",isbn:"978-1-80355-829-5",printIsbn:"978-1-80355-828-8",pdfIsbn:"978-1-80355-830-1",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,isSalesforceBook:!1,isNomenclature:!1,hash:"b10af949acb1f5e774e9edd672b1833e",bookSignature:"Assistant Prof. Élvio Gouveia, Dr. Bruna Raquel Gouveia, Prof. Adilson Marques and Dr. Andreas Ihle",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11226.jpg",keywords:"Aging, Health, Determinants, Lifestyle, Geriatrics, Physical Activity, Exercise, Functional Abilities, Mobility, Cognitive Abilities, Quality of Life, Assisted Living",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"October 29th 2021",dateEndSecondStepPublish:"December 24th 2021",dateEndThirdStepPublish:"February 22nd 2022",dateEndFourthStepPublish:"May 13th 2022",dateEndFifthStepPublish:"July 12th 2022",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"5 months",secondStepPassed:!0,areRegistrationsClosed:!0,currentStepOfPublishingProcess:5,editedByType:null,kuFlag:!1,biosketch:"Sport Science researcher with the focus on the assessment and the implementation of strategies to promote physical activity, fitness, and quality of life, with the focus on the physiological assessment of human fitness and the promotion of healthy aging.",coeditorOneBiosketch:"A researcher in Health Sciences mainly focused on Epidemiology, Human Development, Rehabilitation, and Health-associated Technologies.",coeditorTwoBiosketch:"Sport Science researcher with the focus on the assessment and the implementation of strategies to promote physical activity, fitness, and quality of life.",coeditorThreeBiosketch:"Psychological and social sciences researchers with the focus on promoting cognitive and physical health across the lifespan.",coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"320525",title:"Assistant Prof.",name:"Élvio",middleName:null,surname:"Gouveia",slug:"elvio-gouveia",fullName:"Élvio Gouveia",profilePictureURL:"https://mts.intechopen.com/storage/users/320525/images/system/320525.jpg",biography:"Élvio Rúbio Gouveia has a degree in Physical Education, a master’s in Physical Education, and a Ph.D. in Sport Sciences. 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1. Introduction
The last year, the Instituto Nacional de Pediatría at Mexico is commemorating the 50th anniversary of its foundation. Throughout the years, the Pediatric Neurosurgery Department has consolidated itself as an emblematic service in our hospital among the civilian population and has become the reference center in Mexico to treat brain tumors and complex neurosurgical diseases.
The Centro Médico Naval is the referral center for the treatment of complex neurosurgical diseases in the health services of the Secretaría de Marina of Mexico. We serve military personnel and their families, as well as civilian population under certain public health circumstances, as COVID-19 pandemic. The Neurosurgery Department is equipped with the ultimate technological devices for brain tumor treatment, such as neuronavigational systems (Brainlab and Medtronic Systems), intraoperative imaging devices (O-arm), neurophysiological equipment for brain mapping and subcortical stimulation.
This review describes our protocol in both centers for Awake craniotomy and brain mapping for brain tumor resection in pediatric patients.
In recent years, the collaborative work performed by an experienced group of neuroscientific specialties - Neuroanesthesiologist (LAE, NOG), Neuropsychologist (BAM, RAS, CA), Neurophysiologist (LMC/DMR), and a specialist from the Intensive care unit (SLL) and pediatric oncologist (AN); allows us to treat brain tumors located in eloquent areas in young brains.
2. Neuropsychological evaluation
Most neurological diseases have variable expressiveness; the severity of symptoms that define the disorder varies between individuals. The variability of symptom expression should be identified, and the expected effects of treatment defined. The neurological pathology is complex and comprises a set of unique conditions, therefore it is required a multidisciplinary team of professionals and specialists in pediatric neurosurgery and neuropsychology.
Neuropsychological pediatric evaluation faces certain peculiarities. The brain’s functional systems are in development. Thus, certain functions are not able to be properly evaluated. The neuropsychological evaluation tries to obtain a capacity profile which contains weak and strong points. When certain neuropsychological abilities (behavioral and cognitive) are selectively impaired, they may be compatible with the neurological alteration detected. The purpose of an evaluation depends mainly on the reference reason, and this, in turn, depends on the patient’s age, academic grade and cognitive development. Neuropsychological tests are essential for establishing a cognitive disorder; in a patient with a brain tumor, it is crucial to have several chronologically ordered evaluations. All improvements can also be monitored by repeating a series of tests, and changes in symptomatology can be detected early. Furthermore, the intervention’s effectiveness can be documented, and neuropsychological rehabilitation interventions can be scheduled.
Concerning tumors, the tumor growth site does often relate to neuropsychological deficits (e.g., left hemisphere tumors often affect language). However, due to compression and displacement effects, more widespread damage and overall neuropsychological impairment may occur [1].
It is essential to mention that neuropsychological functions result from a complex functional system that cannot be located in restricted areas of the cerebral cortex or isolated cells. With the use of such specific MRI techniques as blood oxygenation level dependent imaging (BOLD), we know that those functions must be organized into systems of areas that work harmoniously, each of which plays its part within the complex functional system, being located in entirely different areas often very distant from each other in the brain.
Neuropsychological functioning is related to tumor malignancy and behavior; neuropsychological performance assessment may be more sensitive in predicting early tumor recurrence than imaging techniques [1].
In recent years, there has been an increase in the need for neuropsychological evaluations in people who have suffered from known organic diseases and psychiatric pathologies where brain dysfunction is suspected. Interestingly, in most western countries, there has been a crescent incorporation of neuropsychologists into hospital services.
The neuropsychological assessment’s primary objective is to identify a possible alteration of functions which are regulated by the cerebral cortex and powerful neuropsychological interventions during sequelae early identification and treatment [2].
When someone faces the need to perform a neuropsychological evaluation, they deal with people who retain a very diverse set of skills depending on their personality characteristics, disease topography, brain edema. These conditions prevent the talk of a rigid evaluation protocol and a set of tests established in advance; they require, on the other hand, a certain level of knowledge to determine in each case the most appropriate evaluation tests [2].
The neuropsychological evaluation has been used during surgeries such as epilepsy and deep brain stimulation to identify adverse outcome risks. The results of this evaluation represent the starting point for neuropsychological treatment and rehabilitation [3].
In a pediatric patient with a brain tumor, the neuropsychological evaluation is performed to determine the patient’s overall cognitive status, specifying the skills preserved in contrast with those affected by brain edema and destruction of tissue secondary to the tumor [4, 5].
To set up the overall cognitive status of the patient before surgery, it requires the application of specific instruments, including standardized batteries, or a set of tests which adapt to the specific problems and needs of each patient; allowing to establish:
Preserved and altered cognitive functions, i.e., a baseline against which to evaluate postoperative function.
The ability of patients to cooperate with transoperative and postoperative needs.
