely superseded by flat panel (FP) detectors these days. Line pair resolution testing of dynamic (fluoroscopy) systems should be replaced by Fourier methods, as image sharpness remains a crucial component of dynamic imaging system performance. Access to the necessary image data will be greatly facilitated with the implementation of the XR-27 NEMA standard.
In this talk we will define the presampling MTF and discuss techniques for the measurement of this parameter via edge and wire based methods. A distinction is made between the sharpness of the total system and that of the underlying subcomponents such as the x-ray detector or x-ray source size. MTF measurements are then used to explore the interplay of component sharpness within the imaging chains used for full field digital mammography (FFDM), digital breast tomosynthesis (DBT) and cardiac angiography imaging.

Medical devices have made a huge contribution to medicine and surgery. They enable diagnostic and therapeutic procedures that were not possible or even envisaged a few decades ago to be undertaken safely. Patients can generally hope to live to an active old age.
However, with sadness we need to acknowledge that medical devices can and do cause harm. Thankfully, the percentage of procedures that result in patient harm or death is very small. Nevertheless there is much that can be done to improve this situation. Medical staff and bioengineers have collaborated successfully to innovate these new procedures and devices. It is important that they contribute to improving safety.
Medical devices can fail for many reasons. They include the following: devices can be too complicated to use, user are poorly trained, devices can unexpectedly transfer to an unwanted mode, they can fail long before their expected life is over, maintenance can be poor, wrong consumables can be used, and the inventing bioengineer may not have fully understood the clinical problem. There is much that can be done to improve this situation.

There is at the moment a rapid increase in the number of Particle Therapy (PT) centres across the world. From being an exotic modality at a few research laboratories for very few patients, the accessibility of PT will soon reach a level where most large cancer centres will be able to offer PT to patients with suitable indications. As a consequence, the radiotherapy community, including those without access to PT, must increase their level of knowledge of all aspects of PT to ensure that the patient selection is done in the most optimal way in order to offer the best possible treatment to those patients who will benefit the most.
In this lecture the basic rationale for PT will be given, primarily for proton therapy but also to some extent for heavier ions such as therapy with Carbon ions. The technology of beam production and delivery will be discussed as well as an overview of radiobiological aspects of PT.
The clinical advantages in terms of dose distributions for some indications will be touched upon but also possible challenges such as robustness and uncertainties. The specific aspects of dosimetry and QA in scanned proton beams will be discussed and finally an outlook will be given for the years to come, including interesting technological achievements that may affect the PT of tomorrow.

Increased use of small photon fields in radiotherapy has raised the need for standardizing their dosimetry using procedures consistent with those for conventional radiotherapy. A Code of Practice for the dosimetry of small static photon fields was prepared by international working group, established by the IAEA with the AAPM and published by the IAEA as TRS-483. It consists of six chapters and two appendices. The first chapter provides an introduction and the second one a brief discussion of the physics of small photon fields with emphasis on those aspects that are relevant to understanding the concepts of the Code of Practice. These include the definition of field size, the field size dependent response of detectors, volume averaging, fluence perturbation corrections, reference conditions and beam quality in non-conventional reference fields. The third chapter introduces all details of the formalism used while the fourth chapter provides a comprehensive overview of suitable dosimeters for reference dosimetry in conventional and machine-specific reference fields and for the determination of field output factors in small fields. The fifth chapter gives practical recommendations for implementing reference dosimetry in both conventional and machine-specific reference fields and the sixth chapter provides the practical recommendations for the determination of field output factors in small photon fields. Detailed discussions on how the data for chapters five and six have been derived from the literature and how their uncertainties have been estimated are given in the Appendices one and two, respectively. For beams with flattening filter (WFF beams) these data are consistent with the ones given in IAEA TRS-398 and the update to AAPM TG-51. For FFF beams additional corrections are taken into account for the difference in water to air stopping power ratios between FFF and WFF beams and for volume averaging due to the non-uniform lateral beam profiles.

