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Pullens P, Devolder P, Van de Velde N, Thienpont T, Achten E, Villeirs G. Declutter the MRI protocol tree: Managing and comparing sequence parameters of multiple clinical Siemens MRI systems. Phys Med 2024; 120:103342. [PMID: 38552273 DOI: 10.1016/j.ejmp.2024.103342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 03/13/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024] Open
Abstract
An MRI protocol tree on a clinical MRI system is a large database containing hundreds of protocols, each containing multiple sequences, and up to 900 parameters per sequence. Protocol variation between scan sessions or patients must be avoided as much as possible, as it may lead to financial loss and less than optimal outcomes for the patient. Without proper management, protocol variation and errors in MRI protocol trees are easily introduced and may remain undetected, leading to a cluttered protocol tree. This in turn reduces the efficiency of the radiological MRI workflow. We introduce a method and open-source software tools for managing MRI protocols on a sequence parameter level, which can detect deviations and variations in the protocol tree. It can be used offline, away from the scanner console, without disturbing the clinical workflow. These tools help to create a standardized protocol library across multiple MRI scanners, reducing variation and errors, enabling radiology departments to create optimal value for the patient and institution.
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Affiliation(s)
- Pim Pullens
- Department of Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Gent, Belgium; Ghent Institute for Functional and Metabolic Imaging, Ghent University, Corneel Heymanslaan 10, 9000 Gent, Belgium; IBITech/Medisip, Faculty of Engineering and Architecture, Ghent University, Corneel Heymanslaan 10, 9000 Gent, Belgium.
| | - Pieter Devolder
- Department of Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Gent, Belgium
| | - Nele Van de Velde
- Department of Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Gent, Belgium
| | - Tony Thienpont
- Department of Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Gent, Belgium
| | - Eric Achten
- Department of Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Gent, Belgium; Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 9000 Gent, Belgium
| | - Geert Villeirs
- Department of Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Gent, Belgium; Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 9000 Gent, Belgium
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Gistelinck L, Van de Velde N, Tandt H, Verslype P, Lemmens G. Effectiveness and Safety of Flumazenil Augmentation During Electroconvulsive Therapy. J ECT 2024:00124509-990000000-00145. [PMID: 38373168 DOI: 10.1097/yct.0000000000001003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
INTRODUCTION Benzodiazepines are considered to negatively affect seizure quality and duration during electroconvulsive therapy (ECT). Several researchers have advocated the use of flumazenil, a competitive benzodiazepine receptor antagonist, for patients treated with benzodiazepines during ECT. However, clinical evidence regarding flumazenil use in ECT remains sparse. The aim of this study is to investigate the effects of flumazenil on seizure duration and adverse effects. METHODS All patients with depressive disorders, treated with flumazenil during a course of ECT in 2019 in a tertiary hospital, were identified through a retrospective chart review. Seizure duration was recorded before and after flumazenil administration. Effectiveness of ECT was assessed using the Inventory of Depressive Symptomatology and the Bush-Francis Catatonia Rating Scale. Postictal agitation was ascertained by identifying patients who received additional sedatives immediately after ECT or who needed physical restraint. RESULTS Twenty-six patients were included, receiving a total of 363 treatments, of which 263 were augmented with flumazenil. Flumazenil administration increased electroencephalogram seizure duration on average with 10.5 seconds comparing ECT with or without flumazenil (P = 0.003). In 21.8% of the cases, no increase in seizure duration was observed. Postictal agitation occurred at least once in 34.6% of the patients receiving flumazenil during their course of ECT. CONCLUSION Our results show that flumazenil increases seizure duration, albeit with limited clinical implications. Noteworthy, the prevalence of postictal agitation is high. When confronted with short seizures, clinicians should therefore deploy other available techniques to lower seizure threshold before considering flumazenil.
