Phd Tore Amundsen Md

Norwegian University of Science and Technology | NTNU · Faculty of Medicine

Background and objective: Patients suspected to have lung cancer, undergo endobronchial ultrasound bronchoscopy (EBUS) for the purpose of diagnosis and staging. For presumptive curable patients, the EBUS bronchoscopy is planned based on images and data from computed tomography (CT) images and positron emission tomography (PET). Our study aimed to e...

Background: Bronchoscopy for peripheral lung lesions may involve image sources such as computed tomography (CT), fluoroscopy, radial endobronchial ultrasound (R-EBUS), and virtual/electromagnetic navigation bronchoscopy. Our objective was to evaluate the feasibility of replacing these multiple monitors with a head-mounted display (HMD), always prov...

Introduction: The established method for assessment of mediastinal and hilar lymph nodes is endobronchial ultrasound bronchoscopy (EBUS) with needle aspirations. Previously, we presented an electromagnetic navigation platform for this purpose. There were several issues with the permanent electromagnetic tracking (EMT) sensor attachment on the tip...

Background: Time-to-treatment is defined as a quality indicator for cancer care but is not well documented. We investigated whether meeting Norwegian timeframes of 35/42 days from referral until start of chemotherapy or surgery/radiotherapy for lung cancer was associated with survival. Patients and methods: The medical records of 439 lung cancer...

Background: Minimizing the time until start of cancer treatment is a political goal. In Norway, the target time for lung cancer is 42 days. The aim of this study was to identify reasons for delays and estimate the effect on the timelines when applying an optimal diagnostic pathway. Methods: Retrospective review of medical records of lung cancer...

Purpose The aim of this paper is to show how a specialized planning and guidance application called Fraxinus, can be built on top of the CustusX platform (www.custusx.org), which is an open source image-guided intervention software platform. Fraxinus has been customized to meet the clinical needs in navigated bronchoscopy. Methods The application...

Objective: Endoluminal visualization in virtual and video bronchoscopy lacks information about the surrounding structures, and the traditional 2 D axial, coronal and sagittal CT views can be difficult to interpret. To address this challenge, we previously introduced a novel visualization technique, Anchored to Centerline Curved Surface, for navigat...

Objective: In flexible endoscopy techniques, such as bronchoscopy, there is often a challenge visualizing the path from start to target based on preoperative data and accessing these during the procedure. An example of this is visualizing only the inside of central airways in bronchoscopy. Virtual bronchoscopy (VB) does not meet the pulmonologist’s...

Purpose: One of the major challenges in electromagnetic navigated bronchoscopy is the navigation accuracy. An initial rigid image-to-patient registration may not be optimal for the entire lung volume, as the lung tissue anatomy is likely to have shifted since the time of computer tomography (CT) acquisition. The accuracy of the initial rigid regis...

The majority of cancer patients with advanced disease experience weight loss, including loss of lean body mass. Severe weight loss is characteristic for cancer cachexia, a condition that significantly impairs functional status and survival. The underlying causes of cachexia are incompletely understood, and currently no therapeutic approach can comp...

Background Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is the endoscopic method of choice for confirming lung cancer metastasis to mediastinal lymph nodes. Precision is crucial for correct staging and clinical decision-making. Navigation and multimodal imaging can potentially improve EBUS-TBNA efficiency. Aims To demonstr...

Background: Side effects of chemotherapy may occur at different time-points in the treatment cycle, and the exact assessment time relative to chemotherapy may affect HRQoL scores. The current study examined the variation of HRQoL during chemotherapy cycles, and whether differences in HRQoL scores varied at selected time-points between patients allo...

Background The time from a referral for suspected lung cancer is received at a hospital until treatment start has been defined as a quality indicator. Current Norwegian recommendation is that ≥70% should start surgery or radiotherapy within 42 calendar days and systemic therapy within 35 days. However, delays can occur due to medical complexity. Th...

Background: Malignant airway obstruction is a feared complication and will most probably occur more frequently in the future because of increasing cancer incidence and increased life expectancy in cancer patients. Minimal invasive treatment using airway stents represents a meaningful and life-saving palliation. We present a new removable airway st...