X-ray-based tomographic imaging such as computed tomography plays an increasingly dominant role in modern medicine and many other disciplines such as security scans and material sciences. In the past 20 years, X-ray tomographic imaging has been enjoying a significant period of innovation, as a result of the rapid advances in research and engineering not only enabled by technological development of hardware and algorithms, but also, more importantly, driven by application needs. This trend is likely to remain at least in the foreseeable future. In the presentation, using examples, I will highlight the past and current, and also speculate the future, evolution and innovation in X-ray tomographic imaging driven by practical applications.
Objectives of the presentation are to discuss
1. Basic principle, and leading medical applications, of diagnostic computed tomography (CT)
2. Algorithm-enabled dose reduction in diagnostic CT
3. Emerging X-ray tomographic technologies enabled by advanced hardware and algorithm
4. C-arm cone-beam CT (CBCT) for radiation therapy, surgery, intervention applications
5. Digital tomosynthesis for screening applications to breast cancer and possibly lung cancer
6. Advances in multi-spectral (or photon-counting) CT

Over the past decade, STORM and STED microscopes produced by the major optics companies became commercially available and super-resolution microscopy transformed from somewhat a specialty to actual applicable tool for biological and biomedical research. Imaging of subcellular structures with unprecedented resolution can shed light on the cause and development of a pathological condition. It came as no surprise that the great potential impact of super-resolution fluorescence microscopy was recognized by the Royal Swedish Academy of Sciences and the Nobel prize in Chemistry was awarded for its development in 2014. In this course, the fundamentals of fluorescence microscopy will be presented, followed by the principles of several derived super-resolution imaging techniques such as Near-field Scanning Optical Microscopy, Stochastic Optical Reconstruction Microscopy, and Stimulated Emission Depletion Microscopy.

Rapid advances in our understanding of radiation responses, at the cellular, tissue and whole body levels have been driven by the advent of new technological approaches for radiation delivery, including the increasing use of ion beam therapies. These take advantage of the Bragg curve to allow more optimized delivery of dose. Alongside this physical advantage there ae also significant biological advantages with increasing radiation quality or linear energy transfer (LET). For protons, the routinely utilized clinical approach is to correct for increased biological effectiveness using a constant Relative Biological Effectiveness (RBE) value of 1.1. However it is well appreciated that this represents a broad average and overlooks the steep rise of Linear Energy Transfer (LET) at the distal end of the Spread-Out Bragg Peak (SOBP). Multiple cellular studies, examining a range of endpoints, have clearly shown this strong physical dependency on LET. This is also dependent on well understood radiobiological parameters such as the alpha/beta values underpinning survival responses, oxygen status and the impact of fractionation.
Despite this dependency on physical parameters, even when taking a panel of cells representing different molecular phenotypes of a particular cancer, there can also be a wide variation in proton RBE, independent of LET. In the drive towards precision medicine it is clear that this will have consequences for individual tumor responses particularly for protons. Further detailed studies evaluating a range of endpoints both in vitro and in vivo to quantify RBE along the full range of the Bragg curve may facilitate the optimization and further exploitation of the potential benefits of proton therapy and indeed other ions. In the longer term, appropriate parameters for individual tumours and normal tissues need to be defined which will allow biological-based treatment optimisation for particle therapies.

In recent years, electrocardiogram (ECG) recorders are available and widely used in clinical practice. Last decade brought a number of other applications such as experimental cardiology, sport medicine, rehabilitation engineering, automotive, smart cities, biometrics, well-being and smart ageing. In this areas, ECG recorders are usually built in a compact form so that users can wear them without much of obstruction in the routine activities, or the recorders are embedded in larger systems. Wearable ECG recorders are becoming very popular because of their low cost, long term recording capability and ease of use. Embedded ECG recorders aim to track heart activity of the user by wireless way to recognize an individual or check his/her current physical or mental health status. Since a huge volume of ECG data is generated in the mentioned applications, automated methods are preferred for analysis of the heart signals. The ECG data may be composed of single-channel or multiple-channel depending upon the type and configuration of the ECG recorder producing ECG signals, heart activity signals or heart rate variability signals. This includes single-lead and multiple-lead wired recorders, video cameras, touchless fingerprint and palm/hand biometric sensors, smart wireless sensor recorders, and others. Methods of data analysis are also different to deal with data and interference accordingly. A wide range of time-frequency methods, optimal filters, deep-learning approaches, ultra low computational complexity algorithms, support vector machines methods, and many others are used for data cleaning, signal classification and feature extraction.

