Publications

@article{nokey,

title = {Deep learning methods for clinical workflow phase-based prediction of procedure duration: a benchmark study},

author = {Emanuele Frassini and Teddy S Vijfvinkel and Rick M Butler and Maarten van der Elst and Benno HW Hendriks and John J van den Dobbelsteen},

doi = {10.1080/24699322.2025.2466426},

year  = {2025},

date = {2025-02-01},

urldate = {2025-02-01},

journal = {Computer Assisted Surgery},

volume = {30},

number = {2466426},

issue = {1},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{nokey,

title = {Benchmarking 2D human pose estimators and trackers for workflow analysis in the cardiac catheterization laboratory},

author = {Rick M Butler and Emanuele Frasini and Teddy S Vijfvinkel and Sjors van Riel and Chavdar Bachvarov and Jan Constandse and Maarten van der Elst and John J van den Dobbelsteen and Benno HW Hendriks},

doi = {10.1016/j.medengphy.2025.104289},

year  = {2025},

date = {2025-02-01},

urldate = {2025-02-01},

journal = {Medical Engineering & Physics},

volume = {136},

number = {104289},

issue = {4},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{nokey,

title = {Baseline Study of Ultra-Clean Air Change Rate, Number, and Type of Microorganisms and Level of Particles During Trauma Surgery},

author = {Jos Lans and Nina MC Mathijssen and PR Goswami and John J van den Dobbelsteen and PG Luscuere},

doi = {10.1177/19375867241302406},

year  = {2024},

date = {2024-12-01},

journal = {HERD Health Environments Research & Design},

volume = {18},

number = {19375867241302406},

issue = {43},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{nokey,

title = {2D Human Pose Tracking in the Cardiac Catheterisation Laboratory with BYTE},

author = {Rick M Butler and Teddy S Vijfvinkel and Emanuele Frassini and Sjors van Riel and Chavdar Bachvarov and Jan Constandse and Maarten van der Elst and John J van den Dobbelsteen and Benno HW Hendriks},

doi = {10.1016/j.medengphy.2024.104270},

year  = {2024},

date = {2024-12-01},

journal = {Medical Engineering & Physics},

volume = {135},

number = {104270},

issue = {4},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{nokey,

title = {Surgical instrument counting: Current practice and staff perspectives on technological support},

author = {Anton Kooijmans and Lieke de Rouw and Maarten van der Elst and John J van den Dobbelsteen},

doi = {10.1016/j.hfh.2024.100087},

year  = {2024},

date = {2024-12-01},

journal = {Human Factors in Healthcare},

volume = {6},

number = {100087},

issue = {9},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Hagenaars2023,

title = {Changes in needle maneuver space and optimal insertion site for midline neuraxial puncture with progressive age: an analysis in computed tomography scans},

author = {Martin Hagenaars and John J van den Dobbelsteen and Dennis J van Gerwen},

doi = {10.1136/rapm-2023-104981},

issn = {1532-8651},

year  = {2024},

date = {2024-12-00},

journal = {Reg Anesth Pain Med},

volume = {49},

number = {12},

pages = {853--860},

publisher = {BMJ},

abstract = {IntroductionWe systematically describe the morphology and accessibility of interspinous spaces across age groups of patients. Our primary goal was to objectively estimate if the maneuver space for a virtual spinal needle changes with age. Our secondary goal was to estimate if the optimal site and angle for midline neuraxial puncture change with age.MethodsMeasurements were performed in mid-sagittal CT images. The CT images were retrospectively collected from the database of the Department of Radiology of our hospital. Three age groups were studied: 21–30 years (n=36, abbreviated Y(oung)), 51–60 years (n=43, abbreviated M(iddle-aged)) and older than 80 years (n=46, abbreviated Old).A needle trajectory is defined by the chosen puncture point and by the angle at which the needle is directed to its target. We define a Spinal Accessibility Index (SAI) by numerically integrating for an interspaceall possible combinationsof puncturepointsandanglesthat lead to a successful virtual puncture. Successful in this context means that the needle tip reaches the spinal or epidural space without bone contact. Reproducible calculation of the SAI was performed with the help of custom-made software. The larger the value of the SAI, the more possible successful needle trajectories exist that the practitioner may choose from.The optimal puncture point and optimal angle in an age group at a certain level of the spine are defined by the combination of these two, which generates the highest success rate of the entire sample of this age group.ResultsAt all levels of the spine, the median SAI differed significantly between age groups (independent-samples Kruskal-Wallis test, p<0.001–0.047). The SAI consistently decreased with increasing age. Post-hoc analyses using pairwise comparisons showed a significantly higher SAI in group Y versus Old at all levels (p<0.001—0.006) except at level thoracic (Th)1–Th2 (p=0.138). The SAI was significantly higher in group M versus Old at all levels (p<0.001–0.028) except at level Th1–Th2 (p=0.061), Th4–Th5 (p=0.083), Th9–Th10 (p=1.00) and Th10–Th11 (p=1.00).ConclusionsNeedle maneuver space in midline neuraxial puncture significantly decreases with progressive age at all levels of the spine. Optimal puncture points and angles are similar between age groups.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Bloemberg2024,

