@article{SKB2021,

title = {Influence of Urethra Sparing on Tumor Control Probability and Normal Tissue Complication Probability in Focal Dose Escalated Hypofractionated Radiotherapy: A Planning Study Based on Histopathology Reference},

author = {Spohn SKB and Sachpazidis I and Wiehle R and Thomann B and Sigle and Bronsert P and Ruf J and Benndorf M and Nicolay NH and Sprave T and Grosu AL and Baltas D and Zamboglou C },

editor = {Tone Frost Bathen, Norwegian University of Science and Technology, Norway},

url = {https://www.frontiersin.org/articles/10.3389/fonc.2021.652678/full

},

doi = {10.3389/fonc.2021.652678},

year  = {2021},

date = {2021-05-14},

journal = {Front. Oncol.},

abstract = {Purpose: Multiparametric magnetic resonance tomography (mpMRI) and prostate specific membrane antigen positron emission tomography (PSMA-PET/CT) are used to guide focal radiotherapy (RT) dose escalation concepts. Besides improvements of treatment effectiveness, maintenance of a good quality of life is essential. Therefore, this planning study investigates whether urethral sparing in moderately hypofractionated RT with focal RT dose escalation influences tumour control probability (TCP) and normal tissue complication probability (NTCP).



Patients and Methods: 10 patients with primary prostate cancer (PCa), who underwent 68Ga PSMA-PET/CT and mpMRI followed by radical prostatectomy were enrolled. Intraprostatic tumour volumes (gross tumor volume, GTV) based on both imaging techniques (GTV-MRI and -PET) were contoured manually using validated contouring techniques and GTV-Union was created by summing both. For each patient three IMRT plans were generated with 60 Gy to the whole prostate and a simultaneous integrated boost up to 70 Gy to GTV-Union in 20 fractions by (Plan 1) not respecting and (Plan 2) respecting dose constraints for urethra as well as (Plan 3) respecting dose constraints for planning organ at risk volume for urethra (PRV = urethra + 2mm expansion). NTCP for urethra was calculated applying a Lyman-Kutcher-Burman model. TCP-Histo was calculated based on PCa distribution in co-registered histology (GTV-Histo). Complication free tumour control probability (P+) was calculated. Furthermore, the intrafractional movement was considered.



Results: Median overlap of GTV-Union and PRV-Urethra was 1.6% (IQR 0-7%). Median minimum distance of GTV-Histo to urethra was 3.6 mm (IQR 2 – 7 mm) and of GTV-Union to urethra was 1.8 mm (IQR 0.0 – 5.0 mm). The respective prescription doses and dose constraints were reached in all plans. Urethra-sparing in Plans 2 and 3 reached significantly lower NTCP-Urethra (p = 0.002) without significantly affecting TCP-GTV-Histo (p = p > 0.28), NTCP-Bladder (p > 0.85) or NTCP-Rectum (p = 0.85), resulting in better P+ (p = 0.006). Simulation of intrafractional movement yielded even higher P+ values for Plans 2 and 3 compared to Plan 1.



Conclusion: Urethral sparing may increase the therapeutic ratio and should be implemented in focal RT dose escalation concepts.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Sachpazidis2020,

title = {Prostate cancer tumour control probability modelling for external beam radiotherapy based on multi-parametric MRI-GTV definition},

author = {Ilias Sachpazidis and Panayiotis Mavroidis and Constantinos Zamboglou and Christina Marie Klein and Anca-Ligia Grosu and Dimos Baltas},

url = {https://rdcu.be/b8N5y

http://www.sachpazidis.com/sachpazidis_et_al-2020-radiation_oncology/},

doi = {https://doi.org/10.1186/s13014-020-01683-4},

year  = {2020},

date = {2020-10-06},

journal = {Radiation Oncology},

abstract = {Purpose: To evaluate the applicability and estimate the radiobiological parameters of linear‑quadratic Poisson tumour control probability (TCP) model for primary prostate cancer patients for two relevant target structures (prostate gland and GTV ). The TCP describes the dose–response of prostate after definitive radiotherapy (RT ). Also, to analyse and identify possible significant correlations between clinical and treatment factors such as planned dose to prostate gland, dose to GTV, volume of prostate and mpMRI‑GTV based on multivariate logistic regression model.



