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Lantz, J., Gupta, V., Henriksson, L., Karlsson, M., Persson, A., Carlhäll, C.-J. & Ebbers, T. (2019). Impact of Pulmonary Venous Inflow on Cardiac Flow Simulations: Comparison with In Vivo 4D Flow MRI. Annals of Biomedical Engineering, 47(2), 413-424
Open this publication in new window or tab >>Impact of Pulmonary Venous Inflow on Cardiac Flow Simulations: Comparison with In Vivo 4D Flow MRI
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2019 (English)In: Annals of Biomedical Engineering, ISSN 0090-6964, E-ISSN 1573-9686, Vol. 47, no 2, p. 413-424Article in journal (Refereed) Published
Abstract [en]

Blood flow simulations are making their way into the clinic, and much attention is given to estimation of fractional flow reserve in coronary arteries. Intracardiac blood flow simulations also show promising results, and here the flow field is expected to depend on the pulmonary venous (PV) flow rates. In the absence of in vivo measurements, the distribution of the flow from the individual PVs is often unknown and typically assumed. Here, we performed intracardiac blood flow simulations based on time-resolved computed tomography on three patients, and investigated the effect of the distribution of PV flow rate on the flow field in the left atrium and ventricle. A design-of-experiment approach was used, where PV flow rates were varied in a systematic manner. In total 20 different simulations were performed per patient, and compared to in vivo 4D flow MRI measurements. Results were quantified by kinetic energy, mitral valve velocity profiles and root-mean-square errors of velocity. While large differences in atrial flow were found for varying PV inflow distributions, the effect on ventricular flow was negligible, due to a regularizing effect by mitral valve. Equal flow rate through all PVs most closely resembled in vivo measurements and is recommended in the absence of a priori knowledge.

Place, publisher, year, edition, pages
Springer-Verlag New York, 2019
Keywords
Sensitivity analysis, Design-of-experiments, Computational fluid dynamics, In vivo measurements
National Category
Medical Image Processing Fluid Mechanics and Acoustics
Identifiers
urn:nbn:se:liu:diva-153252 (URN)10.1007/s10439-018-02153-5 (DOI)000456383600007 ()30362080 (PubMedID)2-s2.0-85055724908 (Scopus ID)
Funder
Knut and Alice Wallenberg Foundation
Available from: 2018-12-06 Created: 2018-12-06 Last updated: 2019-03-22Bibliographically approved
Kataria, B., Nilsson Althen, J., Smedby, Ö., Persson, A., Sökjer, H. & Sandborg, M. (2018). Assessment of image quality in abdominal CT: potential dose reduction with model-based iterative reconstruction. European Radiology
Open this publication in new window or tab >>Assessment of image quality in abdominal CT: potential dose reduction with model-based iterative reconstruction
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2018 (English)In: European Radiology, ISSN 0938-7994, E-ISSN 1432-1084Article in journal (Refereed) Published
Abstract [en]

Purpose To estimate potential dose reduction in abdominal CT by visually comparing images reconstructed with filtered back projection (FBP) and strengths of 3 and 5 of a specific MBIR.

Material and methods A dual-source scanner was used to obtain three data sets each for 50 recruited patients with 30, 70 and 100% tube loads (mean CTDIvol 1.9, 3.4 and 6.2 mGy). Six image criteria were assessed independently by five radiologists. Potential dose reduction was estimated with Visual Grading Regression (VGR).

Results Comparing 30 and 70% tube load, improved image quality was observed as a significant strong effect of log tube load and reconstruction method with potential dose reduction relative to FBP of 22–47% for MBIR strength 3 (p < 0.001). For MBIR strength 5 no dose reduction was possible for image criteria 1 (liver parenchyma), but dose reduction between 34 and 74% was achieved for other criteria. Interobserver reliability showed agreement of 71–76% (κw 0.201–0.286) and intra-observer reliability of 82–96% (κw 0.525–0.783).

Conclusion MBIR showed improved image quality compared to FBP with positive correlation between MBIR strength and increasing potential dose reduction for all but one image criterion.