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Van de Velde N, Geerts PJ, Tandt H, Vanderhasselt MA, Titeca K, Lemmens G. Discontinuation of Continuation or Maintenance Electroconvulsive Therapy Caused by the COVID-19 Pandemic: A Naturalistic Study Investigating Relapse in Patients With Major Depressive Disorder. J ECT 2021; 37:230-237. [PMID: 34145171 DOI: 10.1097/yct.0000000000000785] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Continuation or maintenance electroconvulsive therapy (C/M-ECT) is recommended to reduce relapse rates of patients with major depressive disorder. During the ongoing COVID-19 pandemic, ECT services have come under pressure or needed to close because of redirected resources and safety reasons. We investigated the impact of C/M-ECT discontinuation on relapse in patients with unipolar depressive disorder in Flanders, Belgium. METHODS Between March 30 and June 18, 2020, all patients receiving C/M-ECT in 2 ECT centers were included. Continuation or maintenance electroconvulsive therapy was discontinued in 33 patients and continued in 4 patients. Relapse was defined as the need to restart ECT or the need for hospitalization. Depressive symptoms were assessed every 3 weeks using the Patient Health Questionnaire, the Clinical Global Impression Scale, and 2 additional patient-rated questions. RESULTS Relapse in the discontinuation group was 60.6%. All 4 patients who continued ECT remained remitted. Kaplan-Meier survival analysis showed significantly shorter relapse rates for patients receiving bitemporal and/or frequent C/M-ECT (1- to 2-week intervals). Patients older than 60 years showed longer survival rates. CONCLUSIONS Our results confirm earlier prospective and retrospective data regarding the efficacy and importance of C/M-ECT as relapse prevention. After treatment discontinuation, close monitoring of early warning signs for relapse is crucial, especially in the first few months. With the COVID-19 pandemic continuing, our data provide an indication of the necessity to ensure adequate care and access to ECT not only for the acutely ill but also for the vulnerable patients who are depending on C/M-ECT.
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Affiliation(s)
| | | | - Hannelore Tandt
- From the Department of Psychiatry, Ghent University Hospital, Ghent
| | | | - Koen Titeca
- Department of Psychiatry, AZ Groeninge, Kortrijk
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Tandt HLN, Van de Velde N, De Witte S, Audenaert K, Baeken C, Lemmens GMD. Is twice daily LF-rTMS a viable treatment option for treatment-resistant OCD? Results from an open-label feasibility study. Eur Arch Psychiatry Clin Neurosci 2021; 271:211-214. [PMID: 32472148 DOI: 10.1007/s00406-020-01142-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 05/15/2020] [Indexed: 10/24/2022]
Abstract
Several reports point to the beneficial effects of repetitive transcranial magnetic stimulation (rTMS) in the treatment of resistant obsessive-compulsive disorder (OCD). This study aimed to evaluate the safety and efficacy of rTMS targeting the dmPFC in the treatment of treatment-resistant OCD patients. Twelve patients received 20 sessions of low-frequency (LF) rTMS (1 Hz, 1200 pulses) in a twice daily protocol during 10 weekdays. Y-BOCS and IDS scores modestly but significantly decreased after treatment and at follow-up and HADS anxiety improved at follow-up. LF rTMS may improve OCD, anxiety, and depressive symptoms in treatment-resistant OCD and was a safe and well-tolerated treatment.
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Affiliation(s)
- Hannelore L N Tandt
- Department of Psychiatry, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium.
