Jan Muzik

Performance of the First Combined Smartwatch and Smartphone Diabetes Diary Application Study

Background: Wearable computing has long been described as the solution to many health challenges. However, the use of this technology as a diabetes patient self-management tool has not been fully explored. A promising platform for this use is the smartwatch—a wrist-worn device that not only tells time but also provides internet connection and ability to communicate information to and from a mobile phone. Method: Over 9 months, the design of a diabetes diary application for a smartwatch was completed using agile development methods. The system, including a two-way communication between the applications on the smartwatch and mobile phone, was tested with 6 people with type 1 diabetes. A small number of participants was deliberately chosen due to ensure an efficient use of resources on a novel system. Results: The designed smartwatch system displays the time, day, date, and remaining battery time. It also allows for the entry of carbohydrates, insulin, and blood glucose (BG), with the option to view previously recorded data. Users were able to record specific physical activities, program reminders, and automatically record and transfer data, including step counts, to the mobile phone version of the diabetes diary. The smartwatch system can also be used as a stand-alone tool. Users reported usefulness, responded positively toward its functionalities, and also provided specific suggestions for further development. Suggestions were implemented after the feasibility study. Conclusions: The presented system and study demonstrate that smartwatches have opened up new possibilities within the diabetes self-management field by providing easier ways of monitoring BG, insulin injections, physical activity and dietary information directly from the wrist.

Comparison of fixed-beam IMRT, helical tomotherapy, and IMPT for selected cases

A growing number of advanced intensity modulated treatment techniques is becoming available. In this study, the specific strengths and weaknesses of four techniques, static and dynamic multileaf collimator (MLC), conventional linac-based IMRT, helical tomotherapy (HT), and spot-scanning proton therapy (IMPT) are investigated in the framework of biological, EUD-based dose optimization. All techniques were implemented in the same in-house dose optimization tool. Monte Carlo dose computation was used in all cases. All dose-limiting, normal tissue objectives were treated as hard constraints so as to facilitate comparability. Five patient cases were selected to offer each technique a chance to show its strengths: a deep-seated prostate case (for 15 MV linac-based IMRT), a pediatric case (for IMPT), an extensive head-and-neck case (for HT), a lung tumor (for HT), and an optical neurinoma (for noncoplanar linac-based IMRT with a miniMLC). The plans were compared by dose statistics and equivalent uniform dose metrics. All techniques delivered results that were comparable with respect to target coverage and the most dose-limiting normal tissues. Static MLC IMRT struggled to achieve sufficient target coverage at the same level of dose homogeneity in the lung case. IMPT gained the greatest advantage when lung sparing was important, but did not significantly reduce the risk of nearby organs. Tomotherapy and dynamic MLC IMRT showed mostly the same performance. Despite the apparent conceptual differences, all four techniques fare equally well for standard patient cases. The absence of relevant differences is in part due to biological optimization, which offers more freedom to shape the dose than do, e.g., dose volume histogram constraints. Each technique excels for certain classes of highly complex cases, and hence the various modalities should be viewed as complementary, rather than competing.

On the performances of different IMRT treatment planning systems for selected paediatric cases

BackgroundTo evaluate the performance of seven different TPS (Treatment Planning Systems: Corvus, Eclipse, Hyperion, KonRad, Oncentra Masterplan, Pinnacle and PrecisePLAN) when intensity modulated (IMRT) plans are designed for paediatric tumours.MethodsDatasets (CT images and volumes of interest) of four patients were used to design IMRT plans. The tumour types were: one extraosseous, intrathoracic Ewing Sarcoma; one mediastinal Rhabdomyosarcoma; one metastatic Rhabdomyosarcoma of the anus; one Wilms tumour of the left kidney with multiple liver metastases. Prescribed doses ranged from 18 to 54.4 Gy. To minimise variability, the same beam geometry and clinical goals were imposed on all systems for every patient. Results were analysed in terms of dose distributions and dose volume histograms.ResultsFor all patients, IMRT plans lead to acceptable treatments in terms of conformal avoidance since most of the dose objectives for Organs At Risk (OARs) were met, and the Conformity Index (averaged over all TPS and patients) ranged from 1.14 to 1.58 on primary target volumes and from 1.07 to 1.37 on boost volumes. The healthy tissue involvement was measured in terms of several parameters, and the average mean dose ranged from 4.6 to 13.7 Gy. A global scoring method was developed to evaluate plans according to their degree of success in meeting dose objectives (lower scores are better than higher ones). For OARs the range of scores was between 0.75 ± 0.15 (Eclipse) to 0.92 ± 0.18 (Pinnacle3 with physical optimisation). For target volumes, the score ranged from 0.05 ± 0.05 (Pinnacle3 with physical optimisation) to 0.16 ± 0.07 (Corvus).ConclusionA set of complex paediatric cases presented a variety of individual treatment planning challenges. Despite the large spread of results, inverse planning systems offer promising results for IMRT delivery, hence widening the treatment strategies for this very sensitive class of patients.