Methods: The study included 129 intermediate and high‑risk prostate cancer patients (cN0 and cM0), who were treated with image‑guided intensity modulated radiotherapy (IMRT ) ±androgen deprivation therapy with a median follow‑up period of 81.4 months (range 42.0–149.0) months. Tumour control was defined as biochemical relapse free survival according to the Phoenix definition (BRFS). MpMRI‑GTV was delineated retrospectively based on a pre‑treatment multi‑parametric MR imaging (mpMRI), which was co‑registered to the planning CT. The clinical treatment planning procedure was based on prostate gland, delineated on CT imaging modality. Furthermore, we also fitted the clinical data to TCP model for the two considered targets for the 5‑year follow‑up after radiation treatment, where our cohort was composed of a total number of 108 patients, of which 19 were biochemical relapse (BR) patients.



Results: For the median follow‑up period of 81.4 months (range 42.0–149.0) months, our results indicated an appro‑priate α/β=1.3 Gy for prostate gland and α/β=2.9 Gy for mpMRI‑GTV. Only for prostate gland, EQD2 and gEUD2Gy were significantly lower in the biochemical relapse (BR) group compared to the biochemical control (BC) group. Fitting results to the linear‑quadratic Poisson TCP model for prostate gland and α/β=1.3 Gy were D50=66.8 Gy with 95% CI [64.6 Gy, 69.0 Gy], and γ=3.8 with 95% CI [2.6, 5.2]. For mpMRI‑GTV and α/β= 2.9 Gy, D50 was 68.1 Gy with 95% CI [66.1 Gy, 70.0 Gy], and γ=4.5 with 95% CI [3.0, 6.1]. Finally, for the 5‑year follow‑up after the radiation treatment, our results for the prostate gland were: D50=64.6 Gy [61.6 Gy, 67.4 Gy], γ=3.1 [2.0, 4.4], α/β=2.2 Gy (95% CI was undefined). For the mpMRI‑GTV, the optimizer was unable to deliver any reasonable results for the expected clinical D50 and α/β. The results for the mpMRI‑GTV were D50=50.1 Gy [44.6 Gy, 56.0 Gy], γ=0.8 [0.5, 1.2], α/β=0.0 Gy (95% CI was undefined). For a follow‑up time of 5 years and a fixed α/β=1.6 Gy, the TCP fitting results for prostate gland were D50=63.9 Gy [60.8 Gy, 67.0 Gy], γ=2.9 [1.9, 4.1], and for mpMRI‑GTV D50=56.3 Gy [51.6 Gy, 61.1 Gy], γ=1.3 [0.8, 1.9].



Conclusion: The linear‑quadratic Poisson TCP model was better fit when the prostate gland was considered as responsible target than with mpMRI‑GTV. This is compatible with the results of the comparison of the dose distribu‑tions among BR and BC groups and with the results achieved with the multivariate logistic model regarding gEUD2Gy. Probably limitations of mpMRI in defining the GTV explain these results. Another explanation could be the relatively homogeneous dose prescription and the relatively low number of recurrences. The failure to identify any benefit for considering mpMRI‑GTV as the target responsible for the clinical response is confirmed when considering a fixed α/β =1.6 Gy, a fixed follow‑up time for biochemical response at 5 years or Gleason score differentiation.



Keywords:Tumour control probability (TCP), Linear‑quadratic Poisson model, Multivariate logistic regression model, Therapy response prediction, Prostate cancer

},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{ss2020,

title = {Dosimetric impact of the positional imaging frequency for hypofractionated prostate radiotherapy – a voxel-by-voxel analysis},

author = {Mona Splinter and Ilias Sachpazidis and Tilman Bostel and Tobias Fechter and Constantinos Zamboglou and Christian Thieke and Oliver Jäkel and Peter E. Huber and Jürgen Debus and Dimos Baltas and Nils H. Nicolay},

doi = {10.3389/fonc.2020.564068},

year  = {2020},

date = {2020-09-02},

journal = {Frontiers in Oncology},

abstract = {Background

To investigate deviations between planned and applied treatment doses for hypofractionated prostate radiotherapy and to quantify dosimetric accuracy in dependence of the image guidance frequency.



