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PubMed2001

Comparative ability of EMG, optimization, and hybrid modelling approaches to predict trunk muscle forces and lumbar spine loading during dynamic sagittal plane lifting.

OBJECTIVE: To compare the ability of three modelling approaches to resolve the muscle and joint forces in a lumbar spine model during dynamic sagittal plane lifting. DESIGN: Trunk muscle forces, spine compression, and coactivity predicted through double linear optimization, EMG-assisted, and EMG assisted by optimization approaches were compared.Background. The advantages of EMG-based approaches are known from static task analyses. Limited assessment has been made for dynamic lifting. METHODS: Eleven male subjects performed sagittal plane lifting-lowering at fixed cadence from 0 degrees to 45 degrees of trunk flexion with and without an external load of 12 kg. Three-dimensional kinematics and dynamics as well as surface EMG provided inputs to a 12 muscle lumbar spine model. RESULTS: Trunk muscle coactivity was different between the modelling approaches but spine compression was not. Both EMG-based approaches were sensitive to trunk muscle coactivity and imbalance in left-right muscle forces during sagittal plane lifting. Overall, the best correlations between predicted forces and EMG as well as between forces predicted by different modelling approaches were obtained with the EMG-based models. Only the EMG assisted by optimization approach simultaneously satisfied mechanical and physiological validity. CONCLUSIONS: Both EMG-based approaches demonstrated their potential to detect individual trunk muscle strategies. A more detailed trunk anatomy representation would improve the EMG-assisted approach and reduce the adjustment to muscle force gain through EMG assisted by optimization. RELEVANCE: Injury to the lumbar spine could command alternative strategies of motion to attenuate pain and damage. To understand these strategies, the ideal lumbar spine model should predict individual muscle force patterns and satisfy mechanical equilibrium.

Adult↗

PubMed1999

Determination of the optimal elbow axis for evaluation of placement of prostheses.

OBJECTIVE: To present a method to determine the position and orientation of the mean optimal flexion axis of the elbow in vivo to be used in clinical research. DESIGN: Registering the movements of the forearm with respect to the upper arm during five cycles of flexion and extension of the elbow using a 6 degrees-of-freedom electromagnetic tracking device. BACKGROUND: Loosening of elbow endoprostheses could be caused by not placing the prostheses in a biomechanically optimal way. To evaluate the placement of endoprostheses with regard to loosening, a method to determine the elbow axis is needed. METHODS: The movements of the right forearm with respect to the upper arm during flexion and extension were registered with a 6 degrees-of-freedom electromagnetic tracking device. A mean optimal instantaneous helical axis of 10 elbows was calculated in a coordinate system related to the humerus. RESULTS: The average position of the flexion/extension axis was 0.81 cm (SD 0.66 cm) cranially and 1.86 cm (SD 0.72 cm) ventrally of the epicondylus lateralis. The average angle with the frontal plane was 15.3 degrees (SD 2 degrees). CONCLUSIONS: A useful estimation of the position and orientation of a mean optimal flexion axis can be obtained in vivo.

Adult↗

PubMed2001

Experts' opinions on the profile of optimal care for patients with diabetes mellitus type 2 in the Netherlands.

BACKGROUND: The St. Vincent Declaration has resulted in discussions and initiatives on optimal diabetes care during recent years. Both are based on two sources of knowledge: evidence and experience. We wanted to reveal the experience based knowledge in the Netherlands to identify essential elements or prerequisites for high quality type 2 diabetes care. METHODS: A group of 56 experts on diabetes care were invited to fill in a questionnaire. This included a ranking of 18 elements on the organization of diabetes care and 9 on patient education. RESULTS: The response rate was 87.5%. With regard to the organization of care 'active patient participation', 'protocolized care' and 'patient education' were evaluated as the most important. The integration in daily diabetes care was seen as the most important aspect of patient education. Optimal diabetes patient education would include five sessions (range: 1-10) of 1 h (range: 0.25-3) with active follow-up. The most appropriate disciplines for patient education are the diabetes nurse (chosen by 93% of the experts) and the dietician (77%). CONCLUSIONS: Optimal care for diabetes mellitus type 2 consists of structured care with integrated patient education. The majority of the experts indicated that this is not optimally organized within the Netherlands.