Monte Carlo vs. Pencil Beam based optimization of stereotactic lung IMRT

BackgroundThe purpose of the present study is to compare finite size pencil beam (fsPB) and Monte Carlo (MC) based optimization of lung intensity-modulated stereotactic radiotherapy (lung IMSRT).Materials and methodsA fsPB and a MC algorithm as implemented in a biological IMRT planning system were validated by film measurements in a static lung phantom. Then, they were applied for static lung IMSRT planning based on three different geometrical patient models (one phase static CT, density overwrite one phase static CT, average CT) of the same patient. Both 6 and 15 MV beam energies were used. The resulting treatment plans were compared by how well they fulfilled the prescribed optimization constraints both for the dose distributions calculated on the static patient models and for the accumulated dose, recalculated with MC on each of 8 CTs of a 4DCT set.ResultsIn the phantom measurements, the MC dose engine showed discrepancies < 2%, while the fsPB dose engine showed discrepancies of up to 8% in the presence of lateral electron disequilibrium in the target. In the patient plan optimization, this translates into violations of organ at risk constraints and unpredictable target doses for the fsPB optimized plans. For the 4D MC recalculated dose distribution, MC optimized plans always underestimate the target doses, but the organ at risk doses were comparable. The results depend on the static patient model, and the smallest discrepancy was found for the MC optimized plan on the density overwrite one phase static CT model.ConclusionsIt is feasible to employ the MC dose engine for optimization of lung IMSRT and the plans are superior to fsPB. Use of static patient models introduces a bias in the MC dose distribution compared to the 4D MC recalculated dose, but this bias is predictable and therefore MC based optimization on static patient models is considered safe.

FlexiGuard: Modular biotelemetry system for military applications

The article presents a FlexiGuard modular biotelemetric system for real-time monitoring of special military units. The main focus of the system is on automated monitoring of special forces via parallel monitoring of each member of the special team individually, witch includes collecting sets of physiologic (or environmental) parameters. The systems consists of a set of sensors (for monitoring temperature, heart rate, acceleration, humidity etc.) and modular sensing unit, which records the measured data and sends them to the visualization unit. The measured values (i.e. heart rate, surface temperature of the body and so on) are then visualized in the graphic user interface of the visualization unit. Testing of the functionality of the system took place in both laboratory and real environment. In the case of carrying out the measurements on 34 soldiers at series of 4 probands at the same time, the sensor networks worked without any loss of signal. During the data transfer to the visualization unit, a loss of approx 0.2% of packets occurred. The system thus can offer information to the commander, which may prove essential for the optimalization of operational strategies, taking the state of wellbeing of the team members into account.

Measuring the Response of Patients with Type I Diabetes to Stress Burden

The article presents measurement methodology and systems for measuring and evaluating the response of patients suffering from type I diabetes to stress burden. The proposed methodology and systems have been developed to recognize the effects of strain on patients’ reaction time and their work performance. Stress burden was measured by a multi-sensory monitoring system designed for this purpose. The methods used were based on monitoring physiological stress symptoms by measuring pulse rate, respiratory rate, temperature, galvanic skin resistance, and electrical activity of muscles. It was suggested to monitor the measured parameters in waveform, from initiation of stress stimuli, throughout the period of growth, and up to the point of decline. The research was conducted under the supervision of psychologists, and the proposed methodology for measuring stress burden and its impact on physiological functions of type I diabetics involved a group of patients and a control group of healthy subjects. The proposed measurement methodology would be beneficial not only in the design of systems for detecting mental stress, but also in the treatment of patients suffering from diabetes and the assessment of their physical/mental state while performing demanding work tasks.

