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  • 1.
    Davidsson, Anette
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Exhaled Breath Condensate in Obstructive Lung Diseases: A Methodological study2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Asthma and chronic obstructive pulmonary disease (COPD) are two common inflammatory airway diseases characterized by airway inflammation and mucus hypersecretion. Prediction of the outcome of these diseases may not be performed and the need for non-invasive diagnostic tools capable of identifying inflammation in asthma and COPD becomes therefore obvious. Validation, sensitivity and specificity of most non-invasive methods to detect and monitor inflammatory responses in airways are poor and there is a great need to identify and standardize less invasive, or non-invasive methods for investigation of airway inflammation.

    Epithelial lining fluid (ELF) covers the airway surface and contains soluble and insoluble inflammatory cell products and plasma proteins originating and passively transferred from the underlying tissue. Airborne aerosol particles containing ELF saturated with water may be recovered in exhaled air by allowing the air to pass a cold surface, creating exhaled breath condensate (EBC). EBC may then be analysed for various components of interest.

    The aims of this thesis were (1) to explore whether a certain profile of inflammatory cell markers in EBC, saliva or serum may be identified in patients with allergic asthma or COPD, (2) to evaluate the efficacy and reproducibility of a measurable marker in EBC using either of the two condensers ECoScreen or RTube and (3) to evaluate the value of chlorine concentrations in EBC as well as reproducibility of assessments of certain compounds in EBC.

    Material and methods: Thirty-six patients with asthma, 49 smokers or ex-smokers and 25 healthy volunteers participated in three clinical studies. In addition, efficacy, reproducibility and comparison of the two condensers were studied in an ex vivo set up using aerosols of solutions of saline, myeloperoxidase (MPO) or human neutrophil lipocalin (HNL). Aerosol boluses were transferred by means of a servo ventilator to either of the two condensers. Concentrations of chlorine (presumed to be a marker of mucous secretion) in EBC or saliva were analyzed by means of a sensitive coulometric technique (AOX). The inflammatory cell markers histamine, MPO, HNL, lysozyme, cysteinyl-leukotrienes (CysLT) and eosinophil cationic protein (ECP) were analysed in EBC, saliva and/or serum by means of ELISA, RIA, EIA or immunochemical fluorescence methods, respectively. Lung function tests, including diffusion capacity were measured by standard techniques according to clinical routines.

    Results and Conclusions: Chlorine measurements served as the main tool in our tests and intra-assay variability <10% was recorded. However, flow dependency, temperature dependency, substance dependency and concentration dependency characterized yields of EBC. Despite acceptable analytical precision, low concentration levels of inflammation markers, biological variability and occasionally contamination with saliva mean that the feasibility of the EBC method is limited. Despite biological variability, concentrations of chlorine in EBC were significantly higher during than after a mild pollen season, suggesting that chlorine concentrations in EBC are a sensitive marker of allergic airway inflammation. A vast number of confounding factors made interpretations of EBC data obtained from COPD and non-COPD patients difficult and traditional diagnostic tools, such as diffusion capacity (DLCO) and serum lysozyme appeared to best discriminate between COPD and non-COPD.

    List of papers
    1. Quantitative Assessment and Repeatability of Chlorine in Exhaled Breath Condensate: Comparison of Two Types of Condensators
    Open this publication in new window or tab >>Quantitative Assessment and Repeatability of Chlorine in Exhaled Breath Condensate: Comparison of Two Types of Condensators
    2005 (English)In: Respiration, ISSN 0025-7931, E-ISSN 1423-0356, Vol. 72, no 5, p. 529-536Article in journal (Refereed) Published
    Abstract [en]

    Background: Airway condition is presumably reflected in epithelial lining fluid (ELF). Exhaled breath condensate (EBC) has been used as a surrogate marker of the composition of ELF.

    Objectives: This study aimed at assessing the technical repeatability of chlorine measurements in EBC and comparing two separate condensators (Ecoscreen® and R Tube) regarding recovery and repeatability. Furthermore, the association between condensate recoveries and variations in the airway status were scrutinized.

    Methods: EBC was collected using two condensators from 10 healthy volunteers. In addition, 13 asthmatic patients produced EBC with or without an added resistance of 5 cm H2O (Res5), applied to the outflow tract of Ecoscreen. All tests were done in random order. Chlorine levels (analyzed by a coulometric technique) in EBC served as a tool for investigation.

    Results: Chlorine was measurable in all samples. The coefficient of repeatability of chlorine measurements was <10%. Chlorine levels were higher in EBC obtained from R Tube (p < 0.001), and differences in recoveries and variability in chlorine levels were presumably related to technical differences in the condensators and not to the repeatability of chlorine measurements per se. Air-flow-dependent chlorine levels were obtained from healthy volunteers. Application of Res5, recruiting additional alveoli, resulted in increased recovery of the EBC volume, but not of chlorine, from those that had the most pronounced airway obstruction (p = 0.05).

