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Additional file 1: Supplementary materials.

Background: Historically, endocrine therapy was used in a range of scenarios in patients with rising PSA, both as a treatment for locally advanced non-metastatic prostate cancer and PSA recurrence following curative intended therapy. In the present study the objective was to investigate if chemotherapy added to endocrine therapy could improve progression-free survival (PFS). Materials and Methods: Patients with hormone-naïve, non-metastatic prostate cancer and rising prostate-specific antigen (PSA), enrolled from Sweden, Denmark, the Netherlands, and Finland, were randomized to long-term bicalutamide (150 mg daily) or plus docetaxel (75 mg/m2, q3w, 8–10 cycles) without prednisone, after stratification for the site, prior local therapy or not, and PSA doubling time. The primary endpoint was 5-year PFS analyzed with a stratified Cox proportional hazards regression model on intention to treat basis. Results: Between 2009 and 2018, a total of 348 patients were randomized; 315 patients had PSA relapse after radical treatment, 33 patients had no prior local therapy. Median follow-up was 4.9 years (IQR 4.0–5.1). Adding docetaxel improved PFS (HR 0.68, 95% CI 0.50–0.93; p = 0.015). Docetaxel showed an advantage for patients with PSA relapse after prior local therapy (HR 0.67, 95% CI 0.49–0.94; p = 0.019). One event of neutropenic infection/fever occurred in 27% of the patients receiving docetaxel. Limitations were slow recruitment, lack of enrolling patients without radical local treatment, and too short follow-up for evaluation of overall survival in patients with PSA relapse. Conclusion: Docetaxel improved PFS in patients starting bicalutamide due to PSA relapse after local therapy or localized disease without local therapy. Confirmatory studies of the efficacy of docetaxel in the setting of PSA-only relapse in addition to endocrine therapies may be justified if longer follow-up will show increased metastatic-free survival.

Background Perirectal spacers may be beneficial to reduce rectal side effects from radiotherapy (RT). Here, we present the impact of a hyaluronic acid (HA) perirectal spacer on rectal dose as well as spacer stability, long-term gastrointestinal (GI) and genitourinary (GU) toxicity and patient-reported outcome (PRO). Methods In this phase II study 81 patients with low- and intermediate-risk prostate cancer received transrectal injections with HA before external beam RT (78 Gy in 39 fractions). The HA spacer was evaluated with MRI four times; before (MR0) and after HA-injection (MR1), at the middle (MR2) and at the end (MR3) of RT. GI and GU toxicity was assessed by physician for up to five years according to the RTOG scale. PROs were collected using the Swedish National Prostate Cancer Registry and Prostate cancer symptom scale questionnaires. Results There was a significant reduction in rectal V70% (54.6 Gy) and V90% (70.2 Gy) between MR0 and MR1, as well as between MR0 to MR2 and MR3. From MR1 to MR2/MR3, HA thickness decreased with 28%/32% and CTV-rectum space with 19%/17% in the middle level. The cumulative late grade ≥ 2 GI toxicity at 5 years was 5% and the proportion of PRO moderate or severe overall bowel problems at 5 years follow-up was 12%. Cumulative late grade ≥ 2 GU toxicity at 5 years was 12% and moderate or severe overall urinary problems at 5 years were 10%. Conclusion We show that the HA spacer reduced rectal dose and long-term toxicity.

Additional file 1: Fig. S1. Analysis of 59 built-in SNP on the HumanMethylation EPIC array to confirm identity of multiple samples taken from the same individual (N and T tissue).

Additional file 2: Fig. S2. Schematic flowchart of the pre-processing steps of the HumanMethylation EPIC arrays.

Additional file 5: Table S2. Top 10 enriched process networks in localized prostate tumor tissue (T) compared to adjacent non-malignant prostate tissue (N) or in prostate cancer bone metastases (M) compared to localized tumors.

Additional file 3: Fig. S3. Silhouette analysis showing the cluster consistencies of the MCA positive and negative clusters in Figure 4A.

Introduction: Radiotherapy is an established treatment option for prostate cancer (PCa), both as primary treatment and secondary treatment after radical prostatectomy (RP). Since 1998, detailed data on radiotherapy delivered to Swedish men with PCa (e.g. treatment modalities, absorbed doses, fractionation) have been collated within PCa data Base Sweden (PCBaSe). This study reports patterns of radical radiotherapy for PCa in Sweden over the past two decades. Materials and methods: All men with non-metastatic PCa (1998–2016) who received external beam radiotherapy (EBRT) or high or low dose-rate brachytherapy (HDR-BT/LDR-BT) were identified in PCBaSe. Analyses included: trends in radiation techniques, fractionation patterns and total doses over time; PCa-specific survival comparing treatment in 2007–2017 with 1998–2006; and regional variation in type of primary radiotherapy. Results: About 20,876 men underwent primary radiotherapy. The main treatment modalities include conventionally fractionated (2.0 Gy/fraction) EBRT (51%), EBRT with HDR-BT boost (27%) and hypofractionated (>2.4 Gy/fraction) EBRT (11%). EBRT with photon or proton boost and HDR-BT and LDR-BT monotherapies were each used minimally. Use of dose-escalated EBRT (>74 Gy) and moderate hypofractionation increased over time, while use of HDR-BT declined. Considerable regional variation in treatment modalities was apparent. Risk of PCa death following primary radiotherapy had declined for intermediate-risk (HR: 0.60; 95%CI 0.47–0.87) and high-risk PCa (HR: 0.72; 95%CI 0.61-0.86). Discussion: Increased use of dose escalation and hypofractionated EBRT has occurred in Sweden over the past two decades, reflecting current evidence and practice guidelines. Disease-specific outcomes have also improved. Data collected in PCBaSe provide an excellent resource for further research into RT use in PCa management.