Introduction: Intraoperative navigation in endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) might improve position control and facilitate precise sampling. Aims and objectives: We wanted to test the clinical usefulness of a new multimodal image guiding system with navigated EBUS for mediastinal lymph node TBNA. Methods: Five pa...

Introduction Multimodal image guiding systems may improve precision, safety and documentation of lung cancer staging with endobronchial ultrasound fine needle aspiration (EBUS-TBNA). 3D EBUS is possible using electromagnetic (EM) navigated EBUS. Aims and objectives We wanted to demonstrate the clinical feasibility of 3D EBUS using multimodal image...

Introduction: Endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) has become an important diagnostic tool for the pulmonologist. Learning this procedure and maintaining technical skills requires continuous practice and evaluation. Objectives: The aims of the study were a retrospective evaluation of the diagnostic quality of t...

Introduction: Our motivation is increased bronchoscopic diagnostic yield and optimized preparation, for navigated bronchoscopy. In navigated bronchoscopy, virtual 3D airway visualization is often used to guide a bronchoscopic tool to peripheral lesions, synchronized with the real time video bronchoscopy. Visualization during navigated bronchoscopy...

Purpose: Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) of mediastinal lymph nodes is essential for lung cancer staging and distinction between curative and palliative treatment. Precise sampling is crucial. Navigation and multimodal imaging may improve the efficiency of EBUS-TBNA. We demonstrate a novel EBUS-TBNA navigation...

Introduction: Endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) has become an important diagnostic tool for the pulmonologist. Learning this procedure and maintaining technical skills requires continuous practice and evaluation. Objectives: The aims of the study were a retrospective evaluation of the diagnostic quality o...

Abstract Purpose: Our motivation is reduced preparation time for planning and navigation in bronchoscopy diagnostics, decreased procedure time, and an increased diagnostic yield in navigated bronchoscopy. Me thod: Visualization during navigated bronchoscopy, the segmentation time and methods differs. We compared three different approaches to obtain...

Abstract Purpose: To make a novel visualization technique for improved accuracy and overview in planning and guidance in bronchoscopy diagnostics, decreased procedure time, and an increased diagnostic yield in navigated bronchoscopy. Method: We introduce Anchored to Centerline Curved Surface (ACCuSurf) an Anchored Anyplane Surface (AAS), a 3D struc...

Purpose: To optimize the intra-operative automatic registration procedure for ôCT to patient anatomy alignment during navigated bronchoscopy. Methods: Our intraoperative registration method, an automatic CT to patient based registration during the initial phase of navigated bronchoscopy, was performed in six bronchoscopy patients. An electromagneti...

Purpose: To demonstrate the basic functionality of a new 3D endobronchial ultrasound (EBUS) navigation system, preparing for approved clinical studies. Methods: We modified an EBUS bronchoscope by integrating a sensor for electromagnetic (EM) position tracking close to the ultrasound (US) probe in the tip. A probe calibration process was performed...

Purpose: To test the clinical usefulness of a new multimodal image guiding system with navigated endobronchial ultrasound (EBUS) for mediastinal lymph node sampling. Methods: A patient referred to the Dept of Thoracic Medicine for lung cancer staging by EBUS consented to study participation. Preoperative computer tomography (CT) revealed a lung tum...

Background: Lung cancer can be caused by occupational exposure. This is not always recognised or reported, and not all patients receive the benefits to which they are entitled. Material and method: We collected occupational case histories for patients from Sør-Trøndelag county with a first-time diagnosis of lung cancer. The number of reported ca...

Background. Sarcopenia is a defining feature of cancer cachexia associated with physical decline, poor quality of life and poor prognosis. Thus, maintaining muscle mass is an important aim of cachexia treatment. Many patients at risk for developing cachexia or with cachexia experience side effects of chemotherapy that might aggravate the developmen...