    Conclusion: We conclude that by employing a sensitive analysis technique, chlorine is repeatedly measurable in EBC. We suggest that the bulk of chlorine in EBC originates from large airways and not from the alveolar area. Both condensators were comparable regarding repeatability but differed regarding chlorine recover

    Keywords
    Asthma, Chlorine, Exhaled breath condensate, Repeatability, Volunteers
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-16289 (URN)10.1159/000087679 (DOI)
    Available from: 2009-01-13 Created: 2009-01-13 Last updated: 2017-12-14Bibliographically approved
    2. Chlorine in Breath Condensate: A Measure of Airway Affection in Pollinosis?
    Open this publication in new window or tab >>Chlorine in Breath Condensate: A Measure of Airway Affection in Pollinosis?
    2007 (English)In: Respiration, ISSN 0025-7931, E-ISSN 1423-0356, Vol. 74, no 2, p. 184-191Article in journal (Refereed) Published
    Abstract [en]

    Background: Infiltration of inflammatory cells in bronchial mucosa and glandular hypersecretion are hallmarks of asthma. It has been postulated that exhaled breath condensate (EBC) mirrors events in epithelial lining fluid of airways, such as presence of local inflammation as well as glandular hypersecretion. It is also well known that eosinophil cationic protein (ECP) and cysteinyl-leukotrienes (cys-LT) are released by circulating inflammatory cells when triggered by antigen stimulation in asthma patients.

    Objectives: The aim of this study was to evaluate whether chlorine and/or cys-LT in EBC would reflect changes of exposure of airborne pollen in patients with asthma.

    Methods: EBC and serum were collected from 23 patients with allergic asthma during a pollen season and repeated 5 months later during a period with no aeroallergens. Chlorine was measured by means of a sensitive coulometric technique and cys-LT by an EIA technique. Serum ECP was measured and lung function tests were performed and symptoms noted during both occasions.

    Results: Significantly higher concentrations of chlorine in EBC (p = 0.007) and ECP in serum (p = 0.003) were found during the pollen season compared to post-season. Chlorine levels tended to be higher in patients who reported of chest symptoms compared to those who denied symptoms during the pollen season (p = 0.06). Areas under the receiver-operated characteristic curves (AUCROC) were compared and similar discriminative power to identify exacerbations of asthma was recorded by chlorine in EBC (range 0.67-0.78) and ECP in serum (range 0.64-0.78).

    Conclusion: It is concluded that chlorine in EBC and ECP in serum decreased significantly post-season, and this is suggested to mirror the decrement in airborne antigen. It is furthermore proposed that chlorine in EBC and ECP in serum tend to have a similar capacity to identify seasonal variations in airborne pollen in patients with asthma.

    Place, publisher, year, edition, pages
    Karger, 2007
    Keywords
    Pollen season, Allergic asthma, Exhaled breath condensate, Serum eosinophil cationic protein, Chlorine
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-16291 (URN)10.1159/000091300 (DOI)000244565600010 ()
    Available from: 2009-01-13 Created: 2009-01-13 Last updated: 2017-12-14Bibliographically approved
    3. Efficacy of Two Breath Condensers: An in Vitro Comparative Study
    Open this publication in new window or tab >>Efficacy of Two Breath Condensers: An in Vitro Comparative Study
    2008 (English)Article in journal (Refereed) Submitted
    Abstract [en]

    Examination of exhaled breath condensate (EBC) has been suggested to give information about inflammatory airway diseases.

    The aim of the present study was to compare efficacy and variability in gain of two commercially available condensers, ECoScreen® [E] and RTube [R] in an in vitro experimental set up.

    Methods: Test-fluids containing myeloperoxidase (MPO) or human neutrophil lipocalin (HNL) in addition to saline and bovine serum albumin (BSA) were nebulized. The aerosol was intermittently driven forward by a servoventilator fed by room tempered air, to reach the condenser. Two different concentrations of saline were also dispensed via the same equipment. Analyses of MPO, HNL and chlorine were done by means of ELISA, RIA or a modified adsorbed organic halogen technique (AOX), respectively.

    Results: Significantly higher volumes were recovered by ECoScreen than by RTube during 20-minutes experiments (p<0.001) but not in ten-minute experiments (p>0.05). Based on changes of source concentrations in the nebulizer cup, resulting from nebulization per se, recoveries of HNL tended to be higher by E than by R (p<0.05). In contrast there were no significant differences between condensers in recoveries of MPO or chlorine. The spread of data was wide regarding all tested compounds and of similar degree for both condensers, despite acceptable inter-assay coefficients of variations of all analyses.