The role of the Neuropsychologist in CNS surgery is divided into different stages. The preoperative evaluation aims to locate, if possible, the focus by associating cognitive deficits in a particular brain region. Set a baseline for measuring changes. Predict cognitive risks after surgery and, in conjunction with the neurosurgeon and family members, assess the procedure’s risks/benefits in their quality of life. It is useful as a guide to the neurosurgeon to decide which areas of the brain are at risk and adjust, from there, educational and cognitive rehabilitation programs. Finally, the evaluation can help diagnose psychiatric disorders and their potential impact on cooperation in the operating room. Several reports note that much of the success of awake patient surgery is due to the patient’s active participation in the intraoperative process. During functional testing, patient cooperation allows the team to make real-time surgical decisions to achieve maximum tumor resection with minimal functional deterioration to ensure a better quality of life.
There is no protocolized structure for neuropsychological exploration and monitoring that these patients need; there is not enough information about candidates’ psychological profiles and eligibility criteria. The transoperative evaluation is based on the literature on the Wada test’s use, mainly evaluating language and memory in the dominant hemisphere.
The evaluation depends on the patient’s cooperation and what can be applied; if possible, it should include the functions of speech and language:
Verbal fluency
Denomination
Verbal understanding
Repetition of sentences
Oral reading (if possible)
Memory evaluation should include:
Guidance
Sequencing
Image remembrance/recovery
Repetition of digits
Calculation
Already standardized test subtests measure these areas such as Wechsler Scales, Luria test, Woodkock test, a word list with a letter. These tests are appropriate for the child’s age and the evaluation context.
Postoperative evaluation allows monitoring of its evolution, possible sequelae, and the creation of stimulation programs to achieve its full potential.
It has been estimated that there are transient changes in cognitive functioning within the first three months of post-surgical recovery, which are relatively permanent within the following six months after the intervention. However, the most significant changes can occur up to one year after the intervention.
3. Neuroanesthesiological evaluation
Several anesthetic considerations for awake craniotomy should be granted to avoid injuries in brain surgery. The primary goal is to carry out the lesion’s resection with maximum preservation of neurological functions [6, 7]. This type of management in pediatric patients is limited by anxiety and insufficient understanding, limiting their cooperation during the procedure [8].
The awake craniotomy technique had been developing since the second half of the 19th century when local anesthetics (LA) became widely available. With proper local analgesia, Prof. Horace Horsley was able to perform a craniotomy in awake patients. The benefits were not recognized until 1951, when Prof. Wilder Penfield published LA value for craniotomy in patients with epilepsy to facilitate the resection of epileptogenic focuses [9].
Prof. Penfield argumented that patients with functional neurological pathology should be operated on awake modality and at the same time performing complex and motor activities.
It was initially designed for patients undergoing functional neurological surgery. It is currently offered in pathologies that involve eloquent or motor areas, where real-time monitoring of superior or motor functions is required during tumor resection [10].
The anesthesiologist should know the problems faced during the brain tumor resection in the awake patient, should be aware that at any time, surgery can be switched to a classic craniotomy under total endovenous anesthesia [11].
Scenarios that may be confronted during both phases, asleep or awake, are seizures or movements typical of the patient, result of the suboptimal neuromuscular blockage, or movements in the presence of anxiety or insufficient analgesia. These symptoms can result in severe damage, from lacerations to the scalp, skull fractures, including cervical spine injuries [9]. This technique aims to provide the neurosurgeon tools to perform the lesion’s resection with maximum preservation of eloquent or motor anatomical areas, preserve the patient’s integrity, minimize neurological damage and not to increase the deficit already installed [7, 8]. This technique involves inducing general anesthesia and maintaining airway control with a supraglottic device, it also includes invasive monitoring (catheter placement and urinary catheter), administration of scalp blockage, patient positioning, including fixing the skull to Mayfield’s head clamp to opening the dura mater [9, 10].
The technique consists of awakening the patient, ousting the supraglottic device, and performing cortical mapping or delimitation of the lesion and resection. At the end of the resection, general anesthesia is again continued, the supraglottic device is reinserted, and the dura mater, skull, and skin are closed.
The main objective of anesthetic management is to ensure adequate patient cooperation, maintain comfort throughout the procedure concerning the chosen position for surgery, prevent and treat nausea, vomiting, seizures, and maintain systemic and neurological homeostasis to provide adequate ventilation, hemodynamic stability, and brain relaxation [11].
Optimal tumor resection is maximum mass removal without significant neurological deficits, such as damage to motor or language function. Therefore, it is now considered the treatment of choice for brain tumor surgery in eloquent areas. Compared to craniotomy under general anesthesia, an awake craniotomy may provide a higher degree of tumor removal without postoperative neurological deficits and better survival rates in these patients [12].
The pediatric patient represents a tremendous challenge for the awake craniotomy technique’s success. The cognitive level and emotional maturity will determine their cooperation during the procedure. It is well known that the patient under the age of 16 does not yet have an adult’s maturity, and therefore requires more significant psychological support. In the literature, few patients from 8 to 15 years of age have demonstrated this procedure’s feasibility [11]. Patients under the age of 10, chosen for this procedure, must demonstrate a rigorous level of maturity and motivation, so the child’s degree of development will determine the possibility of exercising this technique [10].
Multidisciplinary assessment (Pediatric neurosurgeon, Neuroanesthesiologist, Neuropsychologist, and Neurophysiologist) is indispensable to mitigate the patient’s stress. Some authors prepare the patient psychologically using videos and teaching material to explain the procedure. The previous visit to the operating theater can be an excellent option to gain the child’s trust and confidence [12, 13].
The Neuroanesthesiologist should know the surgical and neurophysiological needs required for this procedure. We have a wide variety of anesthetics that can be useful but should be individualized to each patient. Propofol, remifentanil, dexmedetomidine, and scalp nerve blockage provide the right conditions for intraoperative brain mapping. Proper patient selection, adequate perioperative psychological support, and correct anesthetic management at each stage of surgery are all crucial for the safety, satisfaction, and success of the procedure. All of them must allow analgesia and a required sedation level according to the surgical moment [10]. It should be emphasized that certain anesthetics may affect the neurophysiological evaluation [12].
The neuroanesthesiologist should describe the procedure to follow, including position, scalp nerve blockage, possible discomfort, motor, and language testing. It would help to relieve the patient’s anxiety and discomfort and to ensure the surgery’s success [13, 14].
There are different craniotomy techniques in an awake patient, but Sleep-Awake-Sleep (SAS) is the most convenient in pediatric patients for its cognitive characteristics. Regardless of the technique chosen, the Neuroanesthesiologist or the person designated for the case must always maintain visual and verbal communication throughout the procedure. The communication at each stage should be clear, and according to the patient’s age, questions and tasks should be planned to consider, explain what the sensation may be, explain the noises of the room and maintain an adequate distraction of the patient to avoid anxiety. Heavy traffic within the room should also be avoided, limit staff access, and minimize room noises that confuse the patient which may cause anxiety. (4) Cooperation will depend on the total absence of pain, leading to an outstanding surgical experience; this is based on the anesthetics offered during the procedure, including efficient regional anesthesia with scalp blockage [15].