Assessment of Postural Stability Using the Method of Postural Somatooscilography

The aim of article is to present new method for evaluating the postural stability using oscillating platform. Proposed methods are alternative to basic methods which are usually parts of the commercial posturography systems. The methods for calculating the postural parameters have been designed in order to objectively quantify and classify the ability of postural stabilization on a standardized oscillatory platform, and determine differences in the postural stabilization of motor function in healthy people and in people with postural instability. The Posturomed (Haider Bioswing GmbH) and biaxial accelerometer sensor were used for measurement the body acceleration during single leg stance provocation test. The postural somatooscilogram has been defined, which shows accelerations of platform, in horizontal plane in both anteroposterior and mediolateral directions over time. Two parameters, Average Damping Coefficient (ADC) and Average Coefficient of Damped Energy (ACDE), were used to evaluate postural stability. The proposed method was implemented in MatLab sw. Patients with postural disorders and control group of healthy subjects were measured. Statistically significant differences have been observed in postural stability between independent postural stable group and postural unstable groups. Based on the findings, we can say that the presented method allows a complex analysis of the single leg stance in patients with postural balance disorders in clinical practice.

Using mobile technologies with psychiatric patients: Assessing the potential to reduce risk of developing diseases related to inactivity

Mental disorders, such as schizophrenia, are accompanied by increased morbidity and mortality rates, potentially reducing the lifespan of patients by up to 10 years. Premature deaths in schizophrenia sufferers are caused mainly by cardiovascular diseases and complications related to excessive weight gain and type 2 diabetes mellitus. Gaining weight is, furthermore, often a side effect of medicine prescribed for the treatment of schizophrenia. This is why treatment protocols are putting a greater emphasis on healthy lifestyle and exercise for patients, which may support both weight loss and suppress feelings of anxiety. It is, therefore, important for a doctor to monitor the exercise habits of their patients. This article focuses on telemonitoring of physical activity and other biological parameters in patients with mental disorders, such as schizophrenia, using the recent m-Health technology in the form of a Fitbit Flex activity tracker. The Soma web portal has been created to continuously monitor, visualize and analyse the data measured on patients within the scope of research activities.

Real-time BSPM processing system

System for acquisition, real-time processing, visualization and recording of multichannel ECG is presented. The system is build up on LiveMap framework which was originally designed for real-time mapping of EEG. The main advantage of the framework is the support for real-time processing and its modularity. Core modules of the LiveMap system were developed in Delphi programming language but all modules and plug-ins are already implemented in .NET framework in C# language. Due to the requirements on the real-time processing system is implemented as multithreaded and can utilize almost unlimited number of processors/cores. Due to optimization on maximal reliability and maximal throughput, different parts of the signal processing pipeline work in synchronous or asynchronous regime with various thread priority. The system has been designed with maximal regard to generalization and openness but also contains many tools simplifying access to the general properties. The processing pipeline consists of modules data acquisition, signal preprocessing module, the main DSP module, post-processing module, data recording module, visualization module and other helper and monitoring modules. The system is highly configurable and is capable to run on machines wide range of computers, from simple PC to powerful multiprocessor ones.

TU‐FF‐A2‐02: Comparison of Fixed‐Beam IMRT, Helical Tomotherapy and IMPT for Selected Cases

Purpose: To identify persistent characteristics of IMRT, helical tomotherapy and IMPT across the range of potential applications. Method and Materials: The comparison of optimized treatment plans from different planning systems is difficult because treatment objective definitions and dose algorithms differ. Here, the techniques were implemented in the same optimization algorithm and Monte Carlo dose computation was available. Each of the techniques may offer benefits for certain cases and be less suitable for others. Five cases of different classes were selected including prostate, pediatric, lung and head‐and‐neck. The optimization employs biologically‐based objectives and enforces constraints for normal tissue doses. For each case, the same prescription and constraints were used. Results: For the clinical dose levels of this study, no treatment modality produced significantly superior plans. IMPT spared larger parts of the OAR. However, the EUD was mostly similar to that reached by photon techniques as it is mostly determined by the extent of the high dose volume. Tomotherapy provided generally better target coverage and higher homogeneity compared to fixed‐beam IMRT. However, the difference was mainly caused by the translation of the fully modulated fluence into static MLC segments. OAR irradiation was equivalent for both photon modalities, with higher mean doses for the tomo. Thus, the advantage of helical irradiation was mostly offset by the finer resolution of the MLC leaves (4 mm), once sufficiently chosen beams were used. On the other hand, noncoplanar beams did not provide a clear benefit. Conclusion: All modalities were optimized with the same planning system, thereby eliminating differences caused by the TPS. The differences between modalities were rarely significant. The quality of the dose distribution is governed by the particle type (mean dose) and the ability to deliver the ideal dose accurately (MLC leaf width, sequencing, number of beams, scanning grid).