    Conclusion: Condensing efficacy tended to be larger using E than R but there was a large variability in results from both condensers. Individual biomolecules may have their specific characteristics, and this must be taken into consideration when planning studies on EBC. We suggest that further methodological studies of the EBC method are warranted.

    Keywords
    Chlorine, HNL, MPO, Exhaled Breath Condensate, efficacy
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-16292 (URN)
    Available from: 2009-01-13 Created: 2009-01-13 Last updated: 2009-08-17Bibliographically approved
    4. Can we predict development of COPD?
    Open this publication in new window or tab >>Can we predict development of COPD?
    2008 (English)Article in journal (Refereed) Submitted
    Abstract [en]

    Background: Cigarette smoking is one of the main causes of chronic obstructive pulmonarydisease (COPD). Chronic inflammation of airways may start years before manifestation ofclinical symptoms, thus early identification of smokers at risk to develop COPD is crucial.Objectives: To evaluate if a single breath test for diffusion capacity (DLCO) or concentrationsof certain biomarkers in exhaled breath condensate (EBC), saliva or serum could identifysubjects with COPD or non-COPD smokers and ex-smokers supposed to be at risk to developCOPD, as suggested by rapid decline of forced expiratory volume in one second (FEV1) during afive year period.

    Methods: Twenty-nine symptom free smokers/ex-smokers, 16 smokers/ex-smokers with COPDand 19 matched healthy non-smoking volunteers were studied by means of spirometry, DLCO,and analyses of EBC, saliva and serum [chlorine, lysozyme, eosinophil cationic protein (ECP)and myeloperoxidase (MPO)]. Area under a receiver operated curve (AUCROC) was used toassess sensitivity and specificity of measurements to identify manifest or risk to get COPD.

    Results: Only DLCO could identify subjects with COPD or risk to develop COPD, as judged byAUCROC (0.85 or 0.75, respectively). Lower DLCO (p=0.003) and higher serum concentrationsof lysozyme (p=0.011) were recorded in those with COPD than non-COPD subjects.Furthermore, concentration of chlorine was higher in EBC from COPD subjects than fromhealthy volunteers (p<0.05). Except for chlorine, none of the remaining biomarkers weredetected in EBC and there was a vast variability of concentrations of biomarkers in saliva.

    Conclusion: DLCO was the most effective discriminator of COPD and rapid decline of lungfunction. Serum concentration of lysozyme was the second strongest discriminator, confirmingprevious findings on involvement of neutrophils in the disease process. The use of EBC as a toolto measure exhaled biomarkers involved in COPD is dubious due to large variability and lowconcentrations of markers in EBC.

    Keywords
    Exhaled Breath Condensate, serum, DLCO, COPD, lysozyme and chlorine
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-16293 (URN)
    Available from: 2009-01-13 Created: 2009-01-13 Last updated: 2009-09-18Bibliographically approved
  • 2.
    Davidsson, Anette
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Histamine release from blood cells and serum ECP in patients with asthma, during and after a mild pollen season.2004In: The European Histamine Research Society, Köln, 2004, p. na-naConference paper (Refereed)
  • 3.
    Davidsson, Anette
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Georgiopoulos, Charalampos
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping.
    Dizdar (Dizdar Segrell), Nil
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuroscience. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Neurology.
    Granerus, Göran
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Zachrisson, Helene
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Comparison between visual assessment of dopaminergic degeneration pattern and semi-quantitative ratio calculations in patients with Parkinsons disease and Atypical Parkinsonian syndromes using DaTSCAN (R) SPECT2014In: Annals of Nuclear Medicine, ISSN 0914-7187, E-ISSN 1864-6433, Vol. 28, no 9, p. 851-859Article in journal (Refereed)
    Abstract [en]

    Objective To verify if I-123-FP-CIT, DaTSCAN (R) can differentiate early stages of Parkinsons disease (PD) as well as patients with Atypical Parkinsonian syndromes (APS) from manifest Parkinsons disease. Methods 128 consecutive patients were investigated with I-123-FP-CIT SPECT during a 4-year period. All patients were diagnosed according to the established consensus criteria for diagnosis of PD (n = 53) and APS (n = 19). Remaining patients were grouped early PD (before onset of L-DOPA medication), (n = 20), vascular PD (n = 6), and non-PD syndromes (n = 30) and SWEDD (n = 1). SPECT images were analyzed visually according to a predefined ranking scale of dopaminergic nerve cell degeneration, distinguishing a posterior-anterior degeneration pattern (egg shape) from a more global and severe degeneration pattern (burst striatum). Striatum uptake ratios were quantitatively analyzed with the 3D software, EXINI. Results In the group of APS patients, the burst striatum pattern was most frequent and found in 61 % (11/18 patients). In PD patients, the egg shape pattern was dominating, especially in early PD where it was present in 95 % (19/20 patients). The positive predictive value for the egg shape pattern to diagnose PD was 92 % in this material (APS and all PD patients) and the specificity 90 % for the burst striatum pattern to exclude APS. The uptake ratios were reduced in both PD and APS patients and closely related to the image ranking. Conclusion In this study, we found that in more than half of the patients it was possible to differentiate between PD and APS by visual interpretation only. Similar results were obtained using semi-quantitative uptake ratios. Combining visual assessment with uptake ratios did not add to the discriminating power of DaTSCAN (R) SPECT in this material.