The premedication should be personalized according to each patient’s needs; short-lived anxiolytics such as midazolam is preferred. It does not affect neurocognitive functions and limits confusion or delirium during the procedure. Minimum doses (100-200mcg/kg) are beneficial for controlling anxiety in young patients with normal preoperative neurological functions. However, in the case of mapping and resection of epileptogenic lesions, any suppressive medication of epileptiform and anticonvulsant activity, including benzodiazepines and barbiturates, should be avoided [16].
Analgesia during awake craniotomy is achieved by blocking nerves in the scalp with local anesthetics. Therefore, the patient’s hemodynamic and physiological state may be more stable in awake craniotomy than in general anesthesia [13].
The first phase of surgery may be performed with total intravenous anesthesia and a supraglottic device. There are current reports of possible adverse effects of general anesthetic agents, including inhaled agents and opioids, on cancer prognosis, such as increased recurrence or metastasis after surgery [14].
Anesthesiologists should provide sufficient sedation and analgesia during the initial craniotomy; a combination of remifentanil and propofol has been considered the standard protocol for sedation of the first stage of awake craniotomy due to ease of use and reliability. The state of drowsiness but with a quick response, is considered the optimal level of sedation in awake craniotomy. Schneider’s model is recommended for propofol’s controlled infusion into awake craniotomy to maintain patients’ spontaneous ventilation [17].
Dexmedetomidine, an alpha-2 agonist, is a propofol alternative for sedation in such procedures, minimally interferes with neurophysiological monitoring, and it also has a minimal respiratory depressant effect. Concomitant dexmedetomidine with scalp blockage provides sufficient conditions for performing awake craniotomy, compared to the propofol-remifentanil combination and the increased risk of respiratory depression [13].
Complications of awake craniotomy include seizures (3–30%), respiratory depression or airway obstruction (7–16%), hypertension (17–24%), nausea and vomiting (0–9%), cerebral edema (7–14%) [18, 19]. In expert hands, the failure of awake craniotomy occurs in less than 2% of cases, regardless of the proper anesthetic technique carried out [18, 20].
Monitored anesthesia care involves keeping the patient awake under spontaneous breathing with low doses of sedative to resection the lesion by avoiding an acute transition from sleep to wakefulness, leading to hypoactive or hyperactive delirium and decrease mapping reliability [19]. The team’s skill and experience are required to achieve optimal sedation, maintaining spontaneous breathing with the patient drowsy but easily reactive [21, 22].
Advantages: Lower requirements for anesthetic agents, lower opioid use, better cooperation during intraoperative testing, shorter surgery duration, and shorter hospital stay.
Disadvantages: Oversedation leading to airway obstruction with respiratory depression, carbon dioxide (CO2) retention, and consequent cerebral edema; or suboptimal sedation that leads to the patient’s likelihood of anxiety and movements [21].
The SAS technique is preferred in cases of requiring more profound sedation during the craniotomy until before the resection of the tumor, and its objectives are to provide comfort for the patient and the surgical team during the pre-awakening phase, protection of painful sensations, to avoid ventilation distress, and to dismiss postoperative memories about the awake phase throughout the surgery [19].
Advantages: Provides the opportunity to control brain edema through hyperventilation, to avoid intraoperative movements of the patient, to lower frequency of seizures and agitation. Used during the implementation of this technique in new hospitals or during the surgical team’s learning curve [8].
Disadvantages: In high-risk patients with comorbidities, difficult airway predictors, or a high risk of bleeding; the SAS technique is controversial [21].
3.1 Anesthetic depth monitoring in awake craniotomy
Researchers compared the Patient State Index, Masimo’s PSi, an electroencephalogram (EEG) parameter obtained from SedLine’s brain function monitoring system® with Medtronic’s Bispectral Index (BIS™) for anesthetic depth monitoring, found that PSi 1.0 was less affected by monopolar Bovie device [23].
Both can be used to monitor anesthetic depth trends in the Sleep-Awake-Sleep phase, to achieve an early and gentle awakening of total intravenous anesthesia [24]. The use of processed electroencephalography indices improves anesthetic titration in the intraoperative period. Processed EEG monitors deliver raw stroke data, numerical anesthesia/sedation depth index, and 2D spectrogram. Deep sedation is associated with poor short- and long-term outcomes in critical patients; cognitive and psychological complications, increased hospital stay and mortality [25].
The use of processed EEG systems as an objective guide to sedative dosing, may decrease medical complications of excessive sedation, such as depressed cardiac contractility and hypotension. BIS’s use provides a decrease in the use of sedation, analgesia, decreased agitation, and fewer failures in extubation.
Processed electroencephalogram can help optimize drug doses in individuals with different pharmacogenomics and sedative clearance; global knowledge of the technology and processed EEG traces is required to avoid misinterpretations, significantly when muscle activity interferes with the processing algorithm [26].
Some pathological states, such as seizures or altered EEG states (Suppression of iatrogenic bursts or seizure coma), may be revealed by processed EEG and thus a complete EEG may be requested [27].
PSi values can range from 0 to 100; higher values indicate a lower degree of sedation as follows: 0–24 outbreak suppression with varying degrees of suppression, 25–49 general anesthesia, and > 50 mild sedation [23]. The algorithm uses specific frequency band performance power combined with symmetry and synchronization changes in multiple cortical regions [24]. Without a doubt, processed EEG systems are an excellent tool to optimize sedation and plan proper awakening in awake craniotomy.
4. Electrocorticography and brain stimulation for brain tumor resection in the awake pediatric patient
Neurophysiological brain cortical mapping is a valuable tool for brain tumor resection by optimizing the extent of resection and minimizing or avoiding a neurological deficit. In the context of resection of supratentorial malignancies, the gross-total resection improves survival, and by the usage of brain mapping, the functional outcome and quality of life are safeguarded in the postoperative period [28].
4.1 Principles
Stimulation can be bipolar or monopolar. In bipolar stimulation, the cathode and anode are at the level of the selected tissue. It is made using a grid of electrodes, deep electrodes, or an intraoperative manual stimulator (Figure 1).
Figure 1.
Principal characteristics of electrodes for brain mapping and bipolar stimulation.
The electric field produced is confined to a small area, usually half the distance between the electrodes, having a low risk of distal activation. Stimulation does not occur unless the electrodes are set directly over the tract, activating the axon’s initial part and its Ranvier nodes, where the most sodium channels are contained. Bipolar stimulation in cortical mapping and the technique described by Penfield and Ojemann, are the most commonly used [29, 30].