Place, publisher, year, edition, pages
Heidelberg: Springer, 2018
Keywords
Dose Computed tomography Iterative reconstruction Abdomen FBP
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:liu:diva-145274 (URN)10.1007/s00330-017-5113-4 (DOI)000431653200023 ()29368163 (PubMedID)2-s2.0-85040915759 (Scopus ID)
Note

Funding agencies: ALF-grant from Region Ostergotland; LFoU-grant from Region Ostergotland; Medical Faculty at Linkoping University

Available from: 2018-02-20 Created: 2018-02-20 Last updated: 2019-10-15Bibliographically approved
Gupta, V., Lantz, J., Henriksson, L., Engvall, J., Karlsson, M., Persson, A. & Ebbers, T. (2018). Automated three-dimensional tracking of the left ventricular myocardium in time-resolved and dose-modulated cardiac CT images using deformable image registration. Journal of Cardiovascular Computed Tomography, 12(2), 139-148
Open this publication in new window or tab >>Automated three-dimensional tracking of the left ventricular myocardium in time-resolved and dose-modulated cardiac CT images using deformable image registration
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2018 (English)In: Journal of Cardiovascular Computed Tomography, ISSN 1934-5925, Vol. 12, no 2, p. 139-148Article in journal (Refereed) Published
Abstract [en]

Background Assessment of myocardial deformation from time-resolved cardiac computed tomography (4D CT) would augment the already available functional information from such an examination without incurring any additional costs. A deformable image registration (DIR) based approach is proposed to allow fast and automatic myocardial tracking in clinical 4D CT images.

Methods Left ventricular myocardial tissue displacement through a cardiac cycle was tracked using a B-spline transformation based DIR. Gradient of such displacements allowed Lagrangian strain estimation with respect to end-diastole in clinical 4D CT data from ten subjects with suspected coronary artery disease. Dice similarity coefficient (DSC), point-to-curve error (PTC), and tracking error were used to assess the tracking accuracy. Wilcoxon signed rank test provided significance of tracking errors. Topology preservation was verified using Jacobian of the deformation. Reliability of estimated strains and torsion (normalized twist angle) was tested in subjects with normal function by comparing them with normal strain in the literature.

Results Comparison with manual tracking showed high accuracy (DSC: 0.99± 0.05; PTC: 0.56mm± 0.47 mm) and resulted in determinant(Jacobian) > 0 for all subjects, indicating preservation of topology. Average radial (0.13 mm), angular (0.64) and longitudinal (0.10 mm) tracking errors for the entire cohort were not significant (p > 0.9). For patients with normal function, average strain [circumferential, radial, longitudinal] and peak torsion estimates were: [-23.5%, 31.1%, −17.2%] and 7.22°, respectively. These estimates were in conformity with the reported normal ranges in the existing literature.

Conclusions Accurate wall deformation tracking and subsequent strain estimation are feasible with the proposed method using only routine time-resolved 3D cardiac CT.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Cardiac computed tomography; 4D CT; Image registration; Strain analysis; Myocardial deformation; Torsion
National Category
Medical Image Processing
Identifiers
urn:nbn:se:liu:diva-147433 (URN)10.1016/j.jcct.2018.01.005 (DOI)000428247900008 ()29402736 (PubMedID)
Funder
Knut and Alice Wallenberg Foundation, KAW 2013.0076
Available from: 2018-05-17 Created: 2018-05-17 Last updated: 2019-04-30Bibliographically approved
Lantz, J., Gupta, V., Henriksson, L., Karlsson, M., Persson, A., Carlhäll, C. & Ebbers, T. (2018). Intracardiac Flow at 4D CT: Comparison with 4D Flow MRI. Radiology, 289(1), 51-58
Open this publication in new window or tab >>Intracardiac Flow at 4D CT: Comparison with 4D Flow MRI
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2018 (English)In: Radiology, ISSN 0033-8419, E-ISSN 1527-1315, Vol. 289, no 1, p. 51-58Article in journal (Refereed) Published
Abstract [en]

Purpose

To investigate four-dimensional (4D) flow CT for the assessment of intracardiac blood flow patterns as compared with 4D flow MRI.