Recently, the number of journals publishing papers related to biomedical engineering is expanding including the “predatory journals”. The well-established “traditional” journals can be easily distinguished from these low-level journals. The main principle of the high-quality journals is to publish only well-written, technically sound papers with a good structure and clear content. Publishers of the best biomedical journals created a set of rules how a good quality paper should be written and other journals have been using these rules as well. Furthermore, strict rules have been followed concerning studies involving human subjects, including the obligatory registration of these studies in a recognized public registry. The lecture analyzes the current requirements of the best biomedical journals and gives the potential authors recommendations how to avoid problems that might be so serious that the high quality journals would refuse the manuscript.

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Major digital radiography detector technologies available in 2018 include computed radiography (CR), flat-panel thin-film-transistor (TFT), and complementary metal-oxide (CMOS) large-area array sensors. Each detector technology has unique attributes for latent image capture of the transmitted x-ray beam, signal conversion, and temporal acquisition capabilities. Similar attributes include wide exposure dynamic range, and pre- and post-processing steps necessary to optimize the resultant images for human viewing and diagnosis. Technological advances continue, with introduction of wireless, flat panel arrays with large and small form factors, systems with variable acquisition gain, discrete photon counting devices, and energy discriminating capabilities. A brief overview of current and future x-ray detectors is discussed in the presentation.
The American Association of Physicists in Medicine is developing harmonized and holistic digital radiography acceptance test and periodic quality control procedures to encompass acquisition detectors in addition to the other components in the system, including the x-ray generator, x-ray tube, anti-scatter grid, automatic exposure control subsystem, informatics interfaces, HL7 - DICOM attributes, image processing/calibration issues, and image display characteristics, as examples. The efforts of the task group, now nearing completion, are described.

Digital radiography wide dynamic range attributes and acquisition post-processing capabilities create visibly consistent appearance despite large differences in incident x-ray intensity to the detector. While underexposures can be identified due to visible quantum mottle, overexposures can be difficult to discern. The generic “Exposure Index” is a manufacturer-proprietary method to provide feedback to the radiographer as an indirect indication of digital image quality and noise. Unfortunately, there are as many proprietary Exposure Index methods as there are manufacturers, and complications arise in a multi-vendor environment with a need to share data across institutions, or to a dose registry database. A unified Exposure Index standard for Digital X-ray Imaging Systems, IEC 62494-1, was developed a decade ago, but only recently has there been substantial implementation in the United States.
The standardized Exposure Index (EI) does not indicate patient dose, but is a linearly proportional estimate of the incident radiation exposure to the detector based upon an analysis of the histogram distribution of relevant digital values calibrated to a known incident air kerma. For a given exam, a “Target Exposure Index” (EIT) value is identified in the imaging system protocol database, based upon the type of exam, the type of detector, and the clinical requirements in terms of image quality (noise). Calculation of a “Deviation Index” (DI) indicates under- or overexposure of the incident radiation to the detector: DI = 10 log (EI/EIT). A value of DI=0 indicates the detector radiation dose is appropriate; negative and positive DI values and their magnitude represent levels of underexposure and overexposure, respectively. Results suggest improved image acquisition reproducibility and radiographic techniques. Radiographers and radiologists benefit from standardized terminology, and clinics can compare exposure index values and deviation index performance with others through a national dose index registry database. Details and experience with the standard are presented.

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Magnetoencephalography (MEG) uses SQUID-based sensors to measure extremely weak extracranial magnetic fields generated by spontaneous and evoked neuronal activity of the human brain. As one of the major functional brain imaging methods MEG allows real time monitoring of sensory and cognitive processes. A range of spatio-temporal localization methods and approaches have been developed which allow most detailed insight into topology and cortical neurodynamics of the activated dynamical neural networks subserving perceptual and cognitive processing of the working brain in health and disease. Due to its non-invasive and non-contact nature as well as the fact that MEG does not exposes subjects to any fields or substances it can be safely used throughout the life-span. The tutorial will provide introduction to MEG instrumentation for newborns, children, and adults, noise cancellation hardware and software solutions, most recent advances in the development of novel sensor technologies, present briefly experimental design, review major analysis approaches and provide an overview of MEG basic and clinical studies, some of which represent unique contributions of MEG to human brain studies.