The standard stimulation paradigm for cortical stimulation described by Penfield, is based on applying a rectangular two-phase pulse with a frequency of 50 Hz on trains lasting 3 to 5 seconds. Pulse duration remains constant at 0.3 ms, starting with an intensity of 1 mA, which increases from 1 mA waiting for a response to stimulation, to a maximum of 15 mA. When using the depth electrodes, the pulse intensity is diminished to a range of 0.5–2.5 mA. In contrast, in monopolar stimulation, a single electrode administers the stimulus, and another reference electrode, usually inserted into the temporal muscle, receives it. The stimulus field is diffuse, and the volume of brain tissue is more significant, with the possibility of activating numerous axons in the motor pathways at a distance of 20 to 25 mm from the stimulation point. It is generally used for subcortical tracks and is known as the High-Frequency Train Technique or Taniguchi Technique [31].
This technique can be used for subcortical functional monitoring in patients under the effect of general anesthesia. A five-pulse monopolar train is typically administered at frequencies between 300 and 500 Hz, with a repetitive frequency of 1 to 3 Hz, including a pulse duration of 0.5 milliseconds and a range between stimuli of 2 to 4 milliseconds (Figure 2). This method is used to assess motor pathways and can also produce motor responses at lower intensities. It is not affected by the preoperative motor state, and the possibility of post-stimulation discharges is low.
Figure 2.
Stimulation techniques.
The register is carried out through the potential evoked motor with electrodes placed in the contralateral limb muscles, such as the abductor pollicis brevis, the flexor, and forearm extender, which are usually good options for the upper extremity. In contrast, the abductor hallucis brevis is the best muscle in the case of the lower limb. For facial muscles, we have as options the orbicularis of the mouth and eyes, and the genius, which allow us to register the language articulation.
4.2 Indications
The intraoperative functional mapping in awake patients is directed to those with neoplastic or epileptogenic diseases located adjacent to the motor, visual, somatosensory, or language areas. We require patient cooperation to detect the change or deficit of their cognitive functions by stimulation during the procedure. Monitoring cortical and subcortical regions, allows us to resect brain tumors near eloquent cortical and white matter tracts, respectively, at the same surgical event. The limitation is that we have little time to perform the cognitive tasks necessary for transoperative assessment. It could represent an anesthesiological challenge because of the technical difficulty of performing a craniotomy in the awake patient and the high risk of transoperative seizures.
4.3 Procedure
General Considerations. Patients are premedicated with midazolam. The surgeon performs local anesthesia with a mixture of 1:1 bupivacaine at 0.5% and lidocaine at 1%; 1:100000 epinephrine for infiltration upon placement of the Mayfield’s head clamp. Sedation is performed by means of propofol (above 100 ug/kg/min) and remifentanil (0.05–2 ug/kg/min). Once the craniotomy is completed, the dura mater and the muscle are infiltrated with lidocaine, and no sedation is offered. At all times of the mapping, propofol and icy ringer solution should be ready to use to suppress post-stimulation discharges. Once the mapping is finished, sedation is carried out with dexmedetomidine (1 ug/kg/min) and remifentanil (0.05 ug/kg/min) [32].
In the case of monitoring asleep patients, the purpose of mapping is exclusively to monitor motor response, so that short-acting opioids, such as remifentanil, supplemented with propofol or dexmedetomidine, are used. Almost all agents inhaled at high doses suppress motor responses, so it is suggested to use at low doses (less than 0.25 MAC), with nitrous oxide being the least suppressive. Propofol, commonly used for mapping, can suppress the motor response between 30 and 60% at levels of 1 to 2 mg/ml, so it is suggested at 1ug/ml doses. Other agents, such as ketamine, opioids, benzodiazepines, have minimal effect on motor responses. The most commonly used scheme is a short-acting opioid with propofol or dexmedetomidine.
Other factors to consider in surgery include temperature, blood pressure, oxygen saturation, and CO2. Hypothermia (less than 35 degrees) or hyperthermia (greater than 38 degrees) can increase the motor response latency, decrease amplitude or suppress it altogether. Hypercapnia (greater than 70 mmHg) and hypocapnia (13 to 30 mmHg) can alter mapping and promote cerebral edema.
Due to late myelinization, larger intensities of 15 mA and a longer stimulus duration of 500 ms are recommended in pediatric patients. It is suggested that the minimum age for evaluating language should be ten years old and for motor evaluation a minimum of 5 years. In case the patient does not cooperate and needs to remain under general anesthesia, the monopolar subcortical stimulation technique is recommended, where a stimulus is administered with a train of five monopolar pulses at frequencies typically between 300 and 500 Hz, with a repeat frequency of 1 to 3 Hz including a pulse duration of 0.5 milliseconds, and an interval of 2 to 4 milliseconds between stimuli.
4.4 Functional mapping
Once the craniotomy is performed and exposed to the cerebral cortex to map, the bipolar stimulation already described is carried out:
Pulse
Biphasic
Frequency
50 Hz
Pulse duration
0.2–03. ms
Stimulus duration
3–5 s
Language
5 s Negative almost 10 s
Current intensity
Increase 0.5–1 mA
Maximal current intensity
10–15 mA
The stimulus should be applied at least three times; it is considered positive when at least 2 out of three times an answer is found. Responses can be either positive (regional movements, dysesthesias, phosphenes) or negative (motor inhibition, language alteration, anomia) (Table 1).
Brain function
Anatomic stimulation
Clinical response
Motor
Primary motor cortex (Brodmann 4): precentral gyrus, 10 mm anterior to the central sulcus and posterior region of central sulcus.
Contralateral muscle contraction.
Supplementary sensitive-motor area: dorsal region of the superior frontal gyrus.
Limb movements vocalization and contralateral cephalic movements.
Silent primary motor cortex: inferior or medial frontal gyrus. Supplementary motor cortex: mesial surface of the superior frontal gyrus, paracentacral lobule and cingulum gyrus.
The negative response inhibits the motor response in the awake patient.
Expressive language (Broca’s area): posterior region of the inferior frontal gyrus in dominant hemishere. Posterior region of medial frontal gyrus, and anterior region of superior temporal gyrus in dominant hemisphere.
Negative response or language disturbances when the patient is asked to read, count numbers, or repeat sentences.
Sensitive language (Wernicke’s area): posterior temporoparietal area or temporal basal area of language (Inferior temporal gyrus, fusiform or hippocampal gyrus).
Negative response; alterations in understanding. Visual confrontation and nomination pictures.
Cortical areas to stimulate during functional mapping.