Methods

Daily diagnostic in-room CTs were carried out in 10 patients in treatment position as image guidance for hypofractionated prostate radiotherapy. Fraction doses were mapped to the planning CTs and recalculated, and applied doses were accumulated voxel-wise using deformable registration. Non-daily imaging schedules were simulated by deriving position correction vectors from individual scans and used to rigidly register the following scans until the next repositioning before dose recalculation and accumulation. Planned and applied doses were compared regarding dose-volume indices and TCP and NTCP values in dependence of the imaging and repositioning frequency.



Results

Daily image-guided repositioning was associated with only negligible deviations of analyzed dose-volume parameters and conformity/homogeneity indices for the prostate, bladder and rectum. Average CTV TCPs did not significantly deviate from the plan values, and rectum NTCPs were highly comparable, while bladder NTCPs were reduced. For non-daily image-guided repositioning, there were significant deviations in the high-dose range from the planned values. Similarly, CTV dose conformity and homogeneity were reduced. While TCPs and rectal NTCPs did not significantly deteriorate for non-daily repositioning, bladder NTCPs appeared falsely diminished in dependence of the imaging frequency.



Conclusions

Using voxel-by-voxel dose accumulation, we showed for the first time that daily image-guided repositioning resulted in only negligible dosimetric deviations for hypofractionated prostate radiotherapy. Regarding dosimetric aberrations for non-daily imaging, daily imaging is required to adequately deliver treatment.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{mts2019,

title = {Dosimetric impact of interfractional variations for post-prostatectomy radiotherapy to the prostatic fossa– relevance for the frequency of position verification imaging and treatment adaptation},

author = {Mona Splinter and, Tilman Bostel and Ilias Sachpazidis and Tobias Fechter and Constantinos Zamboglou and Oliver Jaekel and Peter E. Huber and Jürgen Debus and Dimos Baltas and Nils H. Nicolay},

url = {https://www.frontiersin.org/articles/10.3389/fonc.2019.01191/abstract},

doi = {doi: 10.3389/fonc.2019.01191},

year  = {2019},

date = {2019-10-21},

journal = {Frontiers in Oncology},

abstract = {Background and purpose

To analyze divergences between the planned and applied treatment doses for post-prostatectomy radiotherapy to the prostatic fossa on a voxel-by-voxel basis based on interfractional anatomic variations and imaging frequency.



Materials and methods

For 10 patients receiving intensity-modulated postoperative radiotherapy to the prostatic fossa, position verification was carried out by daily in-room CT imaging in treatment position (340 fraction CTs). Applied fraction doses were recalculated on daily CT scans, and treatment doses were accumulated on a voxel-by-voxel basis after deformable image registration. To simulate weekly imaging, derived weekly position correction vectors were used to rigidly register all daily scans of the respective treatment week onto the planning CT before dose accumulation. Detailed dose statistics of the prescribed and applied treatment doses were compared in relation to the frequency of position verification imaging. Derived NTCP and Pinjury values were calculated for the rectum and bladder.



Results

Despite a large variability in the pelvic anatomy, daily CT-based patient repositioning resulted in largely negligible deviations of the analyzed dose-volume, conformity and uniformity parameters from the planned doses for post-prostatectomy radiotherapy, and only the bladder exhibited significant increases in the accumulated mean and median doses. Derived NTCP for the applied doses to the rectum and bladder and Pinjury values did not significantly deviate from the treatment plan. In contrast, weekly CT-based repositioning resulted in significant decreases of the PTV coverage and dose conformity as well as large deviations of the applied doses to the rectum and bladder from the planned doses. Consecutively, NTCP for the rectum and Pinjury were found falsely reduced for weekly patient repositioning.



Conclusions

Our data indicate for the first time in a voxel-by-voxel analysis that daily imaging is required for reliable adaptive delivery of intensity-modulated radiotherapy to the prostatic fossa. This work will help guiding adaptive treatment strategies for post-prostatectomy radiotherapy. },

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{bostelsach2019,

title = {Dosimetric impact of interfractional variations in prostate cancer radiotherapy – implications for imaging frequency and treatment adaptation},

author = {Tilman Bostel and Ilias Sachpazidis and Mona Splinter and Nina Bougatf and Tobias Fechter and Constantinos Zamboglou and Oliver Jäkel and Peter E. Huber and Dimos Baltas and Jürgen Debus and Nils H. Nicolay},

url = {https://www.frontiersin.org/articles/10.3389/fonc.2019.00940/abstract

},

doi = {10.3389/fonc.2019.00940 },

year  = {2019},

date = {2019-09-06},

journal = {Frontiers in Oncology},

abstract = {Background and purpose

To analyze deviations of the applied from the planned doses for definitive prostate cancer radiotherapy depending on anatomic variations and imaging frequency.