We report on the growth mechanism of spherical silicon nanocrystals in a remote expanding Ar plasma using a time-modulated SiH4 gas injection in the microsecond time range. Under identical time-modulation parameters, we varied the local density of the SiH4 gas by changing its stagnation pressure on the injection line over the range of 0.1–2.0 bar. We observed that nanocrystals were synthesized in a size range from ∼2 to ∼50 nm with monocrystalline morphology. Smaller nanocrystals (∼2–6 nm) with narrower size distributions and with higher number densities were synthesized with an increase of the SiH4 gas-phase density. We related this observation to the rapid depletion of the number density of the molecules, ions, and radicals in the plasma during nanocrystal growth, which can primarily occur via nucleation with no significant subsequent coagulation. In addition, in our remote plasma environment, rapid cooling of the gas in the particle growth zone from ∼1500 to ∼400 K significantly reduces the coalescence...

Purpose Low dose radiation effect on the eye lens has been an area of interest in numerous epidemiological studies. The European epidemiological study EURALOC was conducted between December 2014 and May 2017 with the objective to investigate a possible dose-response relationship by targeting a sufficiently large study population with reasonably high exposure levels, namely interventional cardiologists (ICs). Methods In total 393 subjects have been recruited in the exposed group, they have completed study questionnaires on work history and risk factors for lens opacities and received an ophthalmological examination. As for the control group, 243 subjects have been recruited, completing the same questionnaire on risk factors for lens opacities and ophthalmological examination. Efforts have been made to develop 2 approaches to assess retrospectively the cumulative eye lens doses of the recruited cardiologists. The first approach is based on the individual work history in combination with published eye lens dose data, while the second approach is based on individual routine whole body dosimetry and its conversion to eye lens dose. Innovative approaches have been used for the statistical analysis by using a mixed linear regression and polytomous logistic regression approach, which permit a correct modelling of the lens opacities by taking into account the correlation of the soring outcomes of both eyes in the radio-induced risk estimation as well as dose estimation uncertainties. Results More than 200 dose measurements have been performed in clinical practice to validate both calculation approaches. 1st approach resulted in the most satisfactory with an average ratio between measured and calculated eye lens dose of 0.96 [95%CI: 0.87-1.09] for the left eye and 0.50 [95%CI: 0.44-0.56] for the right eye. The analyses established a significant impact of radiation dose in the occurrence of PSC opacities with a relative risk for ICs of OR = 2.62 (95%CI 1.35–5.08). Conclusion A linear no threshold model provided the better fit of the lens opacities dose-response relationship with an excess relative risk per Gy equal to 1.31 (95% CI 0.13–3.32)

BackgroundThere are no conclusive results from randomized trials on radiotherapy (RT) versus radical prostatectomy (RP) for prostate cancer. Numerous observational studies have suggested that RP is associated with a lower risk of prostate cancer death, but whether results have been biased due to limited adjustments for confounding factors is unknown.ObjectiveTo compare the risk of prostate cancer death after RT versus RP.Design, setting, and participantsNationwide population-based observational study of men in the Prostate Cancer data Base Sweden 3.0 who had undergone RT or RP between 1998 and 2012.Outcome measurements and statistical analysisProstate cancer deaths were compared. Hazard ratios (HRs) were calculated in Cox regression models, including clinical T stage, M stage, Gleason grade group, serum levels of prostate-specific antigen, proportion of biopsy cores with cancer, mode of detection, comorbidity, age, educational level, and civil status. Period analysis with left truncation was performed.Results and limitationsPrimary treatment was RT or RP for 41 503 men. Treatment effect was associated with disease severity. In univariate analysis of RT versus RP, risk of prostate cancer death was higher after RT—low- and intermediate-risk cancer, HR 1.82 (95% confidence interval [CI]: 1.53–2.16), and high-risk cancer, HR 1.57 (95% CI: 1.33–1.85). After full adjustment in period analysis, this difference between the treatments was attenuated—low- and intermediate-risk cancer, HR 1.24 (95% CI: 0.97–1.58), and high-risk cancer, HR 1.03 (95% CI: 0.81–1.31). Confounding remained due to nonrandom allocation to treatment.ConclusionsIn comparison with previous studies, the difference in prostate cancer mortality after RT and RP was much smaller.Patient summaryThe difference in prostate cancer mortality after contemporary radiotherapy and radical prostatectomy was small in contrast to previous studies, indicating that potential side effects should be more emphasized when selecting treatment.