Language tasks such as nomination, articulation, reading, counting, and comprehension are evaluated. It is stimulated with a pulse duration of 0.25 ms on trains from 4 to 60hz, usually used from 1.5 mA and increased to 6. The stimulation is applied from one to two seconds during the completion of the task. The point is stimulated at least three times. A positive point is considered when a 66% language error is observed, such as the absence of language, anomia, and paraphasia. Some authors [30, 33, 34] have established the 10–20 mm concept as a safe margin, i.e., the distance from the resection edge to the mapped language site, in order to determine the risk of language deficits during the postoperative period. Usually, if this distance is greater than 1, the risk of language deficit in the frontal lobe is low.
4.5 Functional mapping considerations
The limitation of the technique is associated with several factors:
Patient’s condition. Previous deficit. These include a pre-existing deficit; usually the most accurate responses are obtained in patients with preserved motor and language functions. Any significant variation in sensation, motor paresis, or alterations of language or anomia, will not allow an appropriate check-in in those areas. Patient’s age. Reduced myelination in pediatric patients, so motor responses are typically more challenging to activate than the standard parameters used in adults. Due to incomplete functional maturation, the motor and language areas can be identified with confidence after 5 and 10 years old, respectively. Some suggested strategies to improve motor monitoring include pulse duration as large as 500 microseconds and increasing load intensity (more than 25 mA); this has been observed in children between 5 and 7 years old, but as they grow and enter adolescence, they get thresholds similar to adulthood. One option for pediatric patients who cannot perform awake functional mapping, is to use other techniques such as primary motor cortex localization using the reserve phase technique, which indirectly allows us to locate the motor area (Figure 3).
Effect of different types of brain injuries. Pre-existing injuries, i.e., brain edema, hemorrhage, herniation syndromes, can increase stimulation thresholds. The restoration of local homeostasis improves the stimulation threshold. Moreover, modification in the functional expressiveness of cortical areas due to the mass effect secondary to neoplasms. In patients with cortical malformations such as dysplasia, an abnormal somatotopic organization is observed and induces several secondary mechanisms, leading to a compensatory reorganization known as neural plasticity [35].
Figure 3.
Reverse-phase. An electrode grid is applied to identify the motor and somatosensory primary cortex. A) Parietal lobule exploration. B) Neurophysiological typical response for somatosensory cortex stimulation. C) Electrode-grid relocation to identify primary motor cortex. D) Reverse-phase demonstration.
4.6 Technical limitations
4.6.1 Lack of standardization
Negative mapping does not protect and creates a questionable problem concerning the reliability of the stimulation. There is a lack of consensus on stimulation paradigms and techniques. Significant variations were observed, not only in stimulation environments, but also in proven functions and protective margins preserved in resection. An example is deficit in language functions after functional mapping. In the survey, several centers where the functional mapping is practiced, only half responded that they regularly tested the four commonly checkable functions (speech production, comprehension, denomination, reading), creating the possibility of false-negative results related to unproven function. It may explain why 41% of centers reported persistent postoperative language deficiencies despite the preservation of language areas, and 56% of this group mentioned the failure to identify crucial language sites [28]. Variability in mapping thresholds has been observed not only at the population level but also in individual patients. One maneuver to facilitate the response in eloquent areas could be to increase the current at each cortical site, regardless of the adjacent post-estimate discharge threshold, instead of mapping the entire exposed cortex into a single current level. Besides, their findings highlighted the need for ECoG during electrocortical stimulation mapping, both to identify when post-stimulation discharges occur and to verify stimulation by recording stimulation artifacts [36].
4.6.2 Post-stimulation
Post-stimulation discharges can evolve into seizures during the surgical procedure, which is why the anesthesiologist should always be ready with propofol as well as the surgeon with an icy ringer solution. These stimuli thresholds are not significantly higher than those used to stimulate sensory, motor, or linguistic responses. However, post-stimulation discharges have been reported during awake craniotomy at 12% [37, 38].
4.6.3 Anesthesiologic challenge
From an anesthetic perspective, cortical functional mapping with an awake patient imposes essential demands on the anesthesiologist ability to facilitate sleep-awake-sleeping procedures and avoid inadequate or excessive sedation. Pain, emesis, and emotional intolerance to the technique are rarely observed, and, of course, seizures can occur. Failure of the functional cortical mapping technique leads to a lower macroscopic total resection incidence and increased postoperative morbidity.
4.7 Intraoperative electrocorticography
4.7.1 Objectives and limitations of intraoperative electrocorticography
Epilepsy surgery involves complete resection of the epileptogenic area (the alleged site generating epileptic seizures, removal or disconnection is necessary in order to prevent further seizures) with minimal postoperative deficits. Electrocorticography (ECoG) allows the epileptogenic zone to be delimited using flexible electrodes placed before and after resection, and to use the electrodes to stimulate and delimit the eloquent area. However, sampling is limited by reduced registration time during surgery [39].
So ECoG is not sufficient to define the epileptogenic zone; many preoperative studies are required, such as video-EEG, functional and structural MRI including PET, SPECT, and sometimes invasive recording with grid placement. The ECoG intraoperative utility as a single element for defining the epileptogenic zone in a reliable way, is based on the assumption that interictal discharges are trustworthy markers of the epileptogenic zone. This assumption has proven unreliable in many cases. One of the most significant transoperative electrocorticography limitations is that primary epileptiform discharges may not be identified from secondary ones by propagating to a distant area. More importantly, ECoG’s in patients with refractory epilepsy to medical treatment has shown interictal multifocal activity, making focus identification a difficult task.
Interictal activity may be affected by anesthetic agents use, as some of those agents decrease activity while others increase them. It is said that the log is reliable when a pattern of awake interictal poly points is observed with a tip frequency exceeding one per minute. Some activation maneuvers, such as hyperventilation or some intravenous anesthetics such as methohexital, etomidate, propofol, and thiopental, have been used.
Unfortunately, the activation induced by these agents could be expanded to previously silent areas. Opioids, such as remifentanil and alfentanil, increase the activity in the epileptogenic zone. Remifentanil has been reported to suppress tips in the normal brain.
Other attempts have been made to locate the epileptogenic area using repetitive cortical electrical stimulation and evaluate its susceptibility to start a discharge and reproduce the patient’s usual seizure. Although early researchers expected post-stimulation discharges originating in the epileptogenic area to have distinctive characteristics (lower post-discharge thresholds and longer durations), this is not true. The use of electrical stimulation to induce the patient’s usual seizures has also shown not to be useful.
Three types of electrodes are used to register intraoperatively, often in combination:
The first type consists of silver wires insulated with a carbon ball or a distal silver ball/silver chloride located on the cortical surface. These electrodes are arranged in an electrode clamping device mounted on the skull at the edge of the craniotomy and attached to the recording device inputs. Although flexible and precise electrode placement, particularly along the resection cavities, is an excellent resource of this type of electrode; the exact distance between electrodes can be problematic, limiting the ability to engrave in a bipolar assembly. Therefore, recording in a reference montage is preferred. Also, electrode placement is limited only to the cortex areas, so it is impossible to register from the lower and medial surfaces. These electrodes can be sterilized and reused.
