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Scheepers MHMC, Al-Difaie Z, Brandts L, Peeters A, Winkens B, Al-Taher M, Engelen SME, Lubbers T, Havekes B, Bouvy ND, Postma AA. Diagnostic Performance of Magnetic Resonance Imaging for Parathyroid Localization of Primary Hyperparathyroidism: A Systematic Review. Diagnostics (Basel) 2023; 14:25. [PMID: 38201335 PMCID: PMC10802165 DOI: 10.3390/diagnostics14010025] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
Accurate preoperative localization is crucial for successful minimally invasive parathyroidectomy in primary hyperparathyroidism (PHPT). Preoperative localization can be challenging in patients with recurrent and/or multigland disease (MGD). This has led clinicians to investigate multiple imaging techniques, most of which are associated with radiation exposure. Magnetic resonance imaging (MRI) offers ionizing radiation-free and accurate imaging, making it an attractive alternative imaging modality. The objective of this systematic review is to provide an overview of the diagnostic performance of MRI in the localization of PHPT. PubMed and Embase libraries were searched from 1 January 2000 to 31 March 2023. Studies were included that investigated MRI techniques for the localization of PHPT. The exclusion criteria were (1) secondary/tertiary hyperparathyroidism, (2) studies that provided no diagnostic performance values, (3) studies published before 2000, and (4) studies using 0.5 Tesla MRI scanners. Twenty-four articles were included in the systematic review, with a total of 1127 patients with PHPT. In 14 studies investigating conventional MRI for PHPT localization, sensitivities varied between 39.1% and 94.3%. When employing more advanced MRI protocols like 4D MRI for PHPT localization in 11 studies, sensitivities ranged from 55.6% to 100%. The combination of MR imaging with functional techniques such as 18F-FCH-PET/MRI yielded the highest diagnostic accuracy, with sensitivities ranging from 84.2% to 100% in five studies. Despite the limitations of the available evidence, the results of this review indicate that the combination of MR imaging with functional imaging techniques such as 18F-FCH-PET/MRI yielded the highest diagnostic accuracy. Further research on emerging MR imaging modalities, such as 4D MRI and PET/MRI, is warranted, as MRI exposes patients to minimal or no ionizing radiation compared to other imaging modalities.
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Affiliation(s)
- Max H. M. C. Scheepers
- GROW School for Oncology and Developmental Biology, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Zaid Al-Difaie
- GROW School for Oncology and Developmental Biology, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Lloyd Brandts
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands
| | - Andrea Peeters
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, CAPHRI, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands;
| | - Mahdi Al-Taher
- Department of Surgery, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands (S.M.E.E.)
| | - Sanne M. E. Engelen
- Department of Surgery, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands (S.M.E.E.)
| | - Tim Lubbers
- GROW School for Oncology and Developmental Biology, Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands (S.M.E.E.)
| | - Bas Havekes
- Department of Internal Medicine, Division of Endocrinology and Metabolic Disease, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Nicole D. Bouvy
- Department of Surgery, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands (S.M.E.E.)
| | - Alida A. Postma
- Department of Radiology and Nuclear Medicine, School for Mental Health and Sciences (MHENS), Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands;
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Heuvelings DJI, Al-Difaie Z, Scheepers MHMC, Okamoto N, Diana M, Stassen LPS, Bouvy ND, Al-Taher M. Simultaneous fluorescence imaging of bowel perfusion and ureter delineation using methylene blue: a demonstration in a porcine model. Surg Endosc 2023; 37:6779-6790. [PMID: 37253870 PMCID: PMC10462514 DOI: 10.1007/s00464-023-10142-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/16/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Intraoperative near-infrared fluorescence imaging (NIRF) with preoperative optical dye administration is a promising technique for quick and easy intraoperative visualization of the ureter and for an improved, real-time assessment of intestinal perfusion. During colorectal surgery, there is a need for simultaneous non-invasive ureteral imaging and bowel perfusion assessment, using one single camera system. The purpose of this study is to investigate the feasibility of simultaneous intestinal perfusion and ureteral imaging using a single commercially available NIRF imaging system. METHODS Six Landrace pigs underwent laparotomy under general anesthesia in this experiment. An intravenous (IV) dose of 0.2 mg/kg indocyanine green (ICG) was given to assess bowel perfusion. Two pairs received a methylene blue (MB) iv injection of 0.75, 0.50 or 0.25 mg/kg respectively to investigate ureteral visualization. Quest Spectrum Fluorescence Camera (Quest Medical Imaging, Middenmeer, The Netherlands) was used for NIRF imaging. RESULTS Ureter visualization and bowel perfusion under NIRF imaging was achieved in all animals. All ureters were visible after five to ten minutes and remained clearly visible until the end of every experiment (120-420 min). A mixed model analysis did not show any significant differences neither between the three groups nor over time. Importantly, we demonstrated that bowel perfusion could be visualized with methylene blue (MB) as well. We observed no interference between ICG and MB and a faster washout of MB. CONCLUSION We successfully demonstrated simultaneous fluorescence angiography with ICG and ureteral imaging with MB in the same surgical procedure, with the same commercially available NIRF imaging equipment. More importantly, we showed that the use MB is adequate for bowel perfusion assessment and ureter visualization with this NIRF imaging system. Besides, MB showed an earlier washout time, which can be clinical beneficial as a repeated dye injection may be necessary during a surgical procedure.