Reading material for MEG tutorial attendees and for all other interested persons.

Contemporary state of art in the field of audiology is based on examination of the hearing function and its disorders with different audiological methods comprising tympanometry, tone audiometry, speech audiometry, oto-acoustic emissions as well as several other audiological tests and objective audiometry based on recording of evoked potentials. In the tutorial speakers will describe in detail all these methods and will inform about the recent improvement of these methods taking into account the fact that with the continuous prolongation of the human life becomes more and more important proper diagnosis of presbycusis. In addition information will be given about the use of modern MRI methods such as functional magnetic resonance, MR morphometry, diffusion tensor imaging and MR spectroscopy in the investigation of hearing disorders. These methods are at present time predominantly used in the research but in the future they could be used routinely in the diagnosis of hearing impairment.

Computed Tomography (CT) scanners are widely known for their use in diagnostic, interventional radiology and fluoroscopy practice. The last years they are also utilized in radiotherapy for . They are equipped with a vast variety of different technology, setup and technical protocols; thus the choices of the medical personnel in charge to practice are numerous. Due to the extended range of almost every parameter of each protocol (kV, mA, rotation time, pitch, filters, reconstruction algorithms, etc.), the radiation dose can vary extremely. Depending on the clinical needs and the technical protocols applied in each CT department, patient radiation dose differs, even for the same clinical indication, anatomical region, technical protocol and sometimes even for the same CT unit. Furthermore, high rates of repeated CT scans in certain cases are reported in the international literature as for example the trauma patients with additional hospital charges and additional radiation exposure. Due to the aforementioned reasons, the urge to monitor, optimize and generally review medical practices in CT units has risen significantly. Furthermore periodical evaluation of all CT parameters enables the end users to control the performance of the CT scanner at all times.
All these clearly point to the critical need for ongoing quality control (QC) and quality assurance (QC). The related educational course lecture will present an extensive review of the latest routine QC tests, based on the most recent publications, starting from more simple tests that can be easily performed by a radiographer or other qualified health professional to the more complex ones that must be executed and analysed by a medical physicist or a medical physics expert.

Radiotherapy plays a pivotal role in the treatment of cancer but it is also associated with a large spectrum of toxicities. Normal tissue complication probability (NTCP) models attempt to describe the dose-response relationship of these toxicities. Prospective data registration programs are increasingly used to collect large standardized data sets of good quality. Modelling techniques become more advanced by adopting methods from the field of (bio)statistics and machine learning, enabling data driven exploration of complicated dose response relationships and a large variety of other predictive factors, including emerging factors like genetics and image features. Also, biological experiments are narrowing down on the potential mechanisms, aiming to find anatomical targets. Still, NTCP models are dominantly phenomenological in nature and depend mostly on data rather than on confirmed theories. They should not be regarded as general abstractions of an absolute truth but as conjectures that originate from accumulated experience. They need to be developed with proper restrictions to guard against overfitting. Generalizability and causality of these models need to be tested in independent cohorts. Even then, many different plausible phenomenological models may exist that are all consistent with the available data. This educational course will include characteristic examples from recent developments in the Netherlands and in our department, illustrating processes from data collection to toxicity reduction.

Image quality in nuclear medicine is limited by several physical factors, including attenuation and scatter inside the patient, inherent noise, and location-dependent resolution (blurring). Some of these effects may be at least partially compensated by applying suitable image filters.
In this talk, after outlining the nature of the degrading phenomena mentioned above, we shall explain how to represent signals and noise in the frequency domain, and how filters can be characterized there. The special aspects of planar gamma camera images as well as the role of filters in reconstruction will be addressed. We shall outline the basic approaches to define and optimize image quality by the selection of appropriate parameters for image processing steps, especially filters, putting emphasis on the practical challenges of nuclear medicine.