The second type of electrode is disposable and consists of silver stainless steel, or platinum disc electrodes embedded in silicone sheets. These blades are arranged in advance as strips containing 4 to 8 electrodes, with a separation of 10 to 15 mm, or larger grids containing 64 electrodes or more. These electrodes can be placed on the exposed cortical surface and allow the flexibility to slide under the craniotomy margins to cover the cortex uncovered surfaces. Because the distances between electrodes are standardized, it is possible to make recordings in both bipolar and referencing assemblies. However, due to the potential for cancelation of common-mode activity under two adjacent electrodes in a bipolar recording, referencing assembly remains preferred and universally accepted as being more reliable. Functional stimulation can also be performed through band and grid electrodes.
Finally, a four-contact depth electrode can also be used to be inserted into the brain’s deeper structures. It is not uncommon for these various electrodes to be used simultaneously, with ball electrodes used to register over the lateral cortex or along the resection margins, while electrode strips are placed in the cortical areas. The recording electrodes can be referenced to several locations, including the mastoid, cervical, and bone flap region.
The ECoG can be registered using digital or analog instruments, although digital has become more used. As the activity recorded on the cortical surface is significantly higher than the one recorded on the skin surface, the recording parameters must be adjusted. Sensitivities between 10 and 50 mV/mm are the most commonly used. Other recommended recording parameters include a 0.5 Hz low-frequency filter and a 70 Hz high-frequency filter.
The usefulness of electrocorticography in anteromedial temporal lobectomy allows delimiting the degree of resection of the hippocampus. The most significant cause of seizure recurrence after temporal lobectomy is the incomplete resection of the affected hippocampus. Therefore, the resection of the hippocampus guided by electrocorticography has been the only procedure with a predictive value. Its usefulness has also been seen in patients with refractory epilepsy to extratemporary location medical treatment, where the need for all patients to require an invasive chronic record is controversial.
In patients with a high concordance between neuroimaging (MRI, PET, and SPECT) and the clinic of seizures, although EEG may not be conclusive in identifying the ictal area, it is indicated to perform the resection of the epileptogenic focus in a single surgical time guided by electrocorticography.
Electrocorticography is very useful in the resection of structural lesions that generate seizures, such as low-grade astrocytomas or malformations, and the surrounding epileptogenous cortex. Patients who had only the lesion resection, have a probability of being free of crisis by 50% and increasing to 87% when electrocorticography is offered.
Electrocorticographography has been very useful in cortical dysplasia resection, where sometimes the image is not very clear, especially in type I cortical focal dysplasias, and where electrocorticography helps define the edges of the margins of the resection.
Finally, ECoG should be used during functional mapping to detect post-stimulus discharges that can occur over a wide threshold range (2 to 15 mA), usually lasting seconds, but some downloads last more than 90 seconds. Post-stimulus discharges have been present in 12% of patients undergoing cortical functional mapping; 65% of these discharges involve more than one electrode, and 10% become epileptic electrographic activity.
5. Clinical experience
Since 2017, we have performed awake craniotomies and brain mapping for brain tumor resection in 8 and 5 cases, respectively. The average age of patients was 12.2 years old with a range of 10–15 years old. No gender predominance was observed (Male/Female ratio 1). The neuropsychological evaluation was performed in all cases. A series of neuropsychological tests were applied to meet the maturity and neurological performance in all cases. Before considering each case as a candidate for an awake craniotomy, an assay was conducted by the neurosurgeon and the neuroanesthesiologist to gain the patient’s confidence. In all cases, the technique was completed. In some cases, conversion to total-endovenous anesthesia was necessary. Intraoperative seizures were not observed during brain mapping or stimulation of eloquent areas in the neighborship of brain tumors.
In order of frequency, the most common histopathological diagnosis was diffuse glioma (n = 3), supratentorial glioblastoma multiforme (n = 2), dysembryoplastic tumor (n = 2), and Primitive Neuroectodermal Tumor (PNET) (n = 1). In all cases, gross total resection was achieved. In malignant gliomas, the overall survival was 32 months. In this group, all patients received adjuvant chemotherapy and radiotherapy. In the cases of diffuse glioma, we have not observed fatalities so far. Currently, the overall survival is 38 months. In the case of PNET, adjuvant therapy and radiotherapy with a linear accelerator were indicated. The free of disease period was 18 months, a new surgical treatment was indicated to improve survival, but in the postoperative period, the patient’s family declined the second-line chemotherapy, and the patient died after 28 months— Case 1 VIDEO.
In all cases, during follow-up, we observed a clinical improvement of neurological deficits. In the two cases of epilepsy secondary to brain tumor activity – dysembryoplastic tumor, the cortical mapping and brain stimulation in eloquent areas improved the seizure control and functional recovery in the postoperative period. In one of these cases, after the tumor’s gross-total resection, a new ECoG helped us identify epileptic activity isolated from the brain tumor. Histopathological analysis revealed cortical dysplasia. After removing the epileptic foci by corticectomy, the new ECoG register showed regular electrocorticographic activity — Case 2 Currently, the two patients with dysembryoplastic tumors are seizure-free (Engel’s class Ia).
6. Conclusions
The SAS technique is a reproducible, safe, and probably the most convenient technique for awake craniotomy in pediatric patients with brain tumors. It is imperative to maintain good communication with the patient from pre-anesthetic assessment, explaining the most confident procedure. SAS will provide the most outstanding comfort before awakening and during neuropsychological and motor tests, recognizing that the neurological evaluation during and after the surgical procedure will be the best indicator of the patient’s condition and success.
Cortical functional mapping allows us to delimit lesions that require resection, such as an epileptogenic zone or a tumor from eloquent regions. For this purpose, with a mature and cooperative patient, surgery may be performed with an awake patient. This technique is reserved for patients without severe neurological deficits in order to preserve the language, somatosensory, or motor functions. If the patient does not cooperate, as are pediatric patients below eight years old, the cortical functional mapping for motor functions could be performed with general anesthesia.
Electrocorticography is widely used in epilepsy and brain tumor surgery. Its usefulness has also been seen in patients undergoing temporary mesial lobectomy to determine the hippocampus degree of resection. Another utility is in resective surgery for structural lesions that cause seizures (tumors, cortical, vascular malformations), in order to delimit the surrounding epileptogenic zone and expand it.
Finally, electrocorticography must be accompanied by the mapping procedure to identify post-stimulation discharges.
7. Clinical cases
Case 1. An 8-year-old boy presented at the emergency department with a two-month history of headache, left-sided weakness (1/5), and generalized seizures. MRI study shows a premotor right brain tumor (A). An awake craniotomy was performed, and gross total resection was achieved. VIDEO. (https://bit.ly/3vXzr2S) (C). The pathology service reports a Primitive Neuroectodermic tumor. The patient receives chemotherapy (Iphosphamide - Carboplatine - Etoposide) and radiotherapy 54 Gy (Lineal-accelerator). During follow-up, a recurrence was suspected (D), and a new surgical treatment was performed (E).
