In radiotherapy, the delineations of the volume of the macroscopic spread of the tumor as the Gross Tumor Volume (GTV), and the surrounding volume of the microscopic spread of the disease as the Clinical Target Volume (CTV), are key tasks for a high quality treatment plan. In order to design a software that also supports cognition, software designers need a deeper understanding of the physicians’ cognitive processes and medical context. This paper presents a research about identifying main medical factors relevant for the delineation in the radiotherapy context as a first step in deepening the understanding for software design. Using two discussion formats with six radiation oncologists, we identified 29 medical factors regarding the delineations of tumorous volumes, categorized into: treatment context, tumor context and tumorous areas. In addition, the role of multimodal images, dose planning, and future wishes have been elaborated. These findings could support the software designers in using Evidence Based Software Engineering approach. It is expected that software designed based on the results presented here, is tailored towards the medical context and cognitive needs of radiation oncologists in the delineations of brain tumor, and therefore will improve the effectiveness and efficiency of their work.

When undertaking a project in community-based co-design, students and their teachers must embrace uncertainty.

During the radiotherapy planning process patient’s medical images are used to determine the optimum configuration of radiation beams for their cancer treatment. The primary aim of radiotherapy planning is to maximize radiation dose to the patient’s tumour while sparing their normal tissues. To achieve this, the boundary of the tumour needs to be accurately identified in the treatment planning process, especially in the step of target volume delineation. Clinically, tumour delineation is performed by physicians, either manually or using semi-automatic/automatic software based on the patient’s CT, PET and/or MRI images. In addition to the expertise of the physician and choices of segmentation algorithms, the usability of the software also plays an important role in the tumour delineation process. In this paper, the usability of the IPLAN ® contouring software was evaluated. First, two evaluators assessed the software according to the heuristic evaluation method. Then three physicians evaluated the same system using the think aloud method. The outcomes of the experiments revealed different insights of the system. With the think aloud method, it was easier to identify end users’ preferences regarding both software interface and hardware input tools. On the other hand, the heuristic evaluation method uncovered more specific issues with the interface. Besides, this method was able to explore more details regarding individual functionalities on the interface. Based on the comparison of the outcomes of both methods, it is suggested that in the process of improving usability of the contouring interface, the think aloud method can be applied to explore preferences of the user. The heuristic evaluation can be applied in designing the details of the interface.

Informal caregivers, who are usually family members or friends of care recipients, provide unpaid assistances to help care recipients remain in their homes. However, they may be prone to depression, grief, fatigue and changes in social relationships. This paper presents the development process of a Product Service System (PSS) which is able to offer a respite to informal caregivers. Based on the Community-Based Co-Design (CBCD) method and the Service, Technology, Organization and Finance (STOF) framework, various qualitative research and design methods were combined in the development process in order to: 1) establish the requirements of the PSS; 2) study the feasibility of the PSS and 3) validate the added value of involving stakeholders in the development process. The development process can be divided into to two parts: First, requirements of the PSS were generated using the CBCD method. Then, in total 8 steps were carried out in the designing process following the STOF framework. In each step, discoveries, insights and/or feedback from different stakeholders were iteratively fed back to requirements of the PSS. Among those steps, a role-play study, which was executed in Step 4, gave a new perspective regarding engaging stakeholders in the design process. The outcomes of the presented research verified the feasibility of the PSS and proved the added value of engaging different stakeholders in the development process. Limitations of the PSS and innovation barriers identified in the development process are discussed as well.

Innovative Product Service Systems are needed in order to keep the healthcare system affordable, while safeguarding or enhancing care quality. Local and European stakeholders are collaborating to address this challenge. As part of such a collaboration, this case study examined application of the Community-based Co-design approach to assistive technology development for informal care. A sequence of methods was applied, involving end-users and communities in the earliest design stages. A design target was found together with informal caregivers, and a solution was iteratively developed together with various stakeholders. This solution enables the informal caregiver both to monitor the care recipient while being away, and to efficiently manage emergency situations if these occur. The solution arranges existing technology in a unique and contextually appropriate way. This makes the solution much more likely to be accepted by end-users and their neighborhood communities. Community-based co-design was essential in reaching this result.

A study was conducted to assess how co-design methods from industrial design engineering can be used for design of complex biomedical information systems (CBIS). The aim was toidentify (hidden) human factors problems, and to identify new technologies and organisational changes. Two cases were analysed and the design process was modelled. First case: design of a radiology workstation – a virtual reality system was designed which integrated work throughout the hospital and for various medical tasks besides diagnostics. Second case: design of the alarm situation at the intensive care unit – a quiet alarm system was proposed. The ‘radical co-design’ method follows a systems approach and resides in the earliest stage of design. Normally this stage is conducted informally in CBIS. In radical co-design, a set of design (research) techniques is used in a controlled manner. In following strict development (depending on selected technologies and organisation) practitioners, scholars, industry and policy makers should take responsibility and should collaborate to reverse the identified problems in targeted actions.