References
1. Najim M. Digital Filters Design for Signal and Image Processing. Vol 1. (Najim M, ed.). London, UK: Wiley; 2006. doi:10.1002/9780470612064.
2. King M, Doherty P, Schwinger R, Jacobs D, Kidder R. Fast Count-Dependent Digital Filtering of Nuclear Medicine Images  Concise Communication. J Nucl Med. 1983;24(11):1039-1045.
3. Lyra M, Ploussi A. Filtering in SPECT image reconstruction. Int J Biomed Imaging. 2011;2011:693795. doi:10.1155/2011/693795.
4. Oppenheim A V., Verghese GC. Signals, Systems and Inference. Pearson; 2015. http://catalogue.pearsoned.co.uk/educator/product/Signals-S

Lower limb amputee’s residual limb / socket interface pressures have been considered as one of the most viable parameters to quantitatively evaluate prosthetic socket fit. This is supported by the number pressure measurement and finite element modelling investigations over the years, attempting to measure and predict residual limb / socket interface pressures respectively. However, a good prosthetic socket fit today is still highly dependent on the skill and experience of the prosthetist. The question we are raising is – what else besides residual limb / socket interface pressures? In this course, we will present fundamental knowledge of socket biomechanics and residual limb / socket interface pressure measurement. With this background, we will discuss the advances in socket design (e.g. pressure casting) motivated by socket biomechanics. Finally, we will present our future perspectives in socket design, highlighting state-of-the-art research such advanced motion analysis (e.g. using the Computer Aided Rehabilitation Environment (CAREN)), patient-specific residual limb / socket interface and neuromusculoskeletal modelling (please, see ilustrative photos here). The overarching aim of this course is to provide fundamental knowledge in socket biomechanics, highlight current and future technologies that could improve socket fitting, and finally encourage research and development in this area to improve the well-being of patients.

Tutorial is focused on description of interactions of electromagnetic (EM) fields with biological systems, mainly from the point of view of physics. Approach to research of biological effects of EM fields (both thermal and non-thermal) will be presented. Usually special exposure chambers are being used for this kind of research. Basic requirement for these exposure chambers in general is a precise dosimetry that allows to evaluate biological effects of EM field even in case of long term EM exposures of small animals that can move freely during the experiments. Basic known results of this research (i.e. both positive and negative biological effects of EM field) will be discussed here. From it it then will result how the positive biological effects can be used in the area of applications of EM fields in medicine and biology. In details will be described the use of microwave technology for cancer treatment by hyperthermia. Principles of new type hyperthermia applicators (e.g. based on MTM technology, etc.) will be mentioned. Last but not least, prospective use of microwave technology for medical diagnostics, e.g. microwave differential tomography, will be given. Part of this presentation will be a description of a special exposure chamber for the research of the biological effects of the EM field at a frequency of 900 MHz, one of mobile phone frequencies. We will present here the results of biological experiments in which the effect of EM field on free radical formation in selected organs of mice was investigated. This is based on a comparison of the level of free radicals in mice actually exposed by EM field to the free radicals level in the control group.

TBA

Early diagnosis and therapy increasingly operate at the cellular, molecular or even at the genetic level. As diagnostic techniques transition from the systems to the molecular level, the role of multimodality molecular imaging becomes increasingly important. Positron emission tomography (PET), x-ray computed tomography (CT) and magnetic resonance imaging (MRI) are powerful techniques for in vivo imaging. The inability of PET to provide anatomical information is a major limitation of standalone PET systems. Combining PET and CT proved to be clinically relevant and successfully reduced this limitation by providing the anatomical information required for localization of metabolic abnormalities. However, this technology still lacks the excellent soft-tissue contrast provided by MRI. Standalone MRI systems reveal structure and function, but cannot provide insight into the physiology and/or the pathology at the molecular level. The combination of PET and MRI, enabling truly simultaneous acquisition, bridges the gap between molecular and systems diagnosis. MRI and PET offer richly complementary functionality and sensitivity; fusion into a combined system offering simultaneous acquisition will capitalize the strengths of each, providing a hybrid technology that is greatly superior to the sum of its parts. However, the technology suffers from a number of drawbacks that will be discussed in this talk.
This talk also reflects the tremendous increase in interest in hybrid imaging technology as both clinical and research tool in the past decade. It offers a brief overview of the historical development of this modality from basic principles to various steps required for obtaining quantitatively accurate data from dedicated standalone PET and combined PET/CT and PET/MR systems. Future opportunities and the challenges facing the adoption of multimodality imaging technologies and their role in biomedical research will also be addressed.

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