Materials and Methods

This prospective study acquired coronary CT angiography and 4D flow MRI data between February and December 2016 in a cohort of 12 participants (age range, 36–74 years; mean age, 57 years; seven men [age range, 36–74 years; mean age, 57 years] and five women [age range, 52–73 years; mean age, 64 years]). Flow simulations based solely on CT-derived cardiac anatomy were assessed together with 4D flow MRI measurements. Flow patterns, flow rates, stroke volume, kinetic energy, and flow components were quantified for both techniques and were compared by using linear regression.

Results

Cardiac flow patterns obtained by using 4D flow CT were qualitatively similar to 4D flow MRI measurements, as graded by three independent observers. The Cohen κ score was used to assess intraobserver variability (0.83, 0.79, and 0.70) and a paired Wilcoxon rank-sum test showed no significant change (P > .05) between gradings. Peak flow rate and stroke volumes between 4D flow MRI measurements and 4D flow CT measurements had high correlation (r = 0.98 and r = 0.81, respectively; P < .05 for both). Integrated kinetic energy quantified at peak systole correlated well (r = 0.95, P < .05), while kinetic energy levels at early and late filling showed no correlation. Flow component analysis showed high correlation for the direct and residual components, respectively (r = 0.93, P < .05 and r = 0.87, P < .05), while the retained and delayed components showed no correlation.

Conclusion

Four-dimensional flow CT produced qualitatively and quantitatively similar intracardiac blood flow patterns compared with the current reference standard, four-dimensional flow MRI.

Place, publisher, year, edition, pages
Oak Brook, IL United States: Radiological Society of North America, Inc., 2018
National Category
Fluid Mechanics and Acoustics Cardiac and Cardiovascular Systems Medical Image Processing
Identifiers
urn:nbn:se:liu:diva-149320 (URN)10.1148/radiol.2018173017 (DOI)000444990900009 ()29944089 (PubMedID)
Funder
Knut and Alice Wallenberg Foundation, Seeing Organ FunctionSwedish Heart Lung Foundation
Available from: 2018-06-28 Created: 2018-06-28 Last updated: 2019-04-12Bibliographically approved
Höök, F., Persson, A. & Kasemo, B. (2017). Nanopartiklar kan förbättra avbildningsteknik och diagnostik. Läkartidningen, 114
Open this publication in new window or tab >>Nanopartiklar kan förbättra avbildningsteknik och diagnostik
2017 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114Article, review/survey (Refereed) Published
Abstract [en]

Nanotechnology can improve diagnostics The unique properties of nanoparticles make them tailorable into diagnostic agents on a molecular level, which allow more sensitive and precise in vitro diagnostics and in vivo imaging. While in vitro applications already have impact on diagnostics, in vivo use remains challenging due to difficulties in preparing nanoparticles with acceptable properties regarding toxicity, specific target accumulation and degradation. This article describes the innovative work of developing such platforms, and concludes that while nanotechnology-based diagnostics and imaging are still scarce at the clinical level, the rapid development of many new concepts, devices and processes that are now in the laboratory pipeline promises significant impact in the near future.

National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:liu:diva-146307 (URN)28675416 (PubMedID)
Available from: 2018-04-07 Created: 2018-04-07 Last updated: 2018-04-07
Romu, T., Camilla, V., Dahlqvist Leinhard, O., Tallberg, J., Dahlström, N., Persson, A., . . . Nyström, F. (2016). A randomized trial of cold-exposure on energy expenditure and supraclavicular brown adipose tissue volume in humans. Metabolism: Clinical and Experimental, 65(6), 926-934
Open this publication in new window or tab >>A randomized trial of cold-exposure on energy expenditure and supraclavicular brown adipose tissue volume in humans
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2016 (English)In: Metabolism: Clinical and Experimental, ISSN 0026-0495, E-ISSN 1532-8600, Vol. 65, no 6, p. 926-934Article in journal (Refereed) Published
Abstract [en]

Objective

To study if repeated cold-exposure increases metabolic rate and/or brown adipose tissue (BAT) volume in humans when compared with avoiding to freeze.

Design

Randomized, open, parallel-group trial.