Attitude of Health Personnel↗

PubMed2002

Optimal pulse-inversion imaging for microsphere contrast agents.

Microbubbles are used as contrast agents because they scatter incident ultrasound (US) efficiently. Pulse-inversion imaging makes use of the asymmetrical difference in response of a bubble to an US pulse and its symmetrical opposite to obtain improved contrast. In this theoretical work, the principle of pulse-inversion imaging is expanded upon by finding the optimal pulse shape to maximize the signal from a bubble. Given a limit on driving intensity, a suitable norm of the bubble response is maximized using optimal control theory to identify the proper pulse/antipulse driving protocol for a single bubble. The optimal pulse yields a several-fold increase in the normed response over the best sinusoidal pulse of the same driving intensity. It was found that the optimal driving for a single bubble also maximizes the nonlinear response of the cloud if its mean bubble size is the same as that of the single bubble.

Biomedical Enhancement↗

PubMed1999

Competition for enzymes in metabolic pathways: implications for optimal distributions of enzyme concentrations and for the distribution of flux control.

The structures of biochemical pathways are assumed to be determined by evolutionary optimization processes. In the framework of mathematical models, these structures should be explained by the formulation of optimization principles. In the present work, the principle of minimal total enzyme concentration at fixed steady state fluxes is applied to metabolic networks. According to this principle there exists a competition of the reactions for the available amount of enzymes such that all biological functions are maintained. In states which fulfil these optimization criteria the enzyme concentrations are distributed in a non-uniform manner among the reactions. This result has consequences for the distribution of flux control. It is shown that the flux control matrix c, the elasticity matrix epsilon, and the vector e of enzyme concentrations fulfil in optimal states the relations c(T)e = e and epsilon(T)e = 0. Starting from a well-balanced distribution of enzymes the minimization of total enzyme concentration leads to a lowering of the SD of the flux control coefficients.

Biological Evolution↗

PubMed1997

Optimal scoring strategies and weights for the formalin test in rats.

The formalin test is a well-established model for assessing inflammatory nociceptive processes and analgesic drug effects. Previous research established the validity of an ordinal relationship among three well-defined pain behavior categories used to compute a composite pain score (CPS). However, optimal weights had not been validated. The present research used data from Coderre et al. (1993) and from Sufka and Roach (1996) to determine and validate optimal pain behavior category weights. Based on multiple regression analyses and Pearson correlations, optimal weights of 1 and 2 are proposed for behavior categories 2 and 3, respectively; behavior category 1 is not scored. These results are consistent with the work of Abbott et al. (1995) and Coderre et al. (1993) in that the ordinal relationship among category weights is preserved, and extend previous work by establishing optimal category weights.

Analgesics, Opioid↗

PubMed1998

Optimization of the mammalian respiratory system: symmorphosis versus single species adaptation.

Taylor and Weibel's principle of symmorphosis hypothesized optimal design of the mammalian respiratory system, with no excess structure relative to its maximal O2 flux, VO2max. Although they found symmorphosis not to be a general principle of design, it might apply to a highly adapted aerobic athlete, e.g. the Thoroughbred racehorse. Using a mathematical model based on empirical data of the equine O2 transport system at normoxic VO2max, the fraction of the total limitation to O2 flux contributed by each of the respiratory transport steps is calculated as either the fractional change (F) in VO2max for a 1% change in each component, or as the fraction of total O2 pressure drop (R(int)) across each component at VO2max. When calculated as F, alveolar ventilation (VA) and pulmonary diffusing capacity (DLO2) are major limiting factors, circulatory convection (Q) is nearly as limiting, and peripheral tissue diffusing capacity (DTO2) is only one-third as important. When calculated as R(int), DLO2 is the major factor, VA and DTO2 contribute significantly, and Q is smallest. These patterns contrast with analogous studies in humans, in which Q is the single major limiting factor. The results suggest that strong selection for aerobic power in horses has maximized the malleable components of their respiratory systems until the least malleable structure, the lungs, has become a major limitation to O2 flux. Symmorphosis cannot determine if such a design is or is not optimized, as every system falls on a continuous distribution of relative optimization among species. However, the concept of symmorphosis is useful for establishing a framework within which a single species can be compared with a quantitatively defined hypothesis of optimal animal design, and compared with other species according to those criteria.