Case 2. A 4-year-old female presented to the neurosurgery department with a history of symptomatic epilepsy since she was 3 years old. A few months later, autism disorder was detected. Partial motor seizures with hand-forearm-shoulder involving and secondary generalization were observed. An MRI study was performed, and a neoplastic lesion in the primary motor cortex was identified. A comprehensive case review was performed. Because of the history of autism disorder, the patient was dismissed as a candidate for awake craniotomy. However, she was considered a candidate for surgical treatment by total endovenous anesthesia. The primary motor cortex was identified with the reverse-phase technique in the operating room, and transoperative electrocorticography was performed. The gross-total resection was achieved for the brain tumor, and a subpial resection was completed after the identification of epileptic foci identified by a new ECoG. A) Preoperative MRI. B) ECoG to define the epileptic activity. C) ECoG after brain tumor resection. D) ECoG identifies epileptic activity in the rostral region of pars triangularis. E) After subpial resection of epileptic foci. F) Follow-up MRI.
Acknowledgments
We acknowledge the intense work, dedication, and commitment of Pediatry and Pediatric Specialties residents, to the great nurse’s team and social workers at the Instituto Nacional de Pediatría and at the Centro Médico Naval of México.
This work is dedicated to respect and honor relatives and worldwide medical staff members who fell during the COVID-19 pandemic.
Conflict of interest
“The authors declare no conflict of interest.”
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Although our experience with this technique was relatively short, we did not observe complications, and a gross total resection was successfully achieved in all cases. In the postoperative period we did not find any new deficiency in our patients. We observed functional recovery - motor and sensitive aphasia, motor strength improvement in hemiplegic patients, and recovery of neurodevelopmental milestones during follow-up. In our experience, the use of awake craniotomy and brain mapping for brain tumor resection in pediatric patients is truly safe and reliable.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/76106",risUrl:"/chapter/ris/76106",book:{id:"10649",slug:"central-nervous-system-tumors"},signatures:"Roberto Garcia-Navarrete, Javier Terrazo-Lluch, Alfonso Marhx-Bracho, Ericka León Alvárez, Natael Olvera González, Beatriz Alvárez-Mora, Rosario Aguilar Silva, Cointa Arroyo, Vianey Maceda Morales, Luz María Cordero, Daniel Magos Rodríguez, Sandra Luz Lizarraga-Lopez, Ana Niembro Zúñiga and Juan Alberto Díaz Ponce Medrano",authors:[{id:"44390",title:"Dr.",name:"Roberto",middleName:null,surname:"Garcia-Navarrete",fullName:"Roberto Garcia-Navarrete",slug:"roberto-garcia-navarrete",email:"roberto.gns@gmail.com",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/44390/images/36_n.jpg",institution:{name:"Instituto Nacional de 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Clinical cases",level:"1"},{id:"sec_20",title:"Acknowledgments",level:"1"},{id:"sec_23",title:"Conflict of interest",level:"1"}],chapterReferences:[{id:"B1",body:'Ownsworth T, Chambers S, Walker D.G., and Shum D. Neuropsychological Assessment of Individuals with Brain Tumor: Comparison of Approaches Used in the Classification of Impairment. Front Oncol. 2015; 5: 56'},{id:"B2",body:'Rausch, R. Psychological evaluation. In: Surgical treatment of epilepsies. New York. Raven Press. 2001'},{id:"B3",body:'Tröster A. Some Clinically Useful Information that Neuropsychology Provides Patients, Carepartners, Neurologists, and Neurosurgeons About Deep Brain Stimulation for Parkinson\'s Disease. Arch Clin Neuropsychol. 2017 Nov; 32(7): 810-828'},{id:"B4",body:'Kaplan, E. F., Goodglass, H., & Weintraub, S. The Boston naming test. Philadelphia: Lippincott Williams & Wilkins, 1983-2001'},{id:"B5",body:'Peña-Casanova J. Integrated neuropsychological exploration program- Barcelona test revised. Barcelona: Masson; 2005'},{id:"B6",body:'Luria, A.R. El cerebro en acción. Barcelona; Martinez Roca; 1984'},{id:"B7",body:'Everett LL, Van Rooyen IF, Warner MH, Shurtleff HA, Saneto RP, Ojemann JG. Use of dexmedetomidine in awake craniotomy in adolescents: Report of two cases. Paediatric Anaesthesia 2006; 16 (3): 338-342'},{id:"B8",body:'Ramírez-Segura EH. Anestesia para craneotomía con el paciente despierto: Técnica dormido-despierto-dormido. Revista Mexicana de Anestesiología 2014; 37(1): 42-46'},{id:"B9",body:'Chui J. Anestesia para craneotomía en el paciente despierto: una actualización. Revista Colombiana de Anestesiología 2015; 43: 22-28'},{id:"B10",body:'McClain CD, Landrigan-Ossar M. Challenges in Pediatric Neuroanesthesia. Awake Craniotomy, Intraoperative Magnetic Resonance Imaging, and Interventional Neuroradiology. Anesthesiology Clinics 2014; 32(1): 83-100'},{id:"B11",body:'Solera RI, Uña OR, Valero I, Laroche F. Awake craniotomy. Considerations in special situations. Revista Española de Anestesiología y Reanimación 2013; 60(7): 392-398'},{id:"B12",body:'Meng L, McDonagh DL, Berger MS, Gelb AW. Anesthesia for awake craniotomy: a how-to guide for the occasional practi- tioner. Can J Anaesth 2017; 64: 517-529'},{id:"B13",body:'Gerritsen JKW, Arends L, Klimek M, Dirven CMF, Vincent AJE. Impact of intraoperative stimulation mapping on high-grade glioma surgery outcome: a meta-analysis. Acta Neurochir (Wien) 2019; 161: 99-107'},{id:"B14",body:'Richardson AM, McCarthy DJ, Sandhu J, Mayrand R, Guerrero C, Rosenberg C, et al. Predictors of successful discharge of pa- tients on postoperative day 1 after craniotomy for brain tumor. World Neurosurg 2019; 126: e869–e877'},{id:"B15",body:'Delion M, Terminassian A, Lehousse T, Aubin G, Malka J, N’Guyen S, Menei P. Specificities of awake craniotomy and brain mapping in children for resection of supratentorial tumors in the language area. World Neurosurgery 2015; 84(6): 1645-1652'},{id:"B16",body:'Zhang K, Gelb AW, Francisco FS. Awake craniotomy: indications, benefits, and techniques. Colombian Journal of Anesthesiology 2018; 46: 49-55'},{id:"B17",body:'Soehle M, Wolf CF, Priston MJ, Neuloh G, Bien CG, Hoeft A, et al. Propofol pharmacodynamics and bispectral index during key moments of awake craniotomy. J Neurosurg Anesthesiol 2018; 30: 32-38'},{id:"B18",body:'Spena G, Roca E, Guerrini F, Panciani PP, Stanzani L, Salmaggi A, et al. Risk factors for intraoperative stimulation-related sei- zures during awake surgery: an analysis of 109 consecutive pa- tients. J Neurooncol 2019; 145: 295-300'},{id:"B19",body:'Eseonu CI, ReFaey K, Garcia O, et al. Awake craniotomy anesthesia: a comparison of the monitored anesthesia care and asleep-awake-asleep techniques. World Neurosurg 2017; 104:679-686'},{id:"B20",body:'Flexman AM, Wang T, Meng L. Neuroanesthesia and outcomes: evidence, opinions, and speculations on clinically relevant topics. Curr Opin Anaesthesiol. 