Methods

Healthy non-selected participants were randomized to achieve cold-exposure 1 hour/day, or to avoid any sense of feeling cold, for 6 weeks. Metabolic rate (MR) was measured by indirect calorimetry before and after acute cold-exposure with cold vests and ingestion of cold water. The BAT volumes in the supraclavicular region were measured with magnetic resonance imaging (MRI).

Results

Twenty-eight participants were recruited, 12 were allocated to controls and 16 to cold-exposure. Two participants in the cold group dropped out and one was excluded. Both the non-stimulated and the cold-stimulated MR were lowered within the group randomized to avoid cold (MR at room temperature from 1841 ± 199 kCal/24 h to 1795 ± 213 kCal/24 h, p = 0.047 cold-activated MR from 1900 ± 150 kCal/24 h to 1793 ± 215 kCal/24 h, p = 0.028). There was a trend towards increased MR at room temperature following the intervention in the cold-group (p = 0.052). The difference between MR changes by the interventions between groups was statistically significant (p = 0.008 at room temperature, p = 0.032 after cold-activation). In an on-treatment analysis after exclusion of two participants that reported ≥ 8 days without cold-exposure, supraclavicular BAT volume had increased in the cold-exposure group (from 0.0175 ± 0.015 l to 0.0216 ± 0.014 l, p = 0.049).

Conclusions

We found evidence for plasticity in metabolic rate by avoiding to freeze compared with cold-exposure in a randomized setting in non-selected humans.

Place, publisher, year, edition, pages
Elsevier, 2016
Keywords
Brown adipose tissue; Cold exposure; Magnetic resonance imaging; Metabolic rate
National Category
Pharmacology and Toxicology
Identifiers
urn:nbn:se:liu:diva-128200 (URN)10.1016/j.metabol.2016.03.012 (DOI)000376145100013 ()27173471 (PubMedID)
Funder
Knut and Alice Wallenberg Foundation
Note

Funding agencies: Linkoping University; County Council of Ostergotland (LUA-ALF), Sweden; Swedish Research Council [2013-4466, 2012-1652, 2014-2516]; Knut and Alice Wallenberg Foundation; Sahlgrenskas University Hospital (LUA-ALF); European Union grant (DIABAT) [HEALTH-F2-

Available from: 2016-05-22 Created: 2016-05-22 Last updated: 2019-06-14
Panayi, G., Wieringa, W. G., Alfredsson, J., Carlsson, J., Karlsson, J.-E., Persson, A., . . . Swahn, E. (2016). Computed tomography coronary angiography in patients with acute myocardial infarction and normal invasive coronary angiography. BMC Cardiovascular Disorders, 16(78)
Open this publication in new window or tab >>Computed tomography coronary angiography in patients with acute myocardial infarction and normal invasive coronary angiography
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2016 (English)In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 16, no 78Article in journal (Refereed) Published
Abstract [en]

Background: Three to five percent of patients with acute myocardial infarction (AMI) have normal coronary arteries on invasive coronary angiography (ICA). The aim of this study was to assess the presence and characteristics of atherosclerotic plaques on computed tomography coronary angiography (CTCA) and describe the clinical characteristics of this group of patients. Methods: This was a multicentre, prospective, descriptive study on CTCA evaluation in thirty patients fulfilling criteria for AMI and without visible coronary plaques on ICA. CTCA evaluation was performed head to head in consensus by two experienced observers blinded to baseline patient characteristics and ICA results. Analysis of plaque characteristics and plaque effect on the arterial lumen was performed. Coronary segments were visually scored for the presence of plaque. Seventeen segments were differentiated, according to a modified American Heart Association classification. Echocardiography performed according to routine during the initial hospitalisation was retrieved for analysis of wall motion abnormalities and left ventricular systolic function in most patients. Results: Twenty-five patients presented with non ST-elevation myocardial infarction (NSTEMI) and five with ST-elevation myocardial infarction (STEMI). Mean age was 60.2 years and 23/30 were women. The prevalence of risk factors of coronary artery disease (CAD) was low. In total, 452 coronary segments were analysed. Eighty percent (24/30) had completely normal coronary arteries and twenty percent (6/30) had coronary atherosclerosis on CTCA. In patients with atherosclerotic plaques, the median number of segments with plaque per patient was one. Echocardiography was normal in 4/22 patients based on normal global longitudinal strain (GLS) and normal wall motion score index (WMSI); 4/22 patients had normal GLS with pathological WMSI; 3/22 patients had pathological GLS and normal WMSI; 11/22 patients had pathological GLS and WMSI and among them we could identify 5 patients with a Takotsubo pattern on echo. Conclusions: Despite a diagnosis of AMI, 80 % of patients with normal ICA showed no coronary plaques on CTCA. The remaining 20 % had only minimal non-obstructive atherosclerosis. Patients fulfilling clinical criteria for AMI but with completely normal ICA need further evaluation, suggestively with magnetic resonance imaging (MRI).