  • 4.
    Davidsson, Anette
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Georgiopoulos, Charalampos
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping.
    Dizdar Segrell, Nil
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuroscience. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Neurology.
    Granerus, Göran
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Zachrisson, Helene
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Comparison between visual assessment of dopaminergic degeneration pattern and semi-quantitative ratio calculations in patients with Parkinson's disease and Atypical Parkinsonian snydromes using DaTSCAN SPECT2014Conference paper (Other academic)
    Abstract [en]

    Background: Parkinson's disease (PD) is a degenerative disorder characterized by the progressive degeneration of dopamine-containing cells in substantia nigra, and it is the second most common neurodegenerative disorder worldwide. It can be difficult to differentiate between idiopathic PD and Atypical Parkinsonian syndromes (APS). In a high percentage of APS patients, the right diagnosis is not established even during late stages of the disease. Currently there is no specific test to verify PD, especially in the early stages of the disease.

    The aim was to verify if 123I-FP-CIT, DaTSCAN ® can differentiate early stages of Parkinson's disease as well as patients with Atypical Parkinsonian syndromes from manifest Parkinson's disease.

    Materials and methods: 121 consecutive patients were investigated with 123I-FP-CIT SPECT, during a four year period. All patients were diagnosed according to the established consensus criteria for diagnosis of Parkinson's disease (PD), (n=53), Atypical Parkinsonian syndromes (APS) (n=18). Remaining patients were grouped early PD (before onset the of L-dopa medication), (n=20), and non-PD syndromes (n=30). SPECT images were analysed visually according to a predefined ranking scale of dopaminergic degeneration, distinguishing a posterior-anterior degeneration pattern (egg shape) to a more global and severe degeneration pattern (burst striatum). Striatum ratios were quantitatively analysed with the 3D software, EXINI.

    Results: In the group of APS patients the burst striatum pattern was most frequent and found in 61% (11/18 patients). In PD patients the egg shape pattern was dominating, especially in early PD where it was present in 95% (19/20 patients). The sensitivity of burst striatum degeneration pattern was 61% (95%-CI 36-83%), specificity 90% (95%-CI 81-96%). The sensitivity of egg shape pattern was 74% (95%-CI 62-84%), specificity 90% (95%-CI 47-90%). The uptake ratios were reduced in both PD and APS patients and closely related to the image pattern. The lowest putamen/caudate ratio was found in early PD.

    Conclusion: In this study we found that in more than half of the patients it was possible to differentiate between PD and APS by visual interpretation only. Similar results were obtained using semi-quantitative uptake ratios, but combining visual assessment with uptake ratios did not add to the discriminating power of DATSCAN ® SPECT in this material

    References: Kahraman D, Eggers C, Schicha H, Timmermann L, Schmidt M. Visual assessment of dopaminergic degeneration pattern in 123I-FP-CIT SPECT differentiates patients with atypical parkinsonian syndromes and idiopathic Parkinson's disease. J Neurol. 2012;259:251-60

  • 5.
    Davidsson, Anette
    et al.
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Naidu-Sjöswärd, Kerstin
    Linköping University, Department of Medicine and Health Sciences, Anesthesiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Intensive Care UHL.
    Lundman, Lena
    Linköping University, The Tema Institute, Department of Water and Environmental Studies. Linköping University, Faculty of Arts and Sciences.
    Schmekel, Birgitta
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Quantitative Assessment and Repeatability of Chlorine in Exhaled Breath Condensate: Comparison of Two Types of Condensators2005In: Respiration, ISSN 0025-7931, E-ISSN 1423-0356, Vol. 72, no 5, p. 529-536Article in journal (Refereed)
    Abstract [en]

    Background: Airway condition is presumably reflected in epithelial lining fluid (ELF). Exhaled breath condensate (EBC) has been used as a surrogate marker of the composition of ELF.

    Objectives: This study aimed at assessing the technical repeatability of chlorine measurements in EBC and comparing two separate condensators (Ecoscreen® and R Tube) regarding recovery and repeatability. Furthermore, the association between condensate recoveries and variations in the airway status were scrutinized.