Materials and methods

Daily in-room CT imaging was performed in treatment position for 10 patients with prostate cancer undergoing radiotherapy (340 fraction CTs). Applied fraction doses were recalculated on daily images, and voxel-wise dose accumulation was performed using a deformable registration algorithm. For weekly imaging, weekly position correction vectors were derived and used to rigidly register daily scans of that week to the planning CT scan prior to dose accumulation. Applied and prescribed doses were compared, and derived TCP and NTCP values were calculated.



Results

Daily CT-based repositioning resulted in non-significant deviations of all analyzed dose-volume, conformity and uniformity parameters to the CTV, bladder and rectum irrespective of anatomic changes. Derived average TCP values were comparable, and NTCP values for the applied doses to the bladder and rectum did not significantly deviate from the planned values. For weekly imaging, the applied D2 to the CTV, rectum and bladder significantly varied from the planned doses, and the CTV conformity index and D98 decreased. While TCP values were comparable, the NTCP for the bladder erroneously appeared reduced for weekly repositioning.



Conclusions

Daily, but not weekly imaging resulted in only negligible deviations of the applied from the planned doses for prostate radiotherapy. Weekly imaging may not be adequately reliable for adaptive treatment delivery techniques for prostate. This work will contribute to devising adaptive re-planning strategies for prostate radiotherapy.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{hipoccvt,

title = { Investigating the role of constrained CVT and CVT in HIPO inverse planning for HDR brachytherapy of prostate cancer},

author = {Ilias Sachpazidis and Jürgen Hense and Panayiotis Mavroidis and Mark Gainey and Dimos Baltas},

editor = {Jeffrey F. Williamson },

url = {https://aapm.onlinelibrary.wiley.com/journal/24734209},

doi = {10.1002/mp.13564},

year  = {2019},

date = {2019-05-04},

journal = {Medical Physics Journal},

publisher = {Wiley},

abstract = {Purpose: The purpose of this study is to investigate the role of the centroidal Voronoi tessellation (CVT) and constrained CVT (CCVT) in inverse planning in combination with the Hybrid Inverse Planning Optimization (HIPO) algorithm in HDR brachytherapy of prostate cancer. HIPO implemented in Oncentra© Prostate treatment planning system, is used for 3D-ultrasound-based intraoperative treatment planning in high dose rate brachytherapy. HIPO utilizes a hybrid iterative process to determine the most appropriate placement of a given number of catheters to fulfil predefined dose-volume constraints. The main goals of the current investigation were to identify a way of improving the performance of HIPO inverse planning; accelerating the HIPO, and to evaluate the effect of the two CVT-based initialisation methods on the dose distribution in the sub-region of prostate that is not accessible by catheters, when trying to avoid perforation of urethra. 



Methods: We implemented the CVT algorithm to generate initial catheter configurations before the initialisation of the HIPO algorithm. We introduced the CCVT algorithm to improve the dose distribution to the sub-volume of prostate within the bounding box of the urethra contours including its upper vertical extension (U-P). For the evaluation, we considered a total of fifteen (15) 3D ultrasound-based HDRBT prostate implants. Execution time and treatment plan quality were evaluated based on the dose-volume histograms of prostate (PTV), its sub-volume U-P, and organs at risk (OARs). Furthermore, the conformity index COIN, the homogeneity index HI and the complication-free tumour control probability (P+) were used for our treatment plan comparisons. Finally, the plans with the recommended HIPO execution mode were compared to the clinically used intraoperative pre-plans. 



Results: The plan quality achieved with CCVT-based HIPO initialisation was superior to the default HIPO initialisation method. Focusing on the U-P sub-region of the prostate, the CCVT method resulted in a significant improvement of all dosimetric indices compared to the default HIPO, when both were executed in the adaptive mode. For that recommended HIPO execution mode, and for U-P, CCVT demonstrated in general higher dosimetric indices than CVT.   Additionally, the execution time of CCVT initialised HIPO was lower compared to both alternative initialisation methods. This is also valid for the values of the aggregate objective function with the differences to the default initialisation method being highly significant. Paired non-parametric statistical tests (Wilcoxon signed-rank) showed a significant improvement of dose-volume indices, COIN and P+ for the plans generated by the CCVT-based catheter configuration initialisation in HIPO compared to the default HIPO initialisation process. Furthermore, in 10 out of 15 cases, the CCVT-based HIPO plans fulfilled all the clinical dose-volume constraints in a single trial without any need for further catheter position adaption. Conclusion: HIPO with CCVT-based initialisation demonstrates better performance regarding the aggregate objective function and convergence when compared to the CVT-based and default catheter configuration initialisation methods. This improved performance of HIPO inverse planning is clearly not at the cost of the dosimetric and radiobiologically evaluated plan quality. We recommend the use of the CCVT method for HIPO initialisation especially in the adaptive planning mode.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Zamboglou2018,