2019 Oct;32(5):539-545'},{id:"B21",body:'Kulikov A, Lubnin A. Anesthesia for awake craniotomy. Current Opinion in Anaesthesiology 2018; 31(5): 506-510'},{id:"B22",body:'Sewell D, Smith M. Awake craniotomy: Anesthetic considerations based on outcome evidence. Current Opinion in Anaesthesiology 2019; 32(5): 546-552'},{id:"B23",body:'Bloom, J., Wyler, D., Torjman, M. C., Trinh, T., Li, L., Mehta, A., … Romo, V. (2020). High Incidence of Burst Suppression during Propofol Sedation for Outpatient Colonoscopy: Lessons Learned from Neuromonitoring. Anesthesiology Research and Practice, 2020, 1-6'},{id:"B24",body:'Castellanos Peñaranda, C., Casas Arroyave, F. D., Gómez, F. J., Pinzón Corredor, P. A., Fernández, J. M., Velez Botero, M., … Marulanda Toro, C. (2020). Technical and clinical evaluation of a closed loop TIVA system with SEDLineTM spectral density monitoring: Multicentric prospective cohort study. Perioperative Medicine, 9(1). doi:10.1186/s13741-019-0130-2'},{id:"B25",body:'Wang ZH, Chen H, Yang YL, et al. Bispectral index can reliably detect deep sedation in mechanically ventilated patients: a prospective multicenter validation study. Anesth Analg. 2017;125:176-183'},{id:"B26",body:'Wang ZH, Chen H, Yang YL, et al. Bispectral index can reliably detect deep sedation in mechanically ventilated patients: a prospective multicenter validation study. Anesth Analg. 2017;125:176-183'},{id:"B27",body:'Devlin JW, Skrobik Y, Gélinas C, et al. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit Care Med. 2018;46:e825–e827'},{id:"B28",body:'Ritaccio AL, Brunner P, Schalk G. Electrical stimulation maping of the brain: Basic Pinciples and emergin alternatives J Clin Neurophysiol, 2018 Marzo (2): 86-97'},{id:"B29",body:'Penfield W, Boldrey E. Somatic Motor and sensory representation in the cerebral cortex of man as studied by electrical stimulation. Brain 1937; 60:389-443'},{id:"B30",body:'Ojemann G, Ojemann J, Lettich E, Berger M. Cortical language localization in left, dominant hemnisphere. An Electrical stimulation mapping investigation in 117 patiens. J Neurosurg 1989;71:316-326'},{id:"B31",body:'Taniguchi M, Cedzich C, Schramm J. Modification of cortical stimulation for motor evoked potentials under general anestesia: technical description. N ueursurgey, 1993, 91 379-385'},{id:"B32",body:'Wang DD, Rolston JD Berger M. Cortical stimulation and Mapping. Cataltepe O, Jallo GI. Pediatric Epilepsy Surgery. Thieme 2ª ed 2020, 277-283'},{id:"B33",body:'Haglund MM, Berger MS, Shamseldin M, Lettich E, Ojemann GA. Cortical localization of temporal lobe language sites in patients with gliomas. Neurosurgery. 1994; 34:567-576. discussion 576'},{id:"B34",body:'Berger MS, Kincaid J, Ojemann GA, Lettich E. Brain mapping techniques to maximize resection, safety, and seizure control in children with brain tumors. Neurosurgery. 1989; 25:786-792'},{id:"B35",body:'Tuxhorn I, Extra- and Intraoperative electrocortical stimulation. Cataltepe O, Jallo GI. Pediatric Epilepsy Surgery. Thieme 2ª ed 2020,134-142'},{id:"B36",body:'Galletine WB, Mikati MA Intraoperative Electrocorticography and cortical stimulation in children. Journal of Clinical Neurophysiology 2009;26(2):95-108'},{id:"B37",body:'Bank AM, Schevonb CA, Hamberger MJ. Characteristics and clinical impact of stimulation-evoked seizures during extraoperative cortical mapping. Epilepsy & Behavior. 2014; 34:6-8'},{id:"B38",body:'Nossek E, Matot I, Shahar T. Barzilia O, Rapopolrt Y, Gonene T, et al. Intraoperative seizures during awake craniotomy: incidence and consequiences: analisys of 4677 patients. Neurosurgery 2013; 73 135-140'},{id:"B39",body:'Pouratian N, Cannestra AF, Bookheimer SY, et al. Variability of intraoperative electrocortical stimulation mapping parameters across and within individuals. J Neurosurg. 2004;101:458-466'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Roberto Garcia-Navarrete",address:"roberto.gns@gmail.com;, rgarcianavarretes@pediatria.gob.mx",affiliation:'
Neurosurgery Department, Instituto Nacional de Pediatria, Mexico
Neurosurgery Department, Centro Medico Naval (Secretaria de Marina Armada de Mexico), Mexico
Neurosurgery Department, Centro Medico ABC, Mexico
Oncology Department, Instituto Nacional de Pediatria, Mexico
'},{corresp:null,contributorFullName:"Juan Alberto Díaz Ponce Medrano",address:null,affiliation:'
Centro Medico Naval, Secretaria de Marina Armada de Mexico, Mexico
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1. Introduction
TLD method is considered an important technique as it can store radiation in trap centers for long period. Glow peaks of thermoluminescence dosimeters are later measured and discussed based on some models related to the physical changes in the band structure of dosimeter because of ionizing radiation exposure. A wide range of substances exhibits thermoluminescence (TL) phenomena after being exposed to nuclear radiation such as activated LiF and CaSO4. Thermoluminescent dosimeter (TLD) emits light when heated up after being irradiated. Due to this special property, TLD could be used as a radiation dosimeter. TLD has many advantages and sensitive to different types of radiation. A dosimeter of higher TL response to thermal neutrons is most commonly used in mixed radiation fields (neutron and gamma ray). The sensitivity of TLD to neutrons depends on the