    Methods: EBC was collected using two condensators from 10 healthy volunteers. In addition, 13 asthmatic patients produced EBC with or without an added resistance of 5 cm H2O (Res5), applied to the outflow tract of Ecoscreen. All tests were done in random order. Chlorine levels (analyzed by a coulometric technique) in EBC served as a tool for investigation.

    Results: Chlorine was measurable in all samples. The coefficient of repeatability of chlorine measurements was <10%. Chlorine levels were higher in EBC obtained from R Tube (p < 0.001), and differences in recoveries and variability in chlorine levels were presumably related to technical differences in the condensators and not to the repeatability of chlorine measurements per se. Air-flow-dependent chlorine levels were obtained from healthy volunteers. Application of Res5, recruiting additional alveoli, resulted in increased recovery of the EBC volume, but not of chlorine, from those that had the most pronounced airway obstruction (p = 0.05).

    Conclusion: We conclude that by employing a sensitive analysis technique, chlorine is repeatedly measurable in EBC. We suggest that the bulk of chlorine in EBC originates from large airways and not from the alveolar area. Both condensators were comparable regarding repeatability but differed regarding chlorine recover

  • 6.
    Davidsson, Anette
    et al.
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Olsson, Eva
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Engvall, Jan
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Gustafsson, Agnetha
    Linköping University, Department of Medical and Health Sciences, Radiation Physics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics UHL.
    Assessment of image quality for SPECT myocardial perfusion imaging with regard to reconstruction algorithms using visual grading regression.2012Conference paper (Other academic)
  • 7.
    Davidsson, Anette
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Olsson, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Engvall, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Gustafsson, Agnetha
    Karolinska University Hospital, Huddinge, Stockholm, Sweden.
    Influence of reconstruction algorithms on image quality in SPECT myocardial perfusion imaging2017In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 37, no 6, p. 655-662Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: We investigated if image- and diagnostic quality in SPECT MPI could be maintained despite a reduced acquisition time adding Depth Dependent Resolution Recovery (DDRR) for image reconstruction. Images were compared with filtered back projection (FBP) and iterative reconstruction using Ordered Subsets Expectation Maximization with (IRAC) and without (IRNC) attenuation correction (AC).

    MATERIALS AND METHODS: Stress- and rest imaging for 15 min was performed on 21 subjects with a dual head gamma camera (Infinia Hawkeye; GE Healthcare), ECG-gating with 8 frames/cardiac cycle and a low-dose CT-scan. A 9 min acquisition was generated using five instead of eight gated frames and was reconstructed with DDRR, with (IRACRR) and without AC (IRNCRR) as well as with FBP. Three experienced nuclear medicine specialists visually assessed anonymized images according to eight criteria on a four point scale, three related to image quality and five to diagnostic confidence. Statistical analysis was performed using Visual Grading Regression (VGR).

    RESULTS: Observer confidence in statements on image quality was highest for the images that were reconstructed using DDRR (P<0·01 compared to FBP). Iterative reconstruction without DDRR was not superior to FBP. Interobserver variability was significant for statements on image quality (P<0·05) but lower in the diagnostic statements on ischemia and scar. The confidence in assessing ischemia and scar was not different between the reconstruction techniques (P = n.s.).

    CONCLUSION: SPECT MPI collected in 9 min, reconstructed with DDRR and AC, produced better image quality than the standard procedure. The observers expressed the highest diagnostic confidence in the DDRR reconstruction.

  • 8.
    Davidsson, Anette
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Olsson, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Engvall, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Holmberg, Bengt
    Gustafsson, Agnetha
    Karolinska University.
    Left ventricle ejection fraction with gated myocardial perfusion SPECT: a comparison between a conventional scintillation detector gamma camera and cadmium-zinc-telluride dectector camera2014Conference paper (Refereed)
  • 9.
    Davidsson, Anette
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Olsson, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Engvall, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Norberg, Pernilla
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics.
    Myokardscintigrafi med ny hjärtkamera (D-SPECT): Hur mycket kan vi minska strålbelastningen till patienten utan att försämra diagnostisk bildkvalité?2015Conference paper (Other academic)
  • 10.
    Davidsson, Anette
    et al.
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Schmekel, Birgitta
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Efficacy of two breath condensers2010In: Journal of clinical laboratory analysis (Print), ISSN 0887-8013, E-ISSN 1098-2825, Vol. 24, no 4, p. 219-223Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Examination of Exhaled Breath Condensate has been suggested to give information about inflammatory airway diseases. OBJECTIVES: The aim was to compare efficacy and variability in gain of two commercially available exhaled breath condensers, ECoScreen and RTube in an in vitro set up. METHODS: Test fluids containing myeloperoxidase (MPO) or human neutrophil lipocalin (HNL) in addition to saline and bovine serum albumin were nebulized and aerosols were transferred by a servo ventilator to either of the two condensers. Analyses of MPO, HNL, or chlorine were done by means of ELISA, RIA, or a modified adsorbed organic halogen technique (AOX), respectively. RESULTS: Recoveries of HNL were higher when using ECoScreen than RTube (Pandlt;0.05). In contrast, there were no significant differences between the two condensers in recoveries of MPO or chlorine. The spread of data was wide regarding all tested compounds. CONCLUSION: Variability in gain was large and ECoScreen was more efficacious then RTube in condensing the tested solutes of HNL, but not those of MPO or chlorine.