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Affiliation(s)
- Danique J I Heuvelings
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
| | - Zaid Al-Difaie
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Max H M C Scheepers
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Nariaki Okamoto
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, Strasbourg, France
| | - Michele Diana
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, Strasbourg, France
- Department of Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France
| | - Laurents P S Stassen
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nicole D Bouvy
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mahdi Al-Taher
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
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Al-Difaie Z, Scheepers MHMC, Engelen SME, Havekes B, Bouvy ND, Postma AA. Diagnostic Value of Four-Dimensional Dynamic Computed Tomography for Primary Hyperparathyroidism in Patients with Low Baseline Parathyroid Hormone Levels. Diagnostics (Basel) 2023; 13:2621. [PMID: 37627880 PMCID: PMC10453623 DOI: 10.3390/diagnostics13162621] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/04/2023] [Accepted: 08/06/2023] [Indexed: 08/27/2023] Open
Abstract
Low baseline levels of parathyroid hormone (PTH) are associated with a higher rate of multiglandular disease, lower localization rates of preoperative imaging modalities, and a higher rate of unsuccessful minimally invasive parathyroidectomies. The objective of this study is to assess the diagnostic value of four-dimensional dynamic computed tomography (4D-CT) in localizing primary hyperparathyroidism (pHPT) in patients with low baseline PTH levels, compared to patients with high baseline PTH levels. Patients with pHPT who received a 4D-CT scan as part of their standard diagnostic evaluation were divided into two groups based on the following criteria: (1) preoperative PTH levels less than 100 pg/mL and (2) patients with preoperative PTH levels greater than 100 pg/mL. All patients underwent parathyroidectomy based on 4D-CT findings, with intraoperative parathyroid hormone monitoring. The lesion-based sensitivity of 4D-CT was 88% in patients with low baseline PTH levels and 94.7% in patients with high baseline PTH levels (p = 0.33). However, the success rate of image-guided resection based on 4D-CT findings was 71.4% in the low baseline PTH group compared to 90.6% in the high baseline PTH group (p = 0.06). Our study demonstrated that 4D-CT has a high lesion-based sensitivity in patients with pHPT and low baseline PTH levels but led to a relatively low rate of successful image-guided resection in patients with low baseline PTH levels. Therefore, it is important to exercise increased caution during 4D-CT-guided surgical exploration of patients with low baseline PTH levels to ensure successful surgical resection of all parathyroid lesions.
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Affiliation(s)
- Zaid Al-Difaie
- GROW School for Oncology and Developmental Biology, Maastricht University, 6229 ER Maastricht, The Netherlands; (Z.A.-D.); (M.H.M.C.S.)
| | - Max H. M. C. Scheepers
- GROW School for Oncology and Developmental Biology, Maastricht University, 6229 ER Maastricht, The Netherlands; (Z.A.-D.); (M.H.M.C.S.)