Cardio vascular disease and the risk of lung cancer, the HUNT study Background and Aims: Inflammation is involved in both lung cancer (LC) and cardio-vascular disease (CVD). We hypothesize that CVD is an independent risk factor for LC. Methods: Data from the Nord-Trøndelag Health Study (1984-2008) linked to the Norwegian Cancer and Death Cause Reg...

Background: Navigated bronchoscopy uses virtual 3-dimensional lung model visualizations created from preoperative computed tomography images often in synchronization with the video bronchoscope to guide a tool to peripheral lesions. Navigated bronchoscopy has developed fast since the introduction of virtual bronchoscopy with integrated electromagn...

Introduction: Inflammation is involved in development of lung cancer and cardiovascular disease (CVD), and we hypothesize that self-reported CVD is an independent risk factor for lung cancer. Methods: Data from the Nord-Trøndelag Health Study (1984-2008) linked to the Norwegian Cancer and Death Cause Registry were analyzed stratified by smoking...

Electromagnetic based navigated bronchoscopy using preoperative CT images has reached the clinic during the last decade. One of the challenges is the "CT to patient anatomy alignment" of the CT images acquired days or even weeks ahead of bronchoscopy. An automatic registration method, without manual registration of anatomical landmarks, was develop...

Background: On the basis of our own experience and literature search, we hypothesised that a canine olfactory test may be useful for detecting lung cancer in an unselected population of patients suspected to have lung cancer. Material and methods: We conducted a prospective study of 93 patients consecutively admitted to hospital with suspected l...

The accuracy of navigated bronchoscopy relies on a best possible correlation between the preoperative computed tomography images used for planning and the actual tumor position during bronchoscopy. Change in lung structure during the procedure may reduce success rate. The size of the lung changes during breathing, which may be predicted and at leas...

Background: Physicians might overestimate benefits and underestimate toxicity of cancer therapy. Thus, patient reported HRQoL is an important part of evaluating treatment effect and assessing side effects. HRQoL is commonly reported once per chemotherapy cycle and just prior to administration of the next course (day 0). Several studies have not det...

9562 Background: Physicians might overestimate benefits and underestimate toxicity of cancer therapy. Thus, patient reported HRQoL is an important part of evaluating treatment effect and assessing side effects. HRQoL is commonly reported once per chemotherapy cycle and just prior to administration of the next course (day 0). Several studies have no...

Lung cancer has the highest mortality of all cancers. Patients with early stage disease have the best cure rates and that emphasizes the importance of early detection. About half of all non-small cell lung cancers (NSCLC) are estrogen receptor positive. The impact of estrogen and its receptors for NSCLC carcinogenesis has been studied but is still...

Introduction: Patients with lung cancer have a high frequency of comorbidity. Data on the impact of diabetes mellitus, the most frequent endocrine disorder, on the prognosis of lung cancer are conflicting. The aim was to investigate the impact of diabetes mellitus on survival in lung cancer. Method: We analyzed data from a cohort, the Nord-Trøndela...

Introduction: Lung cancer has the highest mortality rate of all cancers. Patients with early stage disease may be cured and emphasizes the importance of early detection. About half of all non-small cell lung cancers (NSCLC) are estrogen receptor positive. The impact of estrogen and its receptors for lung cancer carcinogenesis has been studied and i...

Background: Pemetrexed, a multi-folate inhibitor combined with a platinum compound is the first-line treatment of malignant mesothelioma, but median survival is still one year. Intrinsic and acquired resistance to pemetrexed is common, but its biological basis is obscure. Here we report for the first time a genome-wide profile of acquired resistan...

Loading plots and Principal Component Analysis (PCA). The coloured spots in the loading plots above represent differentially expressed genes where red spots in the middle represent Affymetrix and blue represent Illumina, green represent low variance genes overlapping differentially expressed genes between the platforms. The PCA score-plots of the g...

siRNA specific for NT5C (Sigma-Aldrich). (DOCX)

Sheet 1–8. Sheet 1–3. The top 1500 ranked list and GO entities of differentially expressed genes showed an overexpression of genes involved in mitosis, cell cycle checkpoint and DNA repair and down-regulated multicellular organismal development, inflammatory response and vasculogenesis among others. Sheet 4–7. High quality RNA was successfully extr...