  • 11.
    Davidsson, Anette
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Schmekel, Birgitta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Histamine release from blood cells and serum ECP in patients with asthma, during and after a mild pollen season2005In: Inflammation Research, ISSN 1023-3830, E-ISSN 1420-908X, Vol. 54, p. S76-S77Article in journal (Refereed)
  • 12.
    Davidsson, Anette
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Stratelis, Georgios
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Primary Health Care Centres.
    Acevedo, F.
    Karolinska Institutet.
    Schmekel, Birgitta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Can we predict development of COPD?2008Article in journal (Refereed)
    Abstract [en]

    Background: Cigarette smoking is one of the main causes of chronic obstructive pulmonarydisease (COPD). Chronic inflammation of airways may start years before manifestation ofclinical symptoms, thus early identification of smokers at risk to develop COPD is crucial.Objectives: To evaluate if a single breath test for diffusion capacity (DLCO) or concentrationsof certain biomarkers in exhaled breath condensate (EBC), saliva or serum could identifysubjects with COPD or non-COPD smokers and ex-smokers supposed to be at risk to developCOPD, as suggested by rapid decline of forced expiratory volume in one second (FEV1) during afive year period.

    Methods: Twenty-nine symptom free smokers/ex-smokers, 16 smokers/ex-smokers with COPDand 19 matched healthy non-smoking volunteers were studied by means of spirometry, DLCO,and analyses of EBC, saliva and serum [chlorine, lysozyme, eosinophil cationic protein (ECP)and myeloperoxidase (MPO)]. Area under a receiver operated curve (AUCROC) was used toassess sensitivity and specificity of measurements to identify manifest or risk to get COPD.

    Results: Only DLCO could identify subjects with COPD or risk to develop COPD, as judged byAUCROC (0.85 or 0.75, respectively). Lower DLCO (p=0.003) and higher serum concentrationsof lysozyme (p=0.011) were recorded in those with COPD than non-COPD subjects.Furthermore, concentration of chlorine was higher in EBC from COPD subjects than fromhealthy volunteers (p<0.05). Except for chlorine, none of the remaining biomarkers weredetected in EBC and there was a vast variability of concentrations of biomarkers in saliva.

    Conclusion: DLCO was the most effective discriminator of COPD and rapid decline of lungfunction. Serum concentration of lysozyme was the second strongest discriminator, confirmingprevious findings on involvement of neutrophils in the disease process. The use of EBC as a toolto measure exhaled biomarkers involved in COPD is dubious due to large variability and lowconcentrations of markers in EBC.

  • 13.
    Davidsson, Anette
    et al.
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Söderström, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Naidu Sjöswärd, Kerstin
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Intensive Care UHL.
    Schmekel, Birgitta
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Chlorine in Breath Condensate: A Measure of Airway Affection in Pollinosis?2007In: Respiration, ISSN 0025-7931, E-ISSN 1423-0356, Vol. 74, no 2, p. 184-191Article in journal (Refereed)
    Abstract [en]

    Background: Infiltration of inflammatory cells in bronchial mucosa and glandular hypersecretion are hallmarks of asthma. It has been postulated that exhaled breath condensate (EBC) mirrors events in epithelial lining fluid of airways, such as presence of local inflammation as well as glandular hypersecretion. It is also well known that eosinophil cationic protein (ECP) and cysteinyl-leukotrienes (cys-LT) are released by circulating inflammatory cells when triggered by antigen stimulation in asthma patients.

    Objectives: The aim of this study was to evaluate whether chlorine and/or cys-LT in EBC would reflect changes of exposure of airborne pollen in patients with asthma.

    Methods: EBC and serum were collected from 23 patients with allergic asthma during a pollen season and repeated 5 months later during a period with no aeroallergens. Chlorine was measured by means of a sensitive coulometric technique and cys-LT by an EIA technique. Serum ECP was measured and lung function tests were performed and symptoms noted during both occasions.

    Results: Significantly higher concentrations of chlorine in EBC (p = 0.007) and ECP in serum (p = 0.003) were found during the pollen season compared to post-season. Chlorine levels tended to be higher in patients who reported of chest symptoms compared to those who denied symptoms during the pollen season (p = 0.06). Areas under the receiver-operated characteristic curves (AUCROC) were compared and similar discriminative power to identify exacerbations of asthma was recorded by chlorine in EBC (range 0.67-0.78) and ECP in serum (range 0.64-0.78).