title = {Therapeutic prostate cancer interventions: a systematic review on pubic arch interference and needle positioning errors},

author = {Jette Bloemberg and Martijn de Vries and Luigi A. M. J. G. van Riel and Theo M. de Reijke and Aimée Sakes and Paul Breedveld and John J. van den Dobbelsteen},

doi = {10.1080/17434440.2024.2374761},

issn = {1745-2422},

year  = {2024},

date = {2024-07-02},

journal = {Expert Review of Medical Devices},

volume = {21},

number = {7},

pages = {625--641},

publisher = {Informa UK Limited},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{deVries2024,

title = {Dosimetric benefits and preclinical performance of steerable needles in HDR prostate brachytherapy},

author = {M. de Vries and M.E.M.C. Christianen and L. Luthart and K.C. de Vries and I.K.K. Kolkman-Deurloo and J.J. van den Dobbelsteen},

doi = {10.1016/j.medengphy.2024.104177},

issn = {1350-4533},

year  = {2024},

date = {2024-06-00},

journal = {Medical Engineering & Physics},

volume = {128},

publisher = {Elsevier BV},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Lans2024,

title = {What is the effect of reducing the air change rate on the ventilation effectiveness in ultra-clean operating rooms?},

author = {J.L.A. Lans and N.M.C. Mathijssen and A. Bode and J.J. van den Dobbelsteen and M. van der Elst and P.G. Luscuere},

doi = {10.1016/j.jhin.2024.02.007},

issn = {0195-6701},

year  = {2024},

date = {2024-05-00},

journal = {Journal of Hospital Infection},

volume = {147},

pages = {115--122},

publisher = {Elsevier BV},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Schouten2023,

title = {Operating Room Performance Optimization Metrics: a Systematic Review},

author = {Anne M. Schouten and Steven M. Flipse and Kim E. van Nieuwenhuizen and Frank Willem Jansen and Anne C. van der Eijk and John J. van den Dobbelsteen},

doi = {10.1007/s10916-023-01912-9},

issn = {1573-689X},

year  = {2023},

date = {2023-12-00},

journal = {J Med Syst},

volume = {47},

number = {1},

publisher = {Springer Science and Business Media LLC},

abstract = {AbstractLiterature proposes numerous initiatives for optimization of the Operating Room (OR). Despite multiple suggested strategies for the optimization of workflow on the OR, its patients and (medical) staff, no uniform description of ‘optimization’ has been adopted. This makes it difficult to evaluate the proposed optimization strategies. In particular, the metrics used to quantify OR performance are diverse so that assessing the impact of suggested approaches is complex or even impossible. To secure a higher implementation success rate of optimisation strategies in practice we believe OR optimisation and its quantification should be further investigated. We aim to provide an inventory of the metrics and methods used to optimise the OR by the means of a structured literature study. We observe that several aspects of OR performance are unaddressed in literature, and no studies account for possible interactions between metrics of quality and efficiency. We conclude that a systems approach is needed to align metrics across different elements of OR performance, and that the wellbeing of healthcare professionals is underrepresented in current optimisation approaches.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Vijfvinkel2023,

title = {Time is muscle: measuring workflow and procedure duration in the catheterization laboratory},

author = {T S Vijfvinkel and B Nikookar and J Constandse and B H W Hendriks and M Van Der Elst and J J Van Den Dobbelsteen},

doi = {10.1093/eurheartj/ehad655.2947},

issn = {1522-9645},

year  = {2023},

date = {2023-11-09},

volume = {44},

number = {Supplement_2},

publisher = {Oxford University Press (OUP)},

abstract = {Abstract

               

                  Introduction

                  Cardiac catheterization laboratories (cath labs) represent one of the most significant labour- and cost-intensive departments within the hospital. In the coming years, the demand for interventions in cath labs will rise with the increase of the prevalence of cardiovascular diseases. Therefore, optimization of cath lab efficiency is a growing necessity. Previous studies have highlighted the importance of efficiency improvements in hospitals. For example, reliable estimations of procedure duration and real-time progress indications have proven to be critical conditions to enhance efficiency in the operating theatre. Similar developments could also benefit cath labs, as workflow monitoring and management present opportunities to increase both efficiency and patient safety.

               

               

                  Purpose

                  The aim of this study is to measure and quantify the workflow within a cath lab, consisting of all clinical activities and the associated daily routine. Furthermore, the impact of process-, patient-, and staff-related parameters on the workflow will be assessed.