Adaptation, Biological↗

PubMed2001

A technique for optimization of digitally reconstructed radiographs of the chest in virtual simulation.

INTRODUCTION: Virtual simulation (VS) of radiotherapy uses CT data. Digitally reconstructed radiographs (DRRs) are a critical element of this process, and the quality of these images is frequently suboptimal. We present techniques to improve DRR quality for clinical purposes. The results of two approaches to DRR optimization are presented. METHODS AND MATERIALS: One approach to DRR optimization is to use traditional radiographs as a guide and to adjust the algorithm parameters based on image and objective contrast to produce images that more closely resemble traditional radiographs (Method 1). Another approach is to focus on the visibility of specific anatomic structures. Using this method, two DRR images are optimized manually by interactively adjusting reconstruction parameters, then they are combined into a single composite image (Method 2). DRRs for the chest region, generated using both methods, were evaluated by clinical staff based on usability for treatment verification and field definition. RESULTS: Using Method 1, the resulting DRRs more closely resembled traditional radiographs. This technique allows DRR quality to be improved with little user interaction. These DRRs are generally adequate for clinical use, but not optimal for sites such as the chest. Images generated using Method 2 were considered clinically superior in terms of visibility of specific anatomic structures. These images also compare well with traditional radiographs, although they show an increased contrast level between bone and lower density structures. CONCLUSION: Both Methods 1 and 2 can be used to improve DRR quality for clinical purposes. For the chest region, the additional effort required by Method 2 to achieve a more detailed image appears justified.

Algorithms↗

PubMed2002

Conformal radiotherapy optimization with micromultileaf collimators: comparison with radiosurgery techniques.

PURPOSE: Conformal radiotherapy (CRT) consists of irradiating the target volume while avoiding the healthy peripheral tissues and organs at risk as far as possible. One technique used to treat intracranial tumors consists of using micromultileaf collimators (MMLCs). Given the dose constraints involved, it is of interest to optimize MMLC irradiation parameters and compare the results of this technique with those of conventional radiosurgery (RT) techniques (Gamma Knife and linear accelerator stereotactic RT). METHODS AND MATERIALS: MMLC protocols are optimized in two stages. The orientation of the fields, delimited by a beam's eye view technique, is determined using a genetic algorithm method. The weighting of the fields and subfields when using intensity modulation and the position of the leaves are optimized using a simulated annealing method. We compared the results obtained for 8 clinical cases using 5 intensity-modulated fields with those obtained using the two radiosurgery techniques. The comparison indexes are those defined by the Radiation Therapy Oncology Group (RTOG). RESULTS: The results of this study demonstrated the advantages of using intensity modulation and the improvement obtained for the RTOG indexes in the case of CRT with MMLC, although the healthy peripheral tissues were less exposed to radiation with the radiosurgery techniques. The results also highlight the difficulty encountered with radiosurgery techniques in obtaining satisfactory dose homogeneity when the protocol is defined with numerous iosocenters. CONCLUSION: In CRT with MMLC, intensity modulation makes it possible to reduce the number of fields used. It is especially useful to optimize the orientations in the case of target volumes of complex shape or when volumes at risk are in the vicinity of the target. If used correctly, MMLC can be a valuable alternative to conventional radiosurgery techniques.

Algorithms↗

PubMed2003

Optimal stochastic correction strategies for rigid-body target motion.