Purpose To investigate the risk of thromboembolic disease (TED) after radiation therapy (RT) with curative intent for prostate cancer (PCa). Patients and Methods We identified all men who received RT as curative treatment (n=9410) and grouped according to external beam RT (EBRT) or brachytherapy (BT). By comparing with an age- and county-matched comparison cohort of PCa-free men (n=46,826), we investigated risk of TED after RT using Cox proportional hazard regression models. The model was adjusted for tumor characteristics, demographics, comorbidities, PCa treatments, and known risk factors of TED, such as recent surgery and disease progression. Results Between 2006 and 2013, 6232 men with PCa received EBRT, and 3178 underwent BT. A statistically significant association was found between EBRT and BT and risk of pulmonary embolism in the crude analysis. However, upon adjusting for known TED risk factors these associations disappeared. No significant associations were found between BT or EBRT and deep venous thrombosis. Conclusion Curative RT for prostate cancer using contemporary methodologies was not associated with an increased risk of TED.

Background and purpose — Metastatic spinal cord compression (MSCC) as the initial manifestation of malignancy (IMM) limits the time for diagnostic workup; most often, treatment is required before the final primary tumor diagnosis. We evaluated neurological outcome, complications, survival, and the manner of diagnosing the primary tumor in patients who were operated for MSCC as the IMM. Patients and methods — Records of 69 consecutive patients (51 men) who underwent surgery for MSCC as the IMM were reviewed. The patients had no history of cancer when they presented with pain (n = 2) and/or neurological symptoms (n = 67). Results — The primary tumor was identified in 59 patients. In 10 patients, no specific diagnosis could be established, and they were therefore defined as having cancer of unknown primary tumor (CUP). At the end of the study, 16 patients were still alive (median follow-up 2.5 years). The overall survival time was 20 months. Patients with CUP had the shortest survival (3.5 months) whereas patients with prostate cancer (6 years) and myeloma (5 years) had the longest survival. 20 of the 39 patients who were non-ambulatory preoperatively regained walking ability, and 29 of the 30 ambulatory patients preoperatively retained their walking ability 1 month postoperatively. 15 of the 69 patients suffered from a total of 20 complications within 1 month postoperatively. Interpretation — Postoperative survival with MSCC as the IMM depends on the type of primary tumor. Surgery in these patients maintains and improves ambulatory function.

Objective: The aim of this study was to assess the risk of serious adverse effects after radiotherapy (RT) with curative intention and radical prostatectomy (RP). Materials and methods: Men who were diagnosed with prostate cancer between 1997 and 2012 and underwent curative treatment were selected from the Prostate Cancer data Base Sweden. For each included man, five prostate cancer-free controls, matched for birth year and county of residency, were randomly selected. In total, 12,534 men underwent RT, 24,886 underwent RP and 186,624 were controls. Adverse effects were defined according to surgical and diagnostic codes in the National Patient Registry. The relative risk (RR) of adverse effects up to 12 years after treatment was compared to controls and the risk was subsequently compared between RT and RP in multivariable analyses. Results: Men with intermediate- and localized high-risk cancer who underwent curative treatment had an increased risk of adverse effects during the full study period compared to controls: the RR of undergoing a procedures after RT was 2.64 [95% confidence interval (CI) 2.56–2.73] and after RP 2.05 (95% CI 2.00–2.10). The risk remained elevated 10–12 years after treatment. For all risk categories of prostate cancer, the risk of surgical procedures for urinary incontinence was higher after RP (RR 23.64, 95% CI 11.71–47.74), whereas risk of other procedures on the lower urinary tract and gastrointestinal tract or abdominal wall was higher after RT (RR 1.67, 95% CI 1.44–1.94, and RR 1.86, 95% CI 1.70–2.02, respectively). Conclusion: The risk of serious adverse effects after curative treatment for prostate cancer remained significantly elevated up to 12 years after treatment.

5000Background: Docetaxel combined with androgen deprivation therapy (ADT) has improved survival in advanced prostate cancer (PCa). This randomized trial evaluates if six courses of docetaxel impro...