title = {Focal dose escalation for prostate cancer using 68Ga-HBED-CC PSMA PET/CT and MRI: a planning study based on histology reference},

author = {Constantinos Zamboglou and Benedikt Thomann and Khodor Koubar and Peter Bronsert and Tobias Krauss and Hans C Rischke and Ilias Sachpazidis and Vanessa Drendel and Nasr Salman and Kathrin Reichel and Cordula A Jilg and Martin Werner and Philipp T Meyer and Michael Bock and Dimos Baltas and Anca L Grosu},

url = {https://doi.org/10.1186/s13014-018-1036-8

http://www.sachpazidis.com/wp-content/uploads/2018/05/Zamboglou-Thomann-et-al-2018-Focal-dose-escalation-for-prostate-1.pdf},

doi = {10.1186/s13014-018-1036-8},

issn = {1748-717X},

year  = {2018},

date = {2018-05-02},

journal = {Radiation Oncology},

volume = {13},

number = {1},

pages = {81},

abstract = {Focal radiation therapy has gained of interest in treatment of patients with primary prostate cancer (PCa). The question of how to define the intraprostatic boost volume is still open. Previous studies showed that multiparametric MRI (mpMRI) or PSMA PET alone could be used for boost volume definition. However, other studies proposed that the combined usage of both has the highest sensitivity in detection of intraprostatic lesions. The aim of this study was to demonstrate the feasibility and to evaluate the tumour control probability (TCP) and normal tissue complication probability (NTCP) of radiation therapy dose painting using 68Ga-HBED-CC PSMA PET/CT, mpMRI or the combination of both in primary PCa.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{p201801,

title = { Influence of inhomogeneous radiosensitivity distributions and  intrafractional organ movement on the tumour control probability of  focused IMRT in prostate cancer},

author = {Benedikt Thomann and

Ilias Sachpazidis and

Khodor Koubar and

Constantinos Zamboglou and

Panayiotis Mavroidis and 

Rolf Wiehle and

Anca-Ligia Grosu and

Dimos Baltas.},

url = {https://www.sciencedirect.com/science/article/pii/S0167814018300628?_rdoc=1&_fmt=high&_origin=gateway&_docanchor=&md5=b8429449ccfc9c30159a5f9aeaa92ffb

},

doi = {10.1016/j.radonc.2018.02.006},

year  = {2018},

date = {2018-01-29},

journal = {Journal of Radiotherapy and Oncology},

abstract = {Purpose: To evaluate the influence of radioresistance and 

intrafractional movement on the tumour control probability (TCP) in IMRT 

prostate treatments using simultaneous integrated boosts to PSMA-PET/CTdelineated GTVs.

Materials and Methods: 13 patients had PSMA-PET/CT prior to prostatectomy 

and histopathological examination. Two GTVs were available: GTV-PET and 

GTV-histo, which is the true cancer volume. Focused IMRT plans delivering 

77 Gy in 35 fractions to the prostate and 95 Gy to PTV-PET were produced. 

For random portions of the true cancer volume, α and α/β were uniformly 

changed to represent different radiosensitivity reductions. TCP was 

calculated (linear quadratic model) for the true cancer volume with and 

without simulated intrafractional movement.

Results: Intrafractional movement increased the TCP by up to 10.2% in 

individual cases and 1.2% averaged over all cases for medium 

radiosensitivity levels. At lower levels of radiosensitivity, movement 

decreased the TCP. Radiosensitivity reductions of 10-20% led to TCP 

reductions of 1-24% and 10-68% for 1% and 5% affected cancer volume, 

respectively. There is no linear correlation but a sudden breakdown of 

TCPs within a small range of radiosensitivity levels.