PURPOSE: To derive optimal correction strategies for setup errors, including the uncertainty in their measurement, and to analyze their impact on treatment margins. METHODS AND MATERIALS: New concepts like image-guided radiotherapy aim to provide an increasing amount of targeting information during treatment. Future treatment devices incorporating imaging capabilities will facilitate frequent correction of treatment setup errors. It is, therefore, possible to design new correction protocols that reduce not only systematic but also random setup errors. A novel, very general approach to developing optimal correction strategies in the presence of measurement uncertainties is derived from linear systems theory. In the simplest approach, the state variable of the system, which represents the patient, is the spatial displacement of the center-of-mass of the clinical target volume with respect to the planning CT. This displacement is the sum of a systematic and a random component. Uncertainties in the measured value of the state variable due to the measurement process, image processing technique, or organ deformation are naturally incorporated into a linear system. The true value of the displacement can be estimated from the noisy measurements with a stochastic filter (Kalman filter). These estimates provide an optimal control law for the system and therefore optimal values for the setup corrections. In the case of unknown systematic and random error variances, an adaptive version of the filter was implemented. The statistical properties of the filter were investigated by performing simulations of the state space model and assessed for individual patients and a large patient population subject to different action criteria. RESULTS: Over a patient population, the corrections by the Kalman filter estimates are always advantageous compared with the corrections by the measured values themselves. For a small percentage of individual patients, however, the Kalman corrections worsen the results. For large measurement error, the residual standard deviation of the random setup errors can be reduced by approximately 28% for over 90% of the patients. The uncertainty in the measured value impairs the ability to completely account for uncertainties. CONCLUSIONS: The Kalman estimates provide an effective means to perform daily setup corrections in the presence of measurement errors. The linear system approach is very versatile and can be extended to more general state variables.

Algorithms↗

PubMed1996

Optimization of permanent 125I prostate implants using fast simulated annealing.

PURPOSE: Treatment planning of ultrasound-guided transperineal 125I permanent prostatic implants is a time-consuming task, due to the large number of seeds used and the very large number of possible source arrangements within the target volume. The goal of this work is to develop an algorithm based on fast simulated annealing allowing consistent and automatic dose distribution optimization in permanent 125I prostatic implants. METHODS AND MATERIALS: Fast simulated annealing is used to optimize the dose distribution by finding the best seed distribution through the minimization of a cost function. The cost function includes constraints on the dose at the periphery of the planned target volume and on the dose uniformity within this volume. Adjustment between peripheral dose and the dose uniformity can be achieved by varying the weight factor in the cost function. RESULTS: Fast simulated annealing algorithm finds very good seed distributions within 20,000 iterations. The computer time needed for the optimization of a typical permanent implant involving 60 seeds and 14 needles is approximately 15 min. An additional 5 min are necessary for isodose distribution computations and miscellaneous outputs. CONCLUSION: The use of fast simulated annealing allows for an efficient and rapid optimization of dose distribution. This algorithm is now routinely used at our institution in the clinical planning of 125I permanent transperineal prostate implants for early stage prostatic carcinoma.

Algorithms↗

PubMed1998

Simple look-up table of optimized dwell time intervals using a high-dose-rate remote afterloader for endovascular irradiation.

PURPOSE: This article's objective is to develop a simple methodology deliver a uniform radiation dose to the wall of a narrow peripheral artery for preventing restenosis using a high-dose-rate (HDR) 192Ir remote afterloader. METHODS AND MATERIALS: Based upon published two-dimensional data such as anisotropy factors of an HDR 192Ir source calculated from the Monte-Carlo method, arterial wall doses at a close range from an HDR source may be easily calculated using the special formula suggested in Task Group Report No. 43 published by the American Association of Physicists in Medicine. An optimization procedure was used to calculate the optimized dwell times for delivering a uniform dose along arterial walls for various arterial diameters and lengths of lesions. RESULTS: Based on lengths of the stenosis and diameters of arteries or angioplasty balloons, a set of simple look-up tables for optimal dwell time intervals of endovascular radiation treatment have been developed for the MicroSelectron HDR remote afterloader. CONCLUSION: Doses for endovascular irradiation have been accurately calculated with anisotropy factors. For delivering uniform doses along the arterial wall, a set of look-up tables listed for optimal dwell times is available for the HDR remote afterloader.

Arterial Occlusive Diseases↗

PubMed1998

Customized gynecologic interstitial implants: CT-based planning, dose evaluation, and optimization aided by laparotomy.