| | - Nele Van de Velde
- Department of Psychiatry, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Sara De Witte
- Department of Head and Skin-Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium
| | - Kurt Audenaert
- Department of Psychiatry, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium.,Department of Head and Skin-Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium
| | - Chris Baeken
- Department of Psychiatry, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium.,Department of Head and Skin-Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium.,Department of Psychiatry, Free University of Brussels, Brussels, Belgium
| | - Gilbert M D Lemmens
- Department of Psychiatry, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium.,Department of Head and Skin-Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium
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Van de Velde N, Kappen M, Koster EHW, Hoorelbeke K, Tandt H, Verslype P, Baeken C, De Raedt R, Lemmens G, Vanderhasselt MA. Cognitive remediation following electroconvulsive therapy in patients with treatment resistant depression: randomized controlled trail of an intervention for relapse prevention - study protocol. BMC Psychiatry 2020; 20:453. [PMID: 32938410 PMCID: PMC7493867 DOI: 10.1186/s12888-020-02856-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/03/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Major depressive episode (MDE) is worldwide one of the most prevalent and disabling mental health conditions. In cases of persistent non-response to treatment, electroconvulsive therapy (ECT) is a safe and effective treatment strategy with high response rates. Unfortunately, longitudinal data show low sustained response rates with 6-month relapse rates as high as 50% using existing relapse prevention strategies. Cognitive side effects of ECT, even though transient, might trigger mechanisms that increase relapse in patients who initially responded to ECT. Among these side effects, reduced cognitive control is an important neurobiological driven vulnerability factor for depression. As such, cognitive control training (CCT) holds promise as a non-pharmacological strategy to improve long-term effects of ECT (i.e., increase remission, and reduce depression relapse). METHOD/DESIGN Eighty-eight patients aged between 18 and 70 years with MDE who start CCT will be included in this randomized controlled trial (RCT). Following (partial) response to ECT treatment (at least a 25% reduction of clinical symptoms), patients will be randomly assigned to a computer based CCT or active placebo control. A first aim of this RCT is to assess the effects of CCT compared to an active placebo condition on depression symptomatology, cognitive complaints, and quality of life. Secondly, we will monitor patients every 2 weeks for a period of 6 months following CCT/active placebo, allowing the detection of potential relapse of depression. Thirdly, we will assess patient evaluation of the addition of cognitive remediation to ECT using qualitative interview methods (satisfaction, acceptability and appropriateness). Finally, in order to further advance our understanding of the mechanisms underlying effects of CCT, exploratory analyses will be conducted using video footage collected during the CCT/active control phase of the study. DISCUSSION Cognitive remediation will be performed following response to ECT, and an extensive follow-up period will be employed. Positive findings would not only benefit patients by decreasing relapse, but also by increasing acceptability of ECT, reducing the burden of cognitive side-effects. TRIAL REGISTRATION The study is registered with ClinicalTrials.gov . Study ID: NCT04383509 Trial registration date: 12.05.2020.
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Affiliation(s)
- Nele Van de Velde
- Department of Psychiatry, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium.
| | - Mitchel Kappen
- grid.5342.00000 0001 2069 7798Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium ,grid.5342.00000 0001 2069 7798Ghent Experimental Psychiatry (GHEP) lab, Ghent University, Ghent, Belgium
| | - Ernst H. W. Koster
- grid.5342.00000 0001 2069 7798Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Kristof Hoorelbeke
- grid.5342.00000 0001 2069 7798Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Hannelore Tandt
- grid.410566.00000 0004 0626 3303Department of Psychiatry, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Pieter Verslype
- grid.410566.00000 0004 0626 3303Department of Anesthesiology, Ghent University Hospital, Ghent, Belgium
| | - Chris Baeken
- grid.410566.00000 0004 0626 3303Department of Psychiatry, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium ,grid.5342.00000 0001 2069 7798Ghent Experimental Psychiatry (GHEP) lab, Ghent University, Ghent, Belgium ,grid.411326.30000 0004 0626 3362Department of Psychiatry, University Hospital (UZBrussel), Brussels, Belgium ,grid.6852.90000 0004 0398 8763Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Rudi De Raedt
- grid.5342.00000 0001 2069 7798Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Gilbert Lemmens
- grid.410566.00000 0004 0626 3303Department of Psychiatry, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Marie-Anne Vanderhasselt
- grid.5342.00000 0001 2069 7798Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium ,grid.5342.00000 0001 2069 7798Ghent Experimental Psychiatry (GHEP) lab, Ghent University, Ghent, Belgium
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