Venn diagram of up- (red) and down-regulated (green) genes of mesothelioma tumour versus normal parietal pleura. An overlap between the Affymetrix and Illumina platforms of 65% is seen. (TIFF)

Silencing of NT5C and pemetrexed treatment. Cell cycle distribution of NT5C silenced (+) or negative siRNA control (–) in malignant mesothelioma cells, after 48 hours of pemetrexed treatment. The percentages represent the amount of live cells in control and pemetrexed treated cells. Levels of significance: * = P<0.05, ** = P<0.01, *** = P<0.001, **...

Platinum-based doublet chemotherapy is the standard first-line treatment for advanced non-small cell lung cancer (NSCLC), but earlier studies have suggested that non-platinum combinations are equally effective and better tolerated. We conducted a national, randomised study to compare a non-platinum with a platinum combination. Eligible patients had...

Knowledge about lung movement in health and disease is sparse. Current evaluation methods, such as CT, MRI and external view have significant limitations. To study respiratory movement for image guided tumour diagnostics and respiratory physiology, we needed a method that overcomes these limitations.We fitted balloon catheters with electromagnetic...

The authors have studied the accuracy and robustness of a prototype electromagnetic window field generator (WFG) in an interventional radiology suite with a robotic C-arm. The overall purpose is the development of guidance systems combining real-time imaging with tracking of flexible instruments for bronchoscopy, laparoscopic ultrasound, endolumina...

Current image guidance systems for bronchoscopy are limited to the diagnosis of small tumors and placing fiducials for radiation therapy and surgery. Ideally, a navigation system should be useable for the range of bronchoscopic procedures, including therapy with concurrent radiology imaging for control. As most guidance systems rely on electromagne...

Patients with lung cancer have a high frequency of comorbidity. Data on the impact of diabetes mellitus, the most frequent endocrine disorder, on the prognosis of lung cancer are conflicting. The aim was to investigate the impact of diabetes mellitus on survival in lung cancer. We analyzed data from a cohort, the Nord-Trøndelag Health Study (HUNT s...

Background: individualized treatment in lung cancer (LC) needs precise characterization of the tumour and host, and evaluation of best treatment for a patient will in the future be based on his or her individual prognosis. The importance of tumour, pharmacological agent and predictive value is well known, on the other side comorbidity may have an i...

Background: Developing a platform for navigated bronchoscopy, we have suspected that the bronchoscope influences the movement of the lung, especially the adjacent segments, changing the position and movement pattern. We therefore wanted to measure to what extent instruments like the bronchoscope influences the target movement during respiration. M...

Background: Respiratory lung movement is a major challenge in bronchoscopic lung cancer diagnostics and radiation therapy. The current methods for evaluating lung segment and tumor movement (CT/MRI/�uoroscopy/internal and external markers) have important limitations. CT involves a high radiation dose, MRI is incompatible with metallic equipment, an...

Background: We have studied the accuracy and robustness of a new prototype window �eld generator (WFG), in an interventional radiology suite with a robot cone beam CT (rCBCT). The goal was to compare the performance the WFG to a standard �field generator (SFG), both part of the Aurora electromagnetic tracking (EM) system (NDI, Waterloo, Ontario, Ca...

Accuracy of electromagnetic tracking in navigated bronchoscopy with a prototype field generator in an interventional OR setting Background: We have studied the accuracy and robustness of a new prototype window field generator (WFG), in an interventional radiology suite with a robot cone beam CT (rCBCT). The goal was to compare the performance the...

Navigated bronchoscopy – a research platform using intraoperative cone beam CT Background: Bronchoscopy has limitations in diagnosing pulmonary lesions, and the bronchoscopist must rely on preoperative x-ray or CT evaluations, and inadequate perioperative fluoroscopy guided maneuvers (small, sparse, peripheral opacities often visible only in one p...