This dissertation is a study of contemporary Pashto prose writing in a context of war and crisis based on a corpus of digitally published and/or printed short stories from the 1990s onwards. Out of this larger corpus, 16 stories have been selected and analysed under four topics: "The Terrorist", Female agency: Representations of and by, "The Madman", and Axtar: Longing for peace or imaging disillusion. A central idea is that the analysis should be text-oriented, but the contextualisation of the analysed texts is a secondary important focus. Chapter one presents the material and gives a general context to the study. In the second chapter, after a general conceptualisation of the short story genre, I discuss the borders between prose and poetry. In chapter three I provide an overview of Pashto literature where the aim is to pinpoint certain characteristics of literature in what I call a poeticised community, such as that of the Pashtuns. The fourth chapter contains an introduction to the four topics mentioned above, a summary of each of the four stories belonging to the specific topic with selected parts in direct translation from the Pashto original, as well as a discussion of form and contents of each topic separately. Chapter five consists of a general conclusion. An appendix with the original Pashto text of translated sections is found before the bibliography. One feature that has emerged from this study is the notion of how the narratives are often found to communicate and respond to their immediate surroundings, in time as well as in space. Another important conclusion is that devices normally regarded as belonging to the realm of poetry are not uncommon in Pashto short story writing.

Sammendrag Problemstilling: Hvilke faktorer har innvirkning på utvidelse av mammografiscreening, og hvilke tiltak kan bli gjort for å kunne utvide mammografiscreening frem til 74 år? Hensikt: Det er uenigheter i forskningsmiljøet om mammografiscreening bør utvides til en eldre aldersgruppe. Hensikten med oppgaven er å belyse hvilke faktorer som påvirker utvidelse av Mammografiprogrammet, og hvilke tiltak som kan gjennomføres for å muliggjøre mammografiscreening frem til 74 år. Metode: Det ble benyttet litteraturstudie som metode for å besvare problemstillingen. Seks studier dannet grunnlaget for en analysering av hvilke faktorer som påvirker utvidelse av mammografiscreening til en eldre aldersgruppe. Faktorer som blir belyst i denne oppgaven er: mortalitet, overdiagnostisering, falske-positive funn, og kostnadseffektivitet. Resultat: Overdiagnostisering og falske-positive funn blir ansett på som harms, og blir betraktet som de største grunnene for å ikke utvide mammografiscreening. Derimot blir redusert risiko for mortalitet betraktet som benefit. Utvidelse til 74 år reduserte mortalitet, men økte sannsynlighetene for overdiagnostisering og falske-positive funn. Kostnadene for behandling av cancer mammae økte med cancer stadiet, som påvirker både sykehus og pasient. Ved å utvide den øvre aldersgruppen til 74 år, økte kostnadene marginalt grunnet ekstra screeningkostnader, men dette ble balansert av bedre resultater. Konklusjon: Mortalitetsraten sank etter inkludering av eldre kvinner i mammografiscreening. Ved å utvide mammografiscreening vil flere falske-positive funn og tilfeller med overdiagnostisering oppstå, men siden eldre kvinner er mer hormonbetinget og har tidligere undersøkelser for sammenligning, kan det bli antatt at det vil oppstå mindre tilfeller med harms. Kostnadene for å utvide mammografiscreening var lavere enn kostnadene for behandling av cancer mammae i et senere stadium. Regulering etter risikonivå for kvinner og triennal mammografiscreening kan være alternativer for den biennale mammografiscreeningen som blir benyttet i dag. Nøkkelord: cancer mammae, mammografiscreening, utvidelse, harm to benefit-ratio, kostnad Antall ord: 9275 Abstract Thesis: Which factors contribute to expanding mammographic screening, and what measures can be done to be able to extend mammography screening to the age of 74? Purpose: There are disagreements within the research community regarding if mammography screening should be extended to an older age group. The purpose of this thesis is to elucidate the factors influencing the extension of BreastScreen Norway, and identify measures that can be implemented to enable mammography screening up to the age of 74. Method: A literature review was used as the methodological approach to answer the thesis question. Six studies constituted the basis for an analysis of the factors influencing the expansion of mammography screening to an older age group. The factors in this review are defined as: mortality, overdiagnosis, false-negative findings, and cost-effectiveness. Results: Overdiagnosis and false-positive findings are considered as harms, and are regarded as the primary reasons for not expanding mammography screening. However, reduced mortality risk is considered a benefit. Extending mammography screening to the age of 74 resulted in reduced mortality, but increased the chances of overdiagnosis and false-positive findings. The costs of treating cancer mammae increased with cancer stage, affecting both the hospital and patient. By extending the upper age group to 74 years, the costs increased marginally due to extra screening costs, but this was balanced by better outcomes. Conclusion: The mortality rate was reduced after the inclusion of older women in mammography screening. By extending mammography screening, more false-positive findings and cases of overdiagnosis will occur, but since older women are more hormone-dependent and have previous exams for comparison, it can be assumed that there will be fewer cases of harms. The costs of extending mammography screening were lower than the costs of treating cancer mammae at a later stage. Regulating according to women’s risk levels and triennal mammography screening could potentially be alternatives to the current biennal mammography screening that is practiced today. Keywords: cancer mammae, mammography screening, extending, harm to benefit-ratio, cost Number of words: 9275