    Conclusion: It is concluded that chlorine in EBC and ECP in serum decreased significantly post-season, and this is suggested to mirror the decrement in airborne antigen. It is furthermore proposed that chlorine in EBC and ECP in serum tend to have a similar capacity to identify seasonal variations in airborne pollen in patients with asthma.

  • 14.
    Georgiopoulos, Charalampos
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping.
    Davidsson, Anette
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Engström, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Larsson, Elna-Marie
    Uppsala University, Sweden.
    Zachrisson, Helene
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Dizdar (Dizdar Segrell), Nil
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Neurology.
    The diagnostic value of dopamine transporter imaging and olfactory testing in patients with parkinsonian syndromes2015In: Journal of Neurology, ISSN 0340-5354, E-ISSN 1432-1459, Vol. 262, no 9, p. 2154-2163Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to compare the efficacy of olfactory testing and presynaptic dopamine imaging in diagnosing Parkinsons disease (PD) and atypical parkinsonian syndromes (APS); to evaluate if the combination of these two diagnostic tools can improve their diagnostic value. A prospective investigation of 24 PD patients, 16 APS patients and 15 patients with non-parkinsonian syndromes was performed during an 18-month period. Single photon emission computed tomography with the presynaptic radioligand I-123-FP-CIT (DaTSCAN (R)) and olfactory testing with the Brief 12-item Smell Identification Test (B-SIT) were performed in all patients. DaTSCAN was analysed semi-quantitatively, by calculating two different striatal uptake ratios, and visually according to a predefined ranking scale. B-SIT score was significantly lower for PD patients, but not significantly different between APS and non-parkinsonism. The visual assessment of DaTSCAN had higher sensitivity, specificity and diagnostic accuracy compared to olfactory testing. Most PD patients (75 %) had visually predominant dopamine depletion in putamen, while most APS patients (56 %) had visually severe dopamine depletion both in putamen and in caudate nucleus. The combination of DaTSCAN and B-SIT led to a higher rate of correctly classified patients. Olfactory testing can distinguish PD from non-parkinsonism, but not PD from APS or APS from non-parkinsonism. DaTSCAN is more efficient than olfactory testing and can be valuable in differentiating PD from APS. However, combining olfactory testing and DaTSCAN imaging has a higher predictive value than these two methods separately.

  • 15.
    Georgiopoulos, Charalampos
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping.
    Davidsson, Anette
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Granerus, Göran
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Dizdar (Dizdar Segrell), Nil
    Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Chemistry.
    Zachrisson, Helene
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    DaTSCAN SPECT EVALUATION OF PATIENTS WITH MOVEMENT DISORDERS2011In: EUROPEAN JOURNAL OF NEUROLOGY, Wiley-Blackwell, 2011, Vol. 18 (Suppl. 2), no SI, p. 567-567, article id P2617Conference paper (Other academic)
    Abstract [en]

    Introduction: Molecular imaging with DaTSCAN SPECTis widely used as a diagnostic tool in patients with movementdisorders in the form of Parkinson's Disease (PD),Parkinson-plus syndromes and Tremor. In the present studythe potency of DATScan SPECT to detect degeneration inthe basal ganglia in early stages of PD, before the onset ofmedication, is evaluated. In addition the efficacy ofDaTSCAN for differential diagnosis between patients withidiopathic PD and patients with Parkinson-plus syndromesis examined.

    Methodology: Participants: 21 patients with PD in earlystages, before the onset of medication, 20 patients withidiopathic PD and 6 patients with Parkinson-plussyndromes. 15 participants with normal results ofDaTSCAN SPECT and a clinical diagnosis different fromPD or Parkinson-plus were used as control.

    DaTSCAN SPECT: In the present study the quantificationof Striatum Occipital/Occipital and the Xeleris workstation(GE) were used.

    Results: The quantification for patients with idiopathic PD(1.185±0.05687) was significantly lower (p<0.0001) fromthe control (2.369±0.1258) and significantly lower (p<0.05)from that of patients in early stages of PD, before the onsetof medication (1.359±0.05324). There was no significantdifference between the idiopathic PD and Parkinson-plussyndromes (1.103±0.2442).

    Conclusion: DaTSCAN SPECT can detect efficiently earlydegeneration in the basal ganglia before the onset ofmedication is needed. Its efficacy for the differentialdiagnosis between idiopathic PD and Parkinson-plussyndromes is questioned. The combination of imaging andclinical examination is mandatory for a certain diagnosis.