Noise is a direct cause of health problems, long-lasting auditory problems and development problems. Preterm infants are, especially, at risk for auditory and neurocognitive development. Sound levels are very high at the neonatal intensive care unit (NICU) and may contribute to the frequently observed detrimental outcomes of prematurely born infants. Despite efforts to reduce noise level at the NICU, these have not changed over the past years. Although many authors indicate that a systems approach could solve such interrelated problems, methods to do so are generally lacking for the complicated situation in a critical care setting. A new approach was developed, that is, combining Fuzzy Front End earliest stage product development and human factors methods, with a focus on all Human-tech levels and on their interaction. A concept built up from several emerging technologies was developed, including tactile alarms, artificial intelligence for medicine, multimodal alarm system and mobile communication in critical care. Current and envisioned nursing work was modelled. Outcome of the study is an overview of investigations to develop the measures.

Interventional radiology procedures require extensive cognitive processing from the physician. A set of these cognitive functions are aimed to be replaced by technology in order to reduce the cognitive load. However, limited knowledge is available regarding mental processes in interventional radiology. This research focuses on identifying mental model–related processes, in particular during percutaneous procedures, useful to improve image guidance during interventions. Ethnographic studies and a prototype-based study were conducted in order to perform a task analysis and to identify working strategies and cognitive processes. Data were compared to theories from visual imagery. The results indicate a high level of complexity of mental model construction and manipulation, in particular when mentally comparing mental model knowledge with radiology images on screen (e.g., to steer a needle correctly). Regarding current interface support, most difficult is the interpretation and selection of oblique views. New interface principles are needed to bring cognitive demands within reasonable human range, and also accompanying cognitive work strategies should be developed.

In interventional radiology, inserting a needle from the skin to the target lesion is a challenging task, because the physician has to estimate the spatial orientation of the needle based on a sequence of two-dimensional radiology images. We wanted to know what kind of visual aids could support the physician in better estimating the orientation of the needle and reduce task load. Therefore, an experiment was conducted in which user interfaces with different visual aids were tested with physicians. Results show that the appropriate combination of visual aids helps to estimate the orientation of the needle more accurately as well as to reduce task load as compared to current clinical practice.

One of the most technically challenging procedure in interventional radiology is a transjugular intrahepatic portosystemic shunt (TIPS) placement. The main problem is the limited image guidance while navigating. The physician basically punctures blind through the liver into the target portal vein, leading to many unsuccessful punctures and unnecessary risks before access to the portal vein is gained. To be able to improve guidance, developers have to be sure to use the most promising image modality available. This paper compares the available modalities for TIPS to various criteria to find which modality is the most suitable to improve the success of the puncture. Results showed that, even though many user interface improvements are required, real-time three-dimensional ultrasound has the most potential to improve the puncture in the future. The study emphasizes the importance of thorough technology analysis before developing medical devices.

Recent technological solutions for image-guided therapies focus on replacing the cognitive processes of physicians. However, there is a lack of knowledge in the field of cognitive ergonomics regarding radiology image thinking, such as image interpretation and 3D navigation. This paper addresses the need of studying mental models in this context. The goal is to be able to design better user interfaces for advanced technological solutions which match the cognitive processes of physicians. The usefulness of employing a prototype in the early phases of development is shown through the example of oblique view interpretation. Recommendations are given how user interface prototyping can be used to study mental models.

This study investigates how future informatics applications can support and challenge intensive care nurses (ICU nurses) to grow and learn continuously. To this end a research-and-design tool is introduced which is based on a model of the nursing process that starts from the idea that a nurse fulfills three different roles: the role of practitioner (using information immediately to base actions upon), the role of scholar (using information later on to learn from) and the role of human (coping with stress and dealing with emotions). In this paper the focus is on the scholar role. Twenty-eight intensive care staff members from six different hospitals were asked to recount an imposing experience from the perspective of each role. Regarding the scholar role, the participants mentioned 77 learning strategies they adopt for individual as well as organizational learning. Individual learning concerned reflection on former patient cases, reflection on current patient cases to anticipate a change in the patient's condition and reflection on personal behavior and decisions. Organizational learning concerned reflection on former patient cases. Examples of specific strategies were formal team evaluations focused on procedure and understanding the perspective of team members, being present at autopsies, and giving feedback on the nursing skills of colleagues. Based on these strategies design implications are defined for future nursing informatics applications, which will be presented.

Introduction: Transjugular intrahepatic portosystemic shunt (TIPS) is a difficult, but lifesaving procedure in interventional radiology. During this procedure the interventional radiologist (IR) intends to treat the complications of portal hypertension by creating an intrahepatic shunt between the portal vein and the hepatic vein. Currently, the procedure may take two to four (sometimes even six) hours comprising multiple punctures with potential failure of the intervention. One successful puncture would significantly reduce intervention time and success. The aim of this study was to address the information lack regarding the intrahepatic puncture. The findings will serve as an input for future system improvement and puncture improvement.