Sammendrag Problemstilling: Hvilken av undersøkelsene digital mammografi og digital bryst tomosyntese vil gi høyest deteksjon av tumorer i et screeningprogram, og hvilke faktorer kan påvirke deteksjonsraten? Hensikt: Hensikten med denne oppgaven var å se på deteksjonsraten av tumorer ved digital mammografi og digital bryst tomosyntese i et screeningprogram, og å se på hvilke faktorer som kan påvirke deteksjonsraten. Metode: Det er blitt benyttet en kvalitativ litteraturstudie for å besvare denne oppgaven. Ved hjelp av PICO skjema har det blitt funnet søkeord som har blitt tatt i bruk til å finne artikler i ulike databaser. Videre har vi hentet inn data som har blitt analysert og tolket for å kunne finne ut om digital bryst tomosyntese har en høyere deteksjonsrate enn digital mammografi. Resultat: Vi har oppsummert resultatene på deteksjonsrate ved digital mammografi og digital bryst tomosyntese fra fem ulike artikler. Det er flere faktorer som kan påvirke deteksjonsraten og faktorene vi har fokusert på i denne oppgaven er alder, krefttyper, sensitivitet og spesifisitet, tilbakekalling og førstegangs screening. Resultatene blir presentert i form av tekst og tabeller. Konklusjon: Vi konkluderer med at det er sannsynlig at digital bryst tomosyntese vil gi en høyere deteksjon av tumorer enn digital mammografi i et screeningprogram. Det er varierende i hvor stor grad faktorene påvirker deteksjonsraten. Hva slags type alder, kreft, sensitiviteten og førstegangs screenede er faktorer som påvirker deteksjonsraten. Når det kommer til spesifisitet og tilbakekalling er det vanskelig å komme med en sikker konklusjon da det ikke er nok data på dette. Det vil derfor være gunstig å fortsette å forske på tema. Nøkkelord: Digital mammografi, digital bryst tomosyntese, screening, deteksjonsrate, innvirkende faktorer Abstract Topic/research question: Which one of the examinations digital mammography and digital breast tomosynthesis will give the highest detection of tumors in a screening program, and which factors can affect the detection rate? Purpose: The purpose of this study was to look at the detection rate of tumors in digital mammography and digital breast tomosynthesis in a screening program, and to look at which factors that can affect the detection rate. Method: We have used a quantitative literature review to answer these factors. By using a PICO form we found keywords that have been used to find articles in different databases. Further we collected and analyzed data to find out if digital breast tomosynthesis has a higher detection rate than digital mammography. Results: We have compared the detection rate results between digital mammography and digital breast tomosynthesis from five different articles. There are several factors that can affect the detection rate and the factors we have focused on in this study is age, types of cancers, sensitivity and specificity, recall rate and first time screening. The results are presented in text and tables. Conclusion: We have concluded that it is likely that digital breast tomosynthesis will provide a higher detection of tumors than digital mammography in a screening program. The extent to which the factors affect the detection rate varies. Age, what type of cancer, sensitivity and first time screening are factors that affect the detection rate. When it comes to specificity and recall rate it is difficult to come with a conclusion because there is not enough data on this. It will therefore be beneficial to continue to research this topic. Keywords: Digital mammography, digital breast tomosynthesis, screening, detection rate, influential factors

Problemstilling: Hvordan påvirkes radiografer av inadekvate henvisninger på konvensjonell røntgen ved Sykehuset Innlandet? Formål: Et kvalitetssikringsprosjekt for å belyse hvordan radiografer påvirkes av inadekvate henvisninger ved å kartlegge utfordringer i henvisninger til Sykehuset Innlandet. Metoder: Kvantitativ forskningsmetode i form av avkrysningsskjema og kvalitativ forskningsmetode i form av intervju ble anvendt. Radiografer fra konvensjonell røntgen stilte som respondenter på spørreundersøkelsen og fem utvalgte radiografer med lang erfaring fra konvensjonell røntgen stilte som informanter til intervjuene. Resultat: Utfordringer knyttet til henvisninger forekommer regelmessig. Samtlige informanter kjenner til alle utfordringer fra avkrysningsskjemaet. Konsekvenser av misvisende eller mangelfulle henvisninger er unødig tidsbruk, feil bildetakning og supplerende bilder. Informantene hadde ulike teorier om at stor arbeidsmengde blant interne og eksterne henvisere medførte inadekvate henvisninger. Konklusjon: Utfordringer i henvisninger medfører dårlig ressursutnyttelse, ekstra tidsbruk og misnøye blant radiografer. Ved å anvende en henvisningsveileder og øke det tverrfaglige samarbeidet, vil trolig kvaliteten på henvisninger forbedres og ressursene utnyttes på en bedre måte. Thesis question: How are radiographers affected by inadequate referrals from conventional radiography at Sykehuset Innlandet? Purpose: A quality assurance project to enlighten how radiographers are affected by inadequate referrals by identifying challenges in referrals to Sykehuset Innlandet. Methods: Quantitative research method by using a questionnaire and qualitative research method by conducting interviews. Radiographers from conventional radiography participated in the survey and five radiographers with long experience from conventional radiography were interviewed. Results: Referrals with challenges occur regularly. All the informants recognize the challenges from the questionnaire. Consequences by misleading or deficient referrals leads to unnecessary use of time, wrong radiological examinations and additional imaging. The informants had different theories about the workload of internal and external referrers, and if this led to inadequate referrals. Conclusion: Referrals with challenges leads to bad use of resources, extra use of time and dissatisfaction among radiographers. By utilizing referral guidelines and increasing the amount of interdisciplinary collaboration, will probably lead to higher quality referrals and better use of resources.