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD, 2016
Keywords
Acute myocardial infarction; Normal coronary arteries; Computed tomography coronary angiography; MINCA
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-129496 (URN)10.1186/s12872-016-0254-y (DOI)000376723200001 ()27142217 (PubMedID)
Note

Funding Agencies|Swedish Heart and Lung Foundation [20120449]; Region of Ostergotland [437491]; European Union FP 7 [223615]; Medical Research Council of Southeast Sweden [157921]

Available from: 2016-06-20 Created: 2016-06-20 Last updated: 2018-03-23
Zech, W.-D., Hottinger, A.-L., Schwendener, N., Schuster, F., Persson, A., Warntjes, M. J. & Jackowski, C. (2016). Post-mortem 1.5T MR quantification of regular anatomical brain structures. International journal of legal medicine (Print), 130(4), 1071-1080
Open this publication in new window or tab >>Post-mortem 1.5T MR quantification of regular anatomical brain structures
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2016 (English)In: International journal of legal medicine (Print), ISSN 0937-9827, E-ISSN 1437-1596, Vol. 130, no 4, p. 1071-1080Article in journal (Refereed) Published
Abstract [en]

Recently, post-mortem MR quantification has been introduced to the field of post-mortem magnetic resonance imaging. By usage of a particular MR quantification sequence, T1 and T2 relaxation times and proton density (PD) of tissues and organs can be quantified simultaneously. The aim of the present basic research study was to assess the quantitative T1, T2, and PD values of regular anatomical brain structures for a 1.5T application and to correlate the assessed values with corpse temperatures. In a prospective study, 30 forensic cases were MR-scanned with a quantification sequence prior to autopsy. Body temperature was assessed during MR scans. In synthetically calculated T1, T2, and PD-weighted images, quantitative T1, T2 (both in ms) and PD (in %) values of anatomical structures of cerebrum (Group 1: frontal gray matter, frontal white matter, thalamus, internal capsule, caudate nucleus, putamen, and globus pallidus) and brainstem/cerebellum (Group 2: cerebral crus, substantia nigra, red nucleus, pons, cerebellar hemisphere, and superior cerebellar peduncle) were assessed. The investigated brain structures of cerebrum and brainstem/cerebellum could be characterized and differentiated based on a combination of their quantitative T1, T2, and PD values. MANOVA testing verified significant differences between the investigated anatomical brain structures among each other in Group 1 and Group 2 based on their quantitative values. Temperature dependence was observed mainly for T1 values, which were slightly increasing with rising temperature in the investigated brain structures in both groups. The results provide a base for future computer-aided diagnosis of brain pathologies and lesions in post-mortem magnetic resonance imaging.