| | - Sanne M. E. Engelen
- Department of Surgery, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
| | - Bastiaan Havekes
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
| | - Nicole D. Bouvy
- Department of Surgery, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
| | - Alida A. Postma
- Department of Radiology and Nuclear Medicine, School for Mental Health and Sciences (MHENS), Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
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Al-Difaie Z, Scheepers MHMC, Bouvy ND, Engelen S, Havekes B, Postma AA. Can virtual non-contrast imaging replace true non-contrast imaging in multiphase scanning of the neck region? Acta Radiol Open 2023; 12:20584601231205159. [PMID: 37767056 PMCID: PMC10521284 DOI: 10.1177/20584601231205159] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
Background Dual-energy computed tomography (DECT) is an advanced imaging method that enables reconstruction of virtual non-contrast (VNC) images from a contrast-enhanced acquisition. This has the potential to reduce radiation exposure by eliminating the need for a true non-contrast (TNC) phase. Purpose The purpose is to evaluate the feasibility of VNC images in the neck region. Materials and methods A total of 100 patients underwent a DECT scan as part of diagnostic workup of primary hyperparathyroidism. VNC images were reconstructed from 30 s (arterial) and 50 s (venous) post-contrast scans. Regions of interest (ROIs) were placed in thyroid tissue, lymph node, carotid artery, jugular vein, fat, and sternocleidomastoid muscle. Mean densities of all anatomical structures were compared between VNC and TNC images. Results For all anatomical structures except the thyroid gland, the difference in mean density between TNC and VNC images was less than 15 HU. The mean difference in density between TNC and VNC images of the thyroid was 53.2 HU (95% CI 46.8; 59.6, p = <0.001). Conclusion This study demonstrated an acceptable agreement in density between true non-contrast and virtual non-contrast images for most anatomical structures in the neck region. Therefore, VNC images may have the potential to replace TNC images in the neck. However, due to significant differences in CT density of thyroid tissue, true non-contrast imaging cannot be directly substituted by virtual non-contrast imaging when examining the thyroid and its surrounding tissue.
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Affiliation(s)
- Zaid Al-Difaie
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Max HMC Scheepers
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Nicole D Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sanne Engelen
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bas Havekes
- Division of Endocrinology and Metabolic Disease, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Alida A Postma
- Department of Radiology and Nuclear Medicine, School for Mental Health and Neuroscience, Neuroradiology, Maastricht University Medical Center, Maastricht, The Netherlands
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Okamoto N, Al-Difaie Z, Scheepers MHMC, Heuvelings DJI, Rodríguez-Luna MR, Marescaux J, Diana M, Stassen LPS, Bouvy ND, Al-Taher M. Simultaneous, Multi-Channel, Near-Infrared Fluorescence Visualization of Mesenteric Lymph Nodes Using Indocyanine Green and Methylene Blue: A Demonstration in a Porcine Model. Diagnostics (Basel) 2023; 13:diagnostics13081469. [PMID: 37189570 DOI: 10.3390/diagnostics13081469] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/17/2023] [Accepted: 03/24/2023] [Indexed: 05/17/2023] Open
Abstract
Near-infrared fluorescence (NIRF) image-guided surgery is a useful tool that can help reduce perioperative complications and improve tissue recognition. Indocyanine green (ICG) dye is the most frequently used in clinical studies. ICG NIRF imaging has been used for lymph node identification. However, there are still many challenges in lymph node identification by ICG. There is increasing evidence that methylene blue (MB), another clinically applicable fluorescent dye, can also be useful in the intraoperative fluorescence-guided identification of structures and tissues. We hypothesized that MB NIRF imaging could be used for lymph node identification. The aim of this study was to evaluate the feasibility of intraoperative lymph node fluorescence detection using intravenously (IV) administered MB and compare it to ICG via a camera that has two dedicated near-infrared (NIR) channels. Three pigs were used in this study. ICG (0.2 mg/kg) was administered via a peripheral venous catheter followed by immediate administration of MB (0.25 mg/kg). NIRF images were acquired as video recordings at different time points (every 10 min) over an hour using the QUEST SPECTRUM® 3 system (Quest Medical Imaging, Middenmeer, The Netherlands), which has two dedicated NIR channels for simultaneous intraoperative fluorescence guidance. The 800 nm channel was used to capture ICG fluorescence and the 700 nm channel was used for MB. The target (lymph nodes and small bowel) and the background (vessels-free field of the mesentery) were highlighted as the regions of interest (ROIs), and corresponding fluorescence intensities (FI) from these ROIs were measured. The target-to-background ratio (TBR) was then computed as the mean FI of the target minus the mean FI of the background divided by the mean FI of the background. In all included animals, a clear identification of lymph nodes was achieved at all time points. The mean TBR of ICG in lymph nodes and small bowel was 4.57 ± 1.00 and 4.37 ± 1.70, respectively for the overall experimental time. Regarding MB, the mean TBR in lymph nodes and small bowel was 4.60 ± 0.92 and 3.27 ± 0.62, respectively. The Mann-Whitney U test of the lymph node TBR/small bowel TBR showed that the TBR ratio of MB was statistically significantly higher than ICG. The fluorescence optical imaging technology used allows for double-wavelength assessment. This feasibility study proves that lymph nodes can be discriminated using two different fluorophores (MB and ICG) with different wavelengths. The results suggest that MB has a promising potential to be used to detect lymphatic tissue during image-guided surgery. Further preclinical trials are needed before clinical translation.