Navigated bronchoscopy – a research platform using intraoperative cone beam CT Amundsen T1,2, Leira HO1,2, Tangen GA3, Manstad-Hulaas F2, Langø T3 1 St. Olavs Hospital, Dept. Thoracic Medicine, Trondheim, Norway 2 University of Science and Technology (NTNU), Dept. Circulation and Medical Imaging, Trondheim, Norway 3 SINTEF, Dept. Medical Technolo...

Electromagnetic guided bronchoscopy is a new field of research, essential for the development of advanced investigation of the airways and lung tissue. Consecutive problem-based solutions and refinements are urgent requisites to achieve improvements. For that purpose, our intention is to build a complete research platform for electromagnetic guided...

To investigate whether patients with severe comorbidity receiving platinum-based chemotherapy for advanced non-small-cell lung cancer (NSCLC) have a shorter overall survival, experience more toxicity or more deterioration of health-related quality of life (HRQoL) than other patients during treatment. Patients enrolled onto a phase III trial compari...

Phase III study comparing vinorelbine/gemcitabine with vinorelbine/carboplatin as first-line chemotherapy of advanced NSCLC: A Norwegian Lung Cancer Study Group trial. Background: Platinum based chemotherapy is the standard first line treatment for advanced non- small cell lung cancer (NSCLC). However, side-effects are common and earlier studies h...

Phase III study comparing vinorelbine/gemcitabine with vinorelbine/carboplatin as first-line chemotherapy of advanced NSCLC: A Norwegian Lung Cancer Study Group trial. Ø. Fløtten, R. M. Bremnes, B. H. Grønberg, S. Sundstrøm, T. Amundsen, H. Rolke, U. Aasebø, K. Hornslien, T. Wentzel-Larsen, C. von Plessen, Background: Platinum based chemotherapy i...

Purpose To compare pemetrexed/carboplatin with a standard regimen as first-line therapy in advanced non–small-cell lung cancer NSCLC. Patients and Methods Patients with stage IIIB or IV NSCLC and performance status of 0 to 2 were randomly assigned to receive pemetrexed 500 mg/m ² plus carboplatin area under the curve (AUC) = 5 (Calvert's formula)...

Feasibility of navigated bronchoscopy - an experimental animal model Leira HO, Langø T, Tangen GA, Manstad-Hulaas F, Amundsen T Background Videobronchoscopy has a number of limitations in diagnosis of pulmonary lesions, and directly inspects the airways. The bronchoscopist has to rely on x-ray or CT imaging, fluoroscopy guided manouvers, and ofte...

To investigate the efficacy and tolerability of high-dose pemetrexed as second-line chemotherapy in small cell lung cancer (SCLC). Patients with verified SCLC who had received one prior chemotherapy regimen, aged 18-75 years, WHO Performance Status 0-2, no clinical signs of brain metastases and measurable disease were eligible. Patients received pe...

Patients with unstable coronary disease have changes in the hemostatic system. These patients are often treated with low molecular weight heparin. In patients who are accepted for coronary artery bypass grafting, treatment with low molecular weight heparin is frequently continued until surgery. We hypothesized that in coronary artery bypass graftin...

Lead poisoning may cause irreversible health defects, including anaemia, central nervous system problems and various organ defects. We describe a patient with lead poisoning. A 54-year-old woman was admitted to hospital with anaemia and unspecific gastrointestinal symptoms. Peripheral blood smear and bone marrow aspirate showed basophilic stippling...

Material and methods: We present a review of the history, pathophysiology, diagnosis and treatment of lead poisoning based on relevant literature. Results and interpretation: The human body does not metabolize lead, and lead accumulation may cause organ failure. Lead poisoning may cause serious health defects, including anaemia, central nervous...

To compare perfusion magnetic resonance imaging (MRI) and ventilation-perfusion scintigraphy (V-P scan) in the study of perfusion abnormalities in pulmonary embolism (PE) and to compare the PE results to the findings previously reported for pneumonia and chronic obstructive pulmonary disease (COPD), in terms of perfusion abnormalities. Dynamic cont...