Conclusion: TCP drops significantly within a narrow range of 

radiosensitivity levels. Intrafractional movement can increase TCP when 

the boost volume is surrounded by a sufficiently high dose plateau.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pub201701,

title = {Evaluation of intensity modulated radiation therapy dose painting for localized prostate cancer using 68Ga-HBED-CC PSMA-PET/CT: A planning study based on histopathology reference.},

author = {Zamboglou C and Sachpazidis I and Koubar K and Drendel V and Wiehle R and Kirste S and Mix M and Schiller F and Mavroidis P and Meyer PT and Werner M and Grosu AL and Baltas D},

doi = {doi: 10.1016/j.radonc.2017.04.021},

year  = {2017},

date = {2017-05-09},

journal = {Radiother Oncol},

abstract = {PURPOSE: To demonstrate the feasibility and to evaluate the tumour control probability (TCP) and normal tissue complication probability (NTCP) of IMRT dose painting using 68Ga-HBED-CC PSMA PET/CT for target delineation in prostate cancer (PCa).



METHODS AND MATERIALS: 10 patients had PSMA PET/CT scans prior to prostatectomy. GTV-PET was generated on the basis of an intraprostatic SUVmax of 30%. Two IMRT plans were generated for each patient: Plan77 which consisted of whole-prostate IMRT to 77Gy, and Plan95 which consisted of whole-prostate IMRT to 77Gy and a simultaneous integrated boost to the GTV-PET up to 95Gy (35 fractions). The feasibility of these plans was judged by their ability to adhere to the FLAME trial protocol. TCP-histo/-PET were calculated on co-registered histology (GTV-histo) and GTV-PET, respectively. NTCPs for rectum and bladder were calculated.



RESULTS: All plans reached prescription doses whilst adhering to dose constraints. In Plan77 and Plan95 mean doses in GTV-histo were 75.8±0.3Gy and 96.9±1Gy, respectively. Average TCP-histo values for Plan77 and Plan95 were 70% (range: 15-97%), and 96% (range: 78-100%, p<0.0001). Average TCP-PET values for Plan77 and Plan95 were 55% (range: 27-82%), and 100% (range: 99-100%, p<0.0001). There was no significant difference between TCP-PET and TCP-histo in Plan95 (p=0.25). There were no significant differences in rectal (p=0.563) and bladder (p=0.3) NTCPs.



CONCLUSIONS: IMRT dose painting using PSMA PET/CT was technically feasible and resulted in significantly higher TCPs without higher NTCPs.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{C34-P-19655,

title = {MEDical NETwork : MedNET Helps Rural Peru Access Health Care Services with Telemedicine via Satellite},

author = {Wayne Menary and Ilias Sachpazidis and Despoina Rizou and J Cardenas and C Cabrera},

url = {https://ini.igd.fraunhofer.de/bibcd/INI_Science/papers/2008/08p071.pdf},

year  = {2008},

date = {2008-01-01},

journal = {eHealth Magazine [Online]},

volume = {3},

number = {8},

pages = {31-34},

abstract = {Currently, patients in rural Peru and Brazil travel long distances just to arrive at a rural health centre. Upon arrival, due to a chronic dearth of medical equipment at these health facilities, a patient receives only basic primary care. Access to specialist physicians is rare. If the physician is 

uncertain and decides to refer the patient for further consultation and/or examination, only approximately 5% of patients undertake the journey. Consequently, large sections of the community in these regions are effectively disenfranchised from the health service. 

 

MedNET, an initiative part funded under the Seventh Framework Programme of the European Community (EC), is attempting to tackle this problem of improving access to a quality health care service by enhancing social inclusion for outlying, under-served regions. 

 

MedNet will be deployed in both Peru and Brazil and will enable doctors to constantly monitor patients, assisted by an automated infrastructure which promotes the sharing of knowledge and resources between doctors in remote areas and specialists in urban centres and by providing access to medical 

applications in a range of fields from gynaecology, paediatrics and cardiology to region-specific diseases such as malaria and tuberculosis. Additionally, patient information from examinations will be stored in a secure database along with information concerning demographics and medication 

prescribed.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{C34-P-17104,

title = {Integrated Telemedicine Applications and Services for Oncological Positron Emission Tomography},