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Affiliation(s)
- Nariaki Okamoto
- IRCAD, Research Institute against Digestive Cancer, 67091 Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, 67081 Strasbourg, France
| | - Zaid Al-Difaie
- GROW School for Oncology and Developmental Biology, Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands
| | - Max H M C Scheepers
- GROW School for Oncology and Developmental Biology, Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands
| | - Danique J I Heuvelings
- Department of Surgery, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229 HX Maastricht, The Netherlands
| | - María Rita Rodríguez-Luna
- IRCAD, Research Institute against Digestive Cancer, 67091 Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, 67081 Strasbourg, France
| | - Jacques Marescaux
- IRCAD, Research Institute against Digestive Cancer, 67091 Strasbourg, France
| | - Michele Diana
- IRCAD, Research Institute against Digestive Cancer, 67091 Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, 67081 Strasbourg, France
| | - Laurents P S Stassen
- Department of Surgery, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Nicole D Bouvy
- Department of Surgery, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands
| | - Mahdi Al-Taher
- IRCAD, Research Institute against Digestive Cancer, 67091 Strasbourg, France
- Department of Surgery, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands
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Scheepers MHMC, Al-Difaie Z, Brandts L, Peeters A, van Grinsven B, Bouvy ND. Diagnostic Performance of Electronic Noses in Cancer Diagnoses Using Exhaled Breath: A Systematic Review and Meta-analysis. JAMA Netw Open 2022; 5:e2219372. [PMID: 35767259 PMCID: PMC9244610 DOI: 10.1001/jamanetworkopen.2022.19372] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE There has been a growing interest in the use of electronic noses (e-noses) in detecting volatile organic compounds in exhaled breath for the diagnosis of cancer. However, no systematic evaluation has been performed of the overall diagnostic accuracy and methodologic challenges of using e-noses for cancer detection in exhaled breath. OBJECTIVE To provide an overview of the diagnostic accuracy and methodologic challenges of using e-noses for the detection of cancer. DATA SOURCES An electronic search was performed in the PubMed and Embase databases (January 1, 2000, to July 1, 2021). STUDY SELECTION Inclusion criteria were the following: (1) use of e-nose technology, (2) detection of cancer, and (3) analysis of exhaled breath. Exclusion criteria were (1) studies published before 2000; (2) studies not performed in humans; (3) studies not performed in adults; (4) studies that only analyzed biofluids; and (5) studies that exclusively used gas chromatography-mass spectrometry to analyze exhaled breath samples. DATA EXTRACTION AND SYNTHESIS PRISMA guidelines were used for the identification, screening, eligibility, and selection process. Quality assessment was performed using Quality Assessment of Diagnostic Accuracy Studies 2. Generalized mixed-effects bivariate meta-analysis was performed. MAIN OUTCOMES AND MEASURES Main outcomes were sensitivity, specificity, and mean area under the receiver operating characteristic curve. RESULTS This review identified 52 articles with a total of 3677 patients with cancer. All studies were feasibility studies. The sensitivity of e-noses ranged from 48.3% to 95.8% and the specificity from 10.0% to 100.0%. Pooled analysis resulted in a mean (SE) area under the receiver operating characteristic curve of 94% (95% CI, 92%-96%), a sensitivity of 90% (95% CI, 88%-92%), and a specificity of 87% (95% CI, 81%-92%). Considerable heterogeneity existed among the studies because of differences in the selection of patients, endogenous and exogenous factors, and collection of exhaled breath. CONCLUSIONS AND RELEVANCE Results of this review indicate that e-noses have a high diagnostic accuracy for the detection of cancer in exhaled breath. However, most studies were feasibility studies with small sample sizes, a lack of standardization, and a high risk of bias. The lack of standardization and reproducibility of e-nose research should be addressed in future research.
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Affiliation(s)
- Max H. M. C. Scheepers
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Zaid Al-Difaie
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Lloyd Brandts
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, the Netherlands
| | - Andrea Peeters
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, the Netherlands
| | - Bart van Grinsven
- Sensor Engineering, Faculty of Science and Engineering, Maastricht University, Maastricht, the Netherlands
| | - Nicole D. Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
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