PURPOSE: Interstitial perineal implants may be utilized to deliver a high local radiation dose in the treatment of advanced gynecologic malignancies. Lack of knowledge of the precise anatomic relationships between the implant and the target and critical organs may limit efficacy and increase complication risks. Computed tomography (CT)-based planning, dose evaluation, and optimization of customized interstitial implants, aided by laparotomy, have been developed to overcome these limitations. METHODS AND MATERIALS: Twenty patients with locally advanced gynecologic malignancies treated between May 1990 to October 1996 with external irradiation and one or two implants. Interstitial implants were performed when intracavitary brachytherapy was judged to be inadequate or when the response to external radiation and an intracavitary implant was not satisfactory. Customized interstitial implants were planned using preimplantation CT to determine catheter angles and paths that best implanted the target while avoiding pelvic bones and organs. Laparotomy aimed at lysing bowel adhesions, placement of omental carpet, and refining needle placement. Postimplantation CT was used for loading optimization and dose evaluation. RESULTS: Catheter angles 15-25 degrees were found to adequately implant anteriorly laying targets while avoiding pubic bones and bladder. Adhesiolysis of bowel loops from the vaginal apex was required in patients with prior hysterectomy. Small modifications in catheter placements were made during laparotomy in all implants. Postimplantation CTs showed deviations of the catheter positions compared with the planning CTs and were essential in determining target and organ doses and loading optimization. At a median follow-up of 42 months (range: 9-80 months), local control rate is 55% and disease-free survival 40%. Late complications occurred in 2 of 11 of patients without local recurrence. CONCLUSIONS: CT-based planning, loading optimization, and dose evaluation of customized implants improve radiation dose delivery. Laparotomy enhances implant accuracy and safety. Local tumor control rate is still unsatisfactory. It reflects the shortcomings of technical advances alone in poor prognosis tumors like those selected for this series.

Adenocarcinoma↗

PubMed1998

Optimized dose distribution of a high dose rate vaginal cylinder.

PURPOSE: To present a comparison of optimized dose distributions for a set of high-dose-rate (HDR) vaginal cylinders calculated by a commercial treatment-planning system with benchmark calculations using Monte-Carlo-calculated dosimetry data. METHODS AND MATERIALS: Optimized dose distributions using both an isotropic and an anisotropic dose calculation model were obtained for a set of HDR vaginal cylinders. Mathematical optimization techniques available in the computer treatment-planning system were used to calculate dwell times and positions. These dose distributions were compared with benchmark calculations with TG43 formalism and using Monte-Carlo-calculated data. The same dwell times and positions were used for a quantitative comparison of dose calculated with three dose models. RESULTS: The isotropic dose calculation model can result in discrepancies as high as 50%. The anisotropic dose calculation model compared better with benchmark calculations. The differences were more significant at the apex of the vaginal cylinder, which is typically used as the prescription point. CONCLUSION: Dose calculation models available in a computer treatment-planning system must be evaluated carefully to ensure their correct application. It should also be noted that when optimized dose distribution at a distance from the cylinder surface is calculated using an accurate dose calculation model, the vaginal mucosa dose becomes significantly higher, and therefore should be carefully monitored.

Brachytherapy↗

PubMed1999

Optimizing computerized treatment planning for the Gamma Knife by source culling.

PURPOSE: A good plan is crucial to the success of gamma knife treatment, which depends not only on parameters such as the number of shots, shot position, collimator sizes, and shot weight, but also on the number of blocked cobalt sources. However, during treatment, a plug is generally used to block those cobalt sources, so the beam cannot reach critical tissues. We present here an automated method to optimize all of those parameters, and to choose a source set, although the beams of some blocked sources do not hit any critical tissue. This strategy is used to achieve a high dose that better conforms to the tumor shape, and at the same time, avoids healthy tissue. METHODS AND MATERIALS: Using a workstation that integrates the gamma knife treatment planning system, we developed a two-step optimization algorithm. First, we used a modified Powell's method to optimize the location of the shot, collimator size, and shot weight; we used simulated annealing to determine if the number of shots was adequate using this parameter. Then, simulated annealing was used to determine which cobalt sources we needed to block. RESULTS: Application of this optimization method in two cases showed that the treatment plan can be much improved when the set of blocked cobalt sources has been taken into consideration. CONCLUSION: Determining the set of blocked sources is necessary in certain cases. This technique better conforms the desired isodose curves to the outline of the target volume and minimizes damage to the surrounding normal tissues.

