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In the evaluation of the left ventricular (LV) function using magnetic resonance imaging (MRI), a stack of parallel short-axis (SA) cine images is acquired that covers the whole LV. The aim of this study is to quantify the contribution to the LV volume parameters, provided by the most basal image plane that shows the LV wall only in end diastole (ED) but not in end systole (ES). In 57 healthy volunteers (31 men, mean body surface area 1.87 m2), a complete set of parallel SA images was acquired (10-mm slice distance) by breathhold segmented k-space cine MRI (7 ky lines per beat). The LV end-diastolic volume (EDV), stroke volume (SV), ejection fraction (EF), and cardiac output (CO) were determined by slice summation. Calculations were performed both with and without inclusion of the most basal slice. With inclusion of the most basal slice, all parameters were significantly (p < 0.001) larger compared with the values obtained by excluding this slice. EDV was 134 +/- 29 ml versus 113 +/- 26 ml; SV was 93 +/- 18 ml versus 72 +/- 16 ml; EF was 70 +/- 4% versus 64 +/- 4%; and CO was 5.3 +/- 1.4 l/min versus 4.1 +/- 1.1 l/min. The inclusion of the most basal slice leads to significantly larger values of LV volume parameters. Thus, this most basal SA image slice should be included in calculating the EDV. Whether or not this basal SA slice also contributes to the ES volume should be decided by using anatomical criteria on the ES image. The projection line onto the ES image of a long-axis view provides an additional criterion.

Purpose Patient decision aids (PtDAs) have been reported to have a positive influence on patients making a health care decision in trials. Nevertheless, post-trial implementation is poor. The aim of this study is to explore patient, clinician, and organizational success factors for implementing a PtDA designed for breast cancer patients, facing a decision on their radiation treatment. Methods We performed a process evaluation within a multi-center pre- and post-implementation trial. The PtDA was incorporated as much as possible in the logistics of 13 participating centers. Tracking data were collected on PtDA use. Process characteristics were recorded by both clinicians and patients. A logistic regression method was applied to investigate which process characteristics were significantly related to the probability that patients logged in to the PtDA. Results 189 patients received the PtDA of whom140 (77%) used the PtDA. If patients received the link via the surgery department they were more likely to use the PtDA (OR 9.77 (1.28–74.51)), compared to patients that received the link via the radiation oncology department. If the report of the multidisciplinary team stated that radiation treatment “had to be discussed with the patient”, patients were more likely to use the PtDA (OR 2.29 (1.12–4.71)). Educational level was not related to the probability of PtDA use. Conclusions We accomplished a high level of PtDA use. Patients were more likely to use the PtDA if they received the link via the surgery department and if “to be discussed with the patient” was written in the multidisciplinary team report.

Background and aim: Patient decision aids for oncological treatment options, provide information on the effect on recurrence rates and/or survival benefit, and on side-effects and/or burden of different treatment options. However, often uncertainty exists around the probability estimates for recurrence/survival and side-effects which is too relevant to be ignored. Evidence is lacking on the best way to communicate these uncertainties. The aim of this study is to develop a method to incorporate uncertainties in a patient decision aid for breast cancer patients to support their decision on radiotherapy. Methods: Firstly, qualitative interviews were held with patients and health care professionals. Secondly, in the development phase, thinking aloud sessions were organized with four patients and 12 health care professionals, individual and group-wise. Results: Consensus was reached on a pictograph illustrating the whole range of uncertainty for local recurrence risks, in combination with textual explanation that a more exact personalized risk would be given by their own physician. The pictograph consisted of 100 female icons in a 10 x 10 array. Icons with a stepwise gradient color indicated the uncertainty margin. The prevalence and severity of possible sideeffects were explained using verbal labels. Conclusions: We developed a novel way of visualizing uncertainties in recurrence rates in a patient decision aid. The effect of this way of communicating risk uncertainty is currently being tested in the BRASA study (NCT03375801).

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