               

               

                  Methods

                  During an observational study, diagnostic cardiac angiograms (CAGs) were recorded with 5 video cameras in the cath lab. Subsequently, clinically-relevant key points were manually annotated by two independent observers based on the collected video images. These predefined key points were established by consensus among cardiologists. The annotations were converted to represent durations of specific procedure phases. Clinical information of the included procedures was collected from the electronic patient files. Multivariate regression analysis was used to test for correlations between clinical parameters and phase durations.

               

               

                  Results

                  A total of 297 diagnostic CAGs were included in this study. The mean total duration of a CAG was 46,67 minutes (SD ± 17,17). Of all the phases, the preparation phase had the longest duration, with an average of 20,42 minutes (SD ± 9,90). The most contributing factor to the total duration of a procedure was the use of one or more additional catheters besides the standard equipment (Spearman’s ρ=0,42). Furthermore, the cardiologist performing the CAG significantly influenced the phases involving the actual clinical activities, with mean durations ranging from 35,86 minutes to 63,47 minutes. Patient characteristics such as age, BMI and gender did not cause the phase durations to deviate significantly.

               

               

                  Conclusions

                  This study measured cath lab workflow based on key events which were visible during CAGs. The impact of process-, patient- and staff-related factors on the workflow was determined and quantified. This will enable hospital staff and management to understand their current workflow and improve accordingly. Moreover, a detailed understanding of the workflow provides ways to assess workload and guidance towards optimal working conditions. Ultimately, these insights support the development of an algorithm capable of automated continuous workflow monitoring.

               },

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Lans2023,

title = {Capital and operational expenditures of different operating room air-handling installations with conventional or ultra-clean air supply systems},

author = {J.L.A. Lans and N.M.C. Mathijssen and A.A.L. Traversari and I.M. Jacobs and J.J. van den Dobbelsteen and M. van der Elst and P.G. Luscuere},

doi = {10.1016/j.jobe.2023.107714},

issn = {2352-7102},

year  = {2023},

date = {2023-11-00},

journal = {Journal of Building Engineering},

volume = {78},

publisher = {Elsevier BV},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{deVries2023,

title = {MR-guided HDR prostate brachytherapy with teleoperated steerable needles},

author = {M. de Vries and M. Wijntjes and J. Sikorski and P. Moreira and N. J. van de Berg and J. J. van den Dobbelsteen and S. Misra},

doi = {10.1007/s11701-023-01676-x},

issn = {1863-2491},

year  = {2023},

date = {2023-10-00},

journal = {J Robotic Surg},

volume = {17},

number = {5},

pages = {2461--2469},

publisher = {Springer Science and Business Media LLC},

abstract = {AbstractConformity of tumour volumes and dose plans in prostate brachytherapy (BT) can be constrained by unwanted needle deflections, needle access restrictions and visualisation limitations. This work validates the feasibility of teleoperated robotic control of an active steerable needle using magnetic resonance (MR) for guidance. With this system, perturbations can be counteracted and critical structures can be circumvented to access currently inaccessible areas. The system comprises of (1) a novel steerable needle, (2) the minimally invasive robotics in an MR environment (MIRIAM) system, and (3) the daVinci Research Kit (dVRK). MR scans provide visual feedback to the operator controlling the dVRK. Needle steering is performed along curved trajectories to avoid the urethra towards targets (representing tumour tissue) in a prostate phantom with a targeting error of 1.2 ± 1.0 mm. This work shows the potential clinical applicability of active needle steering for prostate BT with a teleoperated robotic system in an MR environment.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{deVries2023b,

title = {PD-0415 Steerable needles enable HDR prostate BT for patients with pubic arch interference},

author = {M. de Vries and M. Christianen and L. Luthart and K. de Vries and I. Kolkman-Deurloo and J. van den Dobbelsteen},

doi = {10.1016/s0167-8140(23)08887-4},

issn = {0167-8140},

year  = {2023},

date = {2023-05-00},

journal = {Radiotherapy and Oncology},

volume = {182},

pages = {S315--S317},

publisher = {Elsevier BV},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Lans2023b,

title = {Air quality in the periphery of operating rooms during surgery},

author = {J.L.A. Lans and A.A.L. Traversari and N.M.C. Mathijssen and T. Sprangers and J.J. van den Dobbelsteen and M. van der Elst and P.G. Luscuere},

doi = {10.1016/j.jhin.2023.01.015},

issn = {0195-6701},

year  = {2023},

date = {2023-05-00},

journal = {Journal of Hospital Infection},

volume = {135},

pages = {193--195},

publisher = {Elsevier BV},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{deVries2022,

title = {Overcoming pubic arch interference in prostate brachytherapy using steerable needles},

author = {Martijn de Vries and Sarah Wilby and Antony L. Palmer and Wojciech Polak and Inna O’Hea and Dominic Hodgson and John van den Dobbelsteen},

doi = {10.5114/jcb.2022.121562},

issn = {1689-832X},

year  = {2022},

date = {2022-00-00},

journal = {jcb},

volume = {14},

number = {5},

pages = {495--500},

publisher = {Termedia Sp. z.o.o.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}