Introduction: Radiotherapy is an established treatment option for prostate cancer (PCa), both as primary treatment and secondary treatment after radical prostatectomy (RP). Since 1998, detailed dataon radiotherapy delivered to Swedish men with PCa (e.g. treatment modalities, absorbed doses, fractionation) have been collated within PCa data Base Sweden (PCBaSe). This study reports patterns of radical radiotherapy for PCa in Sweden over the past two decades.Materials and methods: All men with non-metastatic PCa (1998–2016) who received external beam radiotherapy (EBRT) or high or low dose-rate brachy therapy (HDR-BT/LDR-BT) were identified in PCBaSe. Analyses included: trends in radiation techniques, fractionation patterns and total doses overtime; PCa-specific survival comparing treatment in 2007–2017 with 1998–2006; and regional variationin type of primary radiotherapy.Results: About 20,876 men underwent primary radiotherapy. The main treatment modalities include conventionally fractionated (2.0 Gy/fraction) EBRT (51%), EBRT with HDR-BT boost (27%) and hypofractionated (>2.4 Gy/fraction) EBRT (11%). EBRT with photon or proton boost and HDR-BT and LDR-BT monotherapies were each used minimally. Use of dose-escalated EBRT (>74 Gy) and moderate hypofractionation increased over time, while use of HDR-BT declined. Considerable regional variation in treatment modalities was apparent. Risk of PCa death following primary radiotherapy had declined for intermediate-risk (HR: 0.60; 95%CI 0.47–0.87) and high-risk PCa (HR: 0.72; 95%CI 0.61-0.86).Discussion: Increased use of dose escalation and hypofractionated EBRT has occurred in Sweden over the past two decades, reflecting current evidence and practice guidelines. Disease-specific outcomes have also improved. Data collected in PCBaSe provide an excellent resource for further research into RT use in PCa management. Refereed/Peer-reviewed

Problemstilling: I hvilken grad er 3 års radiografstudenter ved Norges teknisk-naturvitenskapelige universitet (NTNU) Gjøvik i stand til å bedømme bildekvaliteten ved thorax bilder ut ifra Visual Grading Analysis (VGA). Finnes det gjenspeiling ved endring i mAs- verdi og studentenes vurderinger av bildekvalitet? Hensikt: Undersøke i hvilken grad 3 års radiografistudenter er i stand til å bedømme bildekvalitet ved røntgen thorax bilder. Metode: En kvantitativ metode, hvor det er utført et eksperiment. Det har blitt benyttet et «QC Phantom for Digital Chest Radiography» hvor det har blitt tatt 20 bilder. Deltakerne ved 3 års radiografstudie skulle bedømme 20 bildesett opp mot et referansebilde, ut ifra VGA. Resultat: Resultatet fra eksperimentet ble satt opp i VGA score (poengskala). Bildene med mAs- verdier under referanse bildet (0.71 mAs), 0.56 mAs og 0.5 mAs vurderes som dårligere bilder. Ved 0.63 mAs, mer delte meninger og lite flertall vurderte bildet litt dårligere enn referansebildet. Bilder fra 0.8 mAs til 1.1 mAs, hadde en økning i positiv vurdering. Fra 1.25 mAs til 1.6 mAs, var det en splittelse i vurderingen. Fra 1.8 mAs til 4.5 mAs, mente deltakerne at var dårligere i kvalitet. Konklusjon: Denne studien har vist at 3 års radiografistudenter ved NTNU Gjøvik har en høy grad av enighet når det kommer til vurdering av bildekvalitet, og at mAs har en direkte innvirkning på oppfattelse av bildekvalitet. Topic: How good are 3-year radiography students at Norwegian University of Science and Technology (NTNU) Gjøvik able to judge image quality of thorax images based on Visual Grading Analysis (VGA). Is there a correlation in changing mAs- values and the students evaluation of image quality? Goal of study: Explore how good 3-year radiography students are at judging image quality of x-ray thorax images. Method: Quantitative method, in which an experiment was carried out. Using a “QC Phantom for Digital Chest Radiography”, the participants evaluated 20 images side by side with a reference image using relative VGA. Result: The results of the experiment were calculated through their VGA score. The images with lower mAs than the reference image (0.71 mAs), 0.56 mAs and 0.5 mAs were evaluated to be worse in terms of image quality. 0.63 mAs, the evaluations were more spread out, being considered to be slightly worse than the reference image by a small majority. From 0.8 mAs through 1.1 mAs, had increasingly positive evaluations. While 1.25 to 1.6 mAs the students evaluations of the images quality were more spread out. Images valued from 1.8 through 4.5 mAs were evaluated to be worse. Conclusion: This study has shown there is a high level of agreement in 3-year radiography students from NTNU Gjøvik, when it comes to evaluation of image quality, and that mAs has a direct effect on perception of image quality.