author = {George Kontaxakis and Dimitris Visvikis and Roland Ohl and Ilias Sachpazidis and Juan Pablo Suarez and Peter Selby and Catherine Cheze-Le Rest and Andres Santos and Fernando Ortega and Javier Diaz and Leyun Pan and Ludwig Strauss and Antonia Dimitrakopoulou-Strauss and Georgios Sakas and Miguel Angel Pozo},

url = {https://ini.igd.fraunhofer.de/bibcd/INI_Science/papers/2006/06p035.pdf},

year  = {2006},

date = {2006-01-01},

journal = {Oncology Reports: An International Journal devoted to Fundamental and Applied Research in Oncology},

volume = {15},

number = {SpecialIssue},

pages = {1091-1100},

abstract = {TENPET (Trans European Network for Positron Emission Tomography) aims to evaluate the provision of integrated teleconsultation and intelligent computer supported cooperative work services for clinical positron emission tompgraphy (PET) in Europe at its current stage, as it is a multi-centre project 

financially supported by the European Commission (Information Society, eTEN Program). It addresses technological challenges by linking PET Centres and developing supporting services that permit remote consultation between professionals in the field. The technological platform (CE-marked) runs on 

WIN2000/NT/XP systems and incorporates advanced techniques for image visualization, analysis and fusion, as well as for interactive communication and message handling for off-line communications. 

 

Four PET Centres from Spain, France and Germany participate to the pilot system trials. The performance evaluation of the system is carried out via log files and userfilled questionnaires on the frequency of the teleconsultations, their duration and efficancy, quality of the images received, user 

satisfaction. as well as on privacy, ethical and security issues. TENPET promotes the co-opertation and improved communication between PET practitioners that are miles away from their peers or on mobile units, offering options for second opinion and training and permitting physicians to remotely 

consult paptient data if they are away from their centre. It is expected that TENPET will have a significant impact in the development of new skills by PET professionals and will support the establishment of peripheral PET units. To our knowledge, TENPET is the first telemedicine service 

specifically designed for oncological PET. This report presents the technical innovations incorporated in the TENPET platform and the initial pilot studies at real and diverse clinical environments in the field of oncology.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{C34-P-16921,

title = {A Medication Adherence Monitoring System Based on HL7 Messages},

author = {Ilias Sachpazidis and Maria Majadas},

url = {https://ini.igd.fraunhofer.de/bibcd/INI_Science/papers/2006/06p014.pdf},

year  = {2006},

date = {2006-01-01},

journal = {The Journal on Information Technology in Healthcare},

volume = {4},

number = {1},

pages = {49-58},

abstract = {A Medication Adherence Monitoring System (MAMS) system has been designed based on Health Level 7 (HL7) messages. MAMS is a practical and patient-friendly solution that has the potential to both improve medication adherence and monitoring adherence in any group of patients. The proposed system can be 

easily integrated into any hospital administration system by providing an HL7 interface for seamless integration.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{C34-P-16949,

title = {Telemonitoring of Medication Adherence in Patients with Schizophrenia},

author = {S Frangou and Ilias Sachpazidis and A Stasinakis and Georgios Sakas},

url = {https://ini.igd.fraunhofer.de/bibcd/INI_Science/papers/2005/05p218.pdf},

year  = {2005},

date = {2005-01-01},

journal = {Telemedicine Journal and E-Health},

volume = {11},

number = {6},

pages = {675-683},

abstract = {Nonadherence to medication is a widespread problem in schizophrenia and is associated with poor clinical outcomes and inappropriate management and utilization of resources. The aim of the current investigation was to assess the impact of telemonitoring of medication adherence on symptomatology and 

service use in patients with schizophrenia. A total of 108 schizophrenia patients were randomized into three equal groups according to the approaches used to assess medication adherence; self-report, pill counting, and telemonitoring. Telementoring was achieved through an innovative new platform called @HOME. This platform offers clinicians early warnings about impeding nonadherence as well as information about the pattern of medication taking. Patient's adherence was observed over an 8-week period, during which patient's clinical status and service use were recorded. 

 In comparison to the other two groups, patients using @HOME showed improvement in the Global Clinical Impression Scale and a significant reduction in emergency visits and medical appointments. The @HOME platform was highly acceptable by patients, caregivers, and professionals, and required minimal 

training for implementation. 

 

The results of the study suggest that the use of telemonitoring in psychiatric settings was both feasible and acceptable and may be associated with significant clinical and service related benefits.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}