Place, publisher, year, edition, pages
Springer, 2016
Keywords
Brain, MR quantification, Post-mortem magnetic resonance imaging (PMMR), Forensic, Neuroimaging
National Category
Pharmacology and Toxicology
Identifiers
urn:nbn:se:liu:diva-130269 (URN)10.1007/s00414-016-1318-3 (DOI)000378817900026 ()26872469 (PubMedID)
Available from: 2016-08-01 Created: 2016-07-28 Last updated: 2018-01-10Bibliographically approved
De Geer, J., Sandstedt, M., Björkholm, A., Alfredsson, J., Janzon, M., Engvall, J. & Persson, A. (2016). Software-based on-site estimation of fractional flow reserve using standard coronary CT angiography data.. Acta Radiologica, 57(10), 1186-1192
Open this publication in new window or tab >>Software-based on-site estimation of fractional flow reserve using standard coronary CT angiography data.
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2016 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 57, no 10, p. 1186-1192Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The significance of a coronary stenosis can be determined by measuring the fractional flow reserve (FFR) during invasive coronary angiography. Recently, methods have been developed which claim to be able to estimate FFR using image data from standard coronary computed tomography angiography (CCTA) exams.

PURPOSE: To evaluate the accuracy of non-invasively computed fractional flow reserve (cFFR) from CCTA.

MATERIAL AND METHODS: A total of 23 vessels in 21 patients who had undergone both CCTA and invasive angiography with FFR measurement were evaluated using a cFFR software prototype. The cFFR results were compared to the invasively obtained FFR values. Correlation was calculated using Spearman's rank correlation, and agreement using intraclass correlation coefficient (ICC). Sensitivity, specificity, accuracy, negative predictive value, and positive predictive value for significant stenosis (defined as both FFR ≤0.80 and FFR ≤0.75) were calculated.

RESULTS: The mean cFFR value for the whole group was 0.81 and the corresponding mean invFFR value was 0.84. The cFFR sensitivity for significant stenosis (FFR ≤0.80/0.75) on a per-lesion basis was 0.83/0.80, specificity was 0.76/0.89, and accuracy 0.78/0.87. The positive predictive value was 0.56/0.67 and the negative predictive value was 0.93/0.94. The Spearman rank correlation coefficient was ρ = 0.77 (P < 0.001) and ICC = 0.73 (P < 0.001).

CONCLUSION: This particular CCTA-based cFFR software prototype allows for a rapid, non-invasive on-site evaluation of cFFR. The results are encouraging and cFFR may in the future be of help in the triage to invasive coronary angiography.

Place, publisher, year, edition, pages
Sage Publications, 2016
Keywords
Cardiac; computed tomography angiography (CTA); heart; arteries; adults; computer applications – detection/diagnosis
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:liu:diva-123579 (URN)10.1177/0284185115622075 (DOI)000382967500007 ()26691914 (PubMedID)
Note

Funding agencies: Department of Radiology, Region Ostergotland; Swedish Heart-Lung-foundation [20120449]

Available from: 2015-12-29 Created: 2015-12-29 Last updated: 2017-12-01Bibliographically approved
Lundström, C., Waltersson, M., Persson, A. & Treanor, D. (2016). Summary of third Nordic symposium on digital pathology. Journal of Pathology Informatics, 7(12)
Open this publication in new window or tab >>Summary of third Nordic symposium on digital pathology
2016 (English)In: Journal of Pathology Informatics, ISSN 2229-5089, E-ISSN 2153-3539, Vol. 7, no 12Article in journal, Editorial material (Other academic) Published
Abstract [en]

Cross-disciplinary and cross-sectorial collaboration is a key success factor for turning the promise of digital pathology into actual clinical benefits. The Nordic symposium on digital pathology (NDP) was created to promote knowledge exchange in this area, among stakeholders in health care, industry, and academia. This article is a summary of the third NDP symposium in Linkφping, Sweden. The Nordic experiences, including several hospitals using whole-slide imaging for substantial parts of their primary reviews, formed a fertile base for discussions among the 190 NDP attendees originating from 15 different countries. This summary also contains results from a survey on adoption and validation aspects of clinical digital pathology use.

Place, publisher, year, edition, pages
Medknow Publications, 2016
Keywords
Implementation; pathology informatics; validation
National Category
Other Medical Engineering Human Computer Interaction
Identifiers
urn:nbn:se:liu:diva-130542 (URN)10.4103/2153-3539.179902 (DOI)27141318 (PubMedID)2-s2.0-85009253042 (Scopus ID)
Funder
VINNOVA, 2012-01121
Available from: 2016-08-15 Created: 2016-08-15 Last updated: 2018-01-10Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-9446-6981

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