Algorithms↗

PubMed2000

Optimization of coplanar six-field techniques for conformal radiotherapy of the prostate.

PURPOSE: To determine the optimal coplanar treatment technique for six-field conformal radiotherapy of prostate only (PO) or prostate plus seminal vesicles (PSV). METHODS AND MATERIALS: A series of 6-MV six-field coplanar treatment plans were created for PO and PSV volumes in 10 patients prescribed to both 64 and 74 Gy. All plans consisted of laterally-symmetric anterior oblique, lateral, and posterior oblique fields. The posterior oblique fields were varied through 20-45 degrees relative to the lateral fields, and for each of these angles, the anterior oblique fields were varied through 25-65 degrees relative to lateral. The plans were compared by means of rectal volumes irradiated to 80% or more of the prescribed dose (V80); normal tissue complication probability (NTCP) for rectum, bladder, and femoral heads; and tumor control probability (TCP). Femoral head tolerance was designated as 52 Gy to no more than 10% volume. RESULTS: For the PO group, anterior oblique fields at 50 degrees from lateral and posterior oblique fields at 25 degrees from lateral produced the lowest V80, together with femoral head doses which were appropriate for most patients (V80 = 24.4+/-5.3% [1 SD]). Compared to a commonly-used six-field (reference) plan with both anterior and posterior oblique fields at 35 degrees from lateral (V80 = 26.3+/-5.9%), this represented an improvement (p = 0.001). For the PSV group, the optimal anterior and posterior oblique fields were at 65 degrees and 30 degrees from lateral, respectively (V80 = 47.5+/-6.3%). Relative to the reference plan (V80 = 49.4+/-5.6%), this was a marginal improvement (p = 0.07). CONCLUSION: The optimized six-field plans provide increased rectal sparing at both standard and escalated doses. Moreover, the gain in TCP resulting from dose escalation can be achieved with a smaller increase in rectal NTCP using the optimized six-field plans.

Aged↗

PubMed1987

Simultaneous liquid chromatographic determination of seventeen of the major monoamine neurotransmitters, precursors and metabolites. I. Optimization of the mobile phase using factorial designs and a computer program to predict chromatograms.

Utilizing reversed-phase high-performance liquid chromatography (HPLC) with electrochemical detection and optimization of the mobile phase using factorial designs and a constructed computer program to predict chromatograms, it has been possible to obtain a satisfactory resolution of seventeen of the major monoamine neurotransmitters, precursors and metabolites. A rapid (less than 25 min) isocratic system for the simultaneous determination of 3,4-dihydroxyphenylalanine, dopamine, dihydroxyphenylacetic acid, 3-methoxytyramine, homovanillic acid, norepinephrine, normetanephrine, 3,4-dihydroxyphenylethylene glycol, 3-methoxy-4-hydroxyphenylethylene glycol, epinephrine, metanephrine, vanillylmandelic acid, 5-hydroxytryptophan, serotonin, 5-hydroxytryptophol and 5-hydroxyindoleacetic acid in addition to the internal standard isoproterenol is presented. The optimization strategy included selection of variables to optimize by a reduced factorial design a detailed study of these variables by a complete factorial design, theoretical predictions of chromatograms by a constructed computer program and test on the HPLC system. This optimization strategy can easily be applied to any problem of solute separation by liquid chromatography.

Chromatography, High Pressure Liquid↗

PubMed1997

Fractional factorial design optimization of the separation of pilocarpine and its degradation products by capillary electrophoresis.

The separation of pilocarpine and its degradation products by micellar electrokinetic capillary chromatography (MECC) has been optimized by using fractional factorial design of the experiments. Critical parameters were identified in a screening design, and an optimization design was used to optimize the separation. The optimal separation method was based on a borate buffer with sodium dodecyl sulfate (SDS). It is concluded that by using fractional factorial design it is possible to improve the separation of pilocarpine, its trans epimer, isopilocarpine and their hydrolysis products, pilocarpic acid and isopilocarpic acid.

Electrophoresis, Capillary↗