  • 16.
    Karlsson, Henrik
    et al.
    Med radiofysik IMV.
    Angland, Erik
    Linköping University, Department of Medicine and Care.
    Davidsson, Anette
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Gustafsson, Agneta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Radiation Physics. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Radiation Physics.
    Pettersson, Håkan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Radiation Physics. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Radiation Physics.
    Measurements of airborne 99mTc to technologists during technegas ventilation studies2006In: EANM,2006, 2006Conference paper (Other academic)
  • 17.
    Naidu Sjöswärd, Kerstin
    et al.
    Linköping University, Department of Medicine and Care, Anaesthesiology. Linköping University, Faculty of Health Sciences.
    Davidsson, Annette
    Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Schmekel, Birgitta
    Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Single-isomer R-salbutamol is not superior to the racemate ragarding bronchial hyperreactivityManuscript (preprint) (Other academic)
    Abstract [en]

    Twenty-six patients with mild to moderate asthma were enrolled in a doubleblind, randomised, cross-over study. Bronchial response to provocation, given as isocapnic hyperventilation with cold air (IHCA), was measured before and after one week's medication with single isomer R-salbutamol and racemic R/S-salbutamol, respectively. Doses of 0.63 mg R-salbutamol or 1.25 mg R/S-salbutamol were inhaled by nebuliser three times daily dming medication-weeks. Impulse oscillometry (IOS) as well as forced expiratory volume dming one second (FEV1) were methods used to identify bronchial response to provocation. Two patients withdrew from the investigation due to side-effects, one from Rthe other from R,S-salbutamol.

    The aim of this study was to investigate the effects from medication with R,S- and R-salbutamol on bronchial response to provocation.

    Intra-individual differences of < 2% between days in baseline values, measured as total airway resistance (R5) by IOS and ≤ 1% measured as FEV1. indicated comparable resting bronchial conditions. After a week's medication no significant differences in airway responsiveness to provocation could be demonstrated irrespective of the medication used.

    Neither regular medication with inhaled corticosteroids up to 800 mg/day nor any increase in ahway inflammation, was found to influence the results.

    Plasmaconcentrations of R-salbutamol were intra-individually lower after R- than after R,S-salbutamol. Considerable amounts of S-salbutamol were retrieved in plasma after medication with pure R-salbutamol.

    We conclude that we were unable to demonstrate favourable effects of R-salbutamol over R,S-salbutamol regarding response to provocation with cold air after medication of one week's duration.

  • 18.
    Naidu-Sjöswärd, Kerstin
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Intensive Care UHL.
    Mounira, H
    Davidsson, Anette
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Söderkvist, Peter
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of cell biology.
    Schmekel, Birgitta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Single-isomer R-salbutamol is not superior to racemate regarding protection for bronchial hyperresponsiveness2004In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 98, no 10, p. 990-Article in journal (Refereed)
    Abstract [en]

    Bronchial hyper-reactivity (BHR) has been suggested to follow cessation of regular medication with racemic salbutamol. This study aimed at investigating the effects from medication with R,S- and R-salbutamol on bronchial response to provocation with isocapnic hyperventilation of cold air (IHCA). Twenty-six patients with mild to moderate asthma were enrolled in a double-blind, randomised, cross-over study. Bronchial response to provocation was measured before and after 1 week's medication. Doses of 0.63 mg R-salbutamol or 1.25 mg R/S-salbutamol were inhaled three times daily during medication-weeks and a wash-out week intervened. Tests were performed 6 h after the last dose of test drug. Impulse oscillometry and forced expiratory volume during one second were methods used to identify bronchial response to provocation. Two patients withdrew from the investigation due to side-effects, one from R- the other from R,S-salbutamol. Comparable resting bronchial conditions were indicated by differences in baseline lung function values of <2% between study days. No statistically significant medication-dependent differences in BHR could be demonstrated between treatment groups. However, 15 patients exhibited higher (P=0.03) post-treatment BHR after pure R-salbutamol than after R,S-salbutamol. Furthermore, plasma concentrations of R-salbutamol tended to be lower (P=0.08) after medication with R- than after R,S-salbutamol despite equal doses of R-salbutamol given during the two separate treatment periods. We also found that considerable amounts of S-salbutamol were retrieved in plasma after medication with pure R-salbutamol. We conclude that we were unable to demonstrate favourable effects of R-salbutamol over R,S-salbutamol regarding response to provocation with IHCA after regular medication of 1 week's duration.

  • 19.
    Olsson, Anna
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Radiation Physics.
    Davidsson, Anette
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Pettersson, Håkan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Radiation Physics. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Radiation Physics.
    Gustafsson, Agneta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Radiation Physics. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Radiation Physics.
    Finger doses from handling radioative isotopes at a Nuclear Medicine department2006In: EANM,2006, 2006Conference paper (Other academic)
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