Lead poisoning may cause irreversible health de-fects, including anaemia, central nervous system problems and various organ defects. We describe a patient with lead poisoning. A 54-year-old woman was admitted to hospital with anaemia and unspecific gastrointestinal symptoms. Peripheral blood smear and bone mar-row aspirate showed basophilic stippli...

Recent studies have demonstrated the potential of dynamic contrast-enhanced magnetic resonance imaging (MRI) describing pulmonary perfusion. However, breathing motion, susceptibility artifacts, and a low signal-to-noise ratio (SNR) make automatic pixel-by-pixel analysis difficult. In the present work, we propose a novel method to compensate for bre...

Perfusion magnetic resonance (MR) imaging is a promising new method for detection of perfusion defects in the diagnosis of pulmonary embolism. In the present study we evaluated the first-pass characteristics of perfusion MR imaging in patients with pneumonia or chronic obstructive pulmonary disease (COPD), frequent differential diagnoses to pulmona...

Perfusion magnetic resonance (MR) imaging is a promising new method for detection of perfusion defects in the diagnosis of pulmonary embolism. In the present study we evaluated the first-pass characteristics of perfusion MR imaging in patients with pneumonia or chronic obstructive pulmonary disease (COPD), frequent differential diagnoses to pulmona...

To establish a pig model suitable for imitating pulmonary emboli to facilitate research in the diagnosis of pulmonary embolism. Thirteen animals were anesthetized, mechanically ventilated, and subjected to pulmonary artery catheterization initiated from the right external jugular vein. With the use of a Swan-Ganz catheter, repetitive occlusion/repe...

The incidence and distribution of risk factors in non-pregnant women diagnosed with deep vein thrombosis is not well known and was the target of the present study. The medical records of 102 non-pregnant women aged 15-44 hospitalized with deep vein thrombosis at two major Norwegian hospitals were examined retrospectively. The overall incidence of f...

This article reports on a retrospective study in two major Norwegian hospitals of spontaneous reporting to the Adverse Drug Reaction Committee of the Norwegian Medicines Control Agency of adverse reactions from the use of oral contraceptives (OCs) among patients with a diagnosis of venous thromboembolism. In these two hospitals, 168 women between 1...

This study focuses on the incidence and risk profile among young women with a diagnosis of pulmonary embolism over the 10-year period 1988-97. A total of 66 non-pregnant women aged 15-44, treated for the first event of pulmonary embolism, were identified by discharge diagnosis at two main Norwegian hospitals (The Regional Hospital of Trondheim and...

The present paper reports our own experience with MR perfusion imaging and gives an overview of contrast-enhanced pulmonary MR perfusion imaging, MR angiography, and ventilation MR imaging using hyperpolarized gases or oxygen as contrast agent. These methods are discussed within the context of their possible role in the diagnosis of pulmonary disea...

To evaluate the feasibility of magnetic resonance (MR) perfusion imaging in the human lung to help detect perfusion defects distal to suspected pulmonary embolism. Seven patients suspected of having pulmonary embolism first underwent ventilation-perfusion lung scintigraphy followed by MR perfusion imaging with rapid acquisition of two sets of dynam...

Increased risk of arterial and venous thromboembolic disease is well documented in the homocystinuric patient. There is growing evidence that hyperhomocysteinemia is an independent risk factor for premature arteriosclerotic disease, including cerebral, peripheral, and coronary vascular diseases. So far no association has been established between hy...

We have evaluated an automated, simplified, turbidimetric method for the measurement of the C4b binding protein (C4bBP). A comparison with a manually performed electroimmunoassay in plasma samples referred for coagulation analysis (n = 80) revealed a correlation coefficient of 0.88. Lipaemic plasma is not suitable for analysis, whereas moderately h...

Enprofylline, a drug without adenosine antagonism and theophylline, a potent adenosine antagonist, were compared, double-blind, randomized, in acute asthma (n = 33). The drugs were given intravenously as loading over 10 min followed by maintenance infusion for 24 h. Mean final plasma levels were very high with enprofylline (14 mg.l), and larger tha...