Problemstilling: Er trykk- eller kraftstandardisert kompresjon mest egnet som kompresjonsmetode med tanke på smerte hos kvinner på mammografiscreening? Hensikt: Hensikten med oppgaven er å undersøke hvorvidt trykk- eller kraftstandardisert kompresjon er mest egnet som kompresjonsmetode med tanke på smerte hos kvinner på mammografiscreening. Metode: Oppgaven er en kvalitativ litteraturstudie som inkluderer fire selvstendige artikler. Resultat: Resultatene er innhentet fra studier som er gjennomført i Norge og Nederland. Gjennomsnittlig smertescore for kraftstandardisert kompresjon var 2,2 og 3,74. Gjennomsnittlig smertescore for trykkstandardisert kompresjon var 2,4 og 4,29 for CC og 4,71 for MLO. Konklusjon: Resultatene viser at det er variasjoner i gjennomsnittlig smertescore mellom de to kompresjonsmetodene. På bakgrunn av dette kan det i denne oppgaven ikke avgjøres hvilken kompresjonsmetode som er mest egnet på mammografiscreening med tanke på smerte hos kvinner. Vi mener det bør gjøres mer omfattende forskning som tar bakenforliggende faktorer i betraktning ved en evaluering av metodene. Topic/research question: Is pressure or force standardized compression more suitable as a compression method considering women’s experience of pain in screening mammography? Purpose: The purpose of the thesis is to investigate whether pressure or force standardized compression is more suitable as a compression method considering women’s experience of pain in screening mammography. Method: The thesis is a qualitative literature study that includes four independent articles. Results: The results are obtained from studies conducted in Norway and the Netherlands. The mean pain scores for force-standardized compression was 2.2 and 3.74. Mean pain scores for pressure-standardized compression were 2.4, and 4.29 for CC and 4.71 for MLO. Conclusion: Based on the results of this thesis there are variations in the mean pain scores between the two compression methods. It is therefore not possible for us to determine which compression method that is more suitable for screening mammography considering women’s experience of pain. We believe that there should be done more extensive research that takes underlying factors into account when evaluating the methods.

Problemstilling: Hvordan kan radiografer sikre kommunikasjonen med pasienter som ikke kan tilstrekkelig engelsk eller et av de skandinaviske språkene ved CT Colografi? Hensikt: Mangfoldet i Norge har økt betraktelig. Dette fører til at man i helsetjenesten møter på flere fremmedspråklige pasienter som ikke kan norsk, engelsk eller et av de skandinaviske språkene. Vi valgte CT Colografi, der god kommunikasjon er i fokus. Det er fordi det krever en del formidling av informasjon som pasienten må følge for en optimal undersøkelse. Hensikten med studien er dermed å finne ut hvordan man på best mulig måte kan sikre kommunikasjonen mellom radiograf og pasient. Metode: Denne oppgaven er basert på kvalitativ metode, der det ble utført intervjuer med radiografer ved ulike radiologiske avdelinger i Innlandet. Vi ble inspirert av Georgis psykologiske fenomenologiske analysemetode, som ble benyttet for å analysere intervjuene. Resultat: Ut ifra den utvalgte analysemetoden ble intervjuene analysert og resultatene ble delt inn i seks ulike kategorier. De valgte kategoriene er: • Pasientsikkerhet • Kultur, bluferdighet og religion • Tolk • Radiografens opplevelse ved svekket kommunikasjon • Andre undersøkelser og modaliteter • Nåværende tiltak og forslag til sikrere kommunikasjon. Konklusjon: Gjennom intervjuene kom det frem ulike tiltak som radiografene i dag benytter, for å sikre kommunikasjonen med fremmedspråklige pasienter ved språkbarriere. Radiografene kom også med forslag som kan bidra til å sikre kommunikasjonen, men vi konkluderer med at bruken av tolk er det sikreste alternativet. Det er fordi man får en direkte oversettelse, som fører til færre misforståelser. På denne måten får pasienten en tryggere opplevelse, og det oppnås en bedre bildediagnostikk. Research question: How can radiographers ensure communication with patients that do not speak English or any of the Scandinavian languages at CT Colography? Purpose: The diversity in Norway has increased considerably. This has led to health institutions meeting many foreign speaking patients that do not speak Norwegian, English or any of the Scandinavian languages. We chose CT Colography, where good communication is important, because it takes a lot of dissemination of information to the patient to achieve an optimal examination. Therefor the purpose of this study is to find out best possible way to ensure the communication between the radiographer and patient. Method: This study is based on a qualitative method, where we interviewed radiographers from various radiological departments in Innlandet, Norway. We were inspired by Georgi´s psychological phenomenological analysis method to analyse the interviews. Results: Based on the chosen method of analysis, the results were divided into six different categories. The chosen categories are: • Patient safety • Culture, modesty and religion • Interpreter • The radiographers experience when communication is decreased • Other examinations and modalities • Current actions and suggestions Conclusion: Throughout the interviews it occurred various measures that radiographers use today to ensure communication with foreign speaking patients. The radiographers suggested measures that could help to ensure the communication, but we concluded that using an interpreter would be the surest alternative solution. The reason for this is because we get a directly translated dialog with the patient, which leads to less misunderstandings. This also leads to a safer experience for the patient throughout the examination, which results in a better diagnostic imaging.

Problemstilling: Er intravenøs administrering av Buscopan nødvendig ved en CT-veiledet kolografi for å oppnå en optimal diagnostisk undersøkelse? Hensikt: Hensikten med denne besvarelsen er å forsøke å gi svar på om bruk av Buscopan er nødvendig for en god diagnostisk undersøkelse ved CT-veiledet kolografi. Metode: Det er brukt kvalitativ metode og det er gjort en litteraturstudie. Resultat: Forskningsmiljøet er uenige i nødvendigheten av Buscopan for en god diagnostisk undersøkelse. Det er enighet om at god utvidelse og polyppdeteksjon er viktig for en god diagnostisk undersøkelse. De er også generell enighet om at man bør ta hensyn til pasientkomfort i vurderingen av Buscopanbruken. Konklusjon: Buscopan kan være til nytte for pasienter som er eldre og overvektige med generelle helseplager og høyere risiko for kreft. Medikamentet er ikke nødvendigvis av like stor betydning for yngre, friske og normalvektige pasienter. Det kan se ut som man bør vurdere å endre dagens standardbruk av Buscopan. Topic/research question: Is intravenous administration of Buscopan required to obtain an optimal diagnostic examination through conducting a CT-guided colonography. Purpose: The purpose of this thesis is to try and answer if the use of Buscopan is necessary to obtain an optimal diagnostic examination through conducting a CT-guided colonography Method: The study is based on a qualitative method where there has been conducted a literature review. Results: Earlier studies on this subject disagree when it comes to necessity of Buscopan for a good diagnostic examination They agree that both distention and polyp detection is both important criteria for an optimal examination. They also generally agree that patient comfort is an important factor to look at in the evaluation of Buscopan. Conclusion: Buscopan can be of good use for the older and overweight patients with general health problems and a higher risk of colon cancer. The medicament is not necessarily o fuse to younger, healthy patient with a normal weight. It seems like it is necessary to evaluate if today’s standard use of the medication

Problemstilling: Hvilke tiltak foretrekker radiografer for å bedre opplevelsen av MR undersøkelser for pasienter med klaustrofobi? Hensikt: Pasienter som gjennomgår en MR-undersøkelse kan oppleve klaustrofobiske reaksjoner. Målet med denne oppgaven var å finne ut hvilket tiltak, og hvilke strategier radiografer mener er effektive for å redusere klaustrofobiske reaksjoner for pasienten under en MR-undersøkelse. Metode: En kvantitativ metode i form av et spørreskjema ble valg for denne oppgaven. På grunn av utformingen av spørreskjema ble enkelte spørsmål analysert med en kvalitativ analyse. Utvalgene i denne oppgaven bestod av et norsk helseforetak og et privat institutt. Resultater: Det var en svarprosent på 56% ved denne undersøkelsen. “Musikk/radio” var det mest foretrukket hjelpemiddelet etter svaralternativet “annet”. I svaralternativene radiografene selv kunne utdype ble informasjon, kommunikasjon og pasientomsorg vektlagt som de viktigste tiltakene. Konklusjon: God informasjon før undersøkelsen, og kommunikasjon underveis, er det som blir mest vektlagt. De fysiske hjelpemidlene er en bra distraksjon, men det er viktigere å skape trygghet og tillit til pasienten, og yte god pasientomsorg. Research question: Which measures do radiographers prefer to improve the experience of MRI examinations for patients with claustrophobia? Purpose: Patients undergoing MRI may experience claustrophobic reactions. The goal of this exercise was to find out which actions and strategies radiographers believe are effective in reducing claustrophobic reactions to the patient during an MRI examination. Method: A quantitative method in the form of a questionnaire was chosen. Due to the design of the questionnaire, some questions were analyzed using qualitative analysis. The committees in this thesis consisted of a Norwegian health enterprise and a private institute. Results: There was a 56% response rate to the questionnaire. Out of the answer alternatives on the preferred aids, “music/radio” was the most selected alternative after the elaboration alternative. Where the radiographers had an option to elaborate, they emphasized the importance of information, communication and patient care. Conclusion: Good information before the examination, and communication along the way, is the most emphasized tool used. The physical aids are a good distraction, but it is more important to create security and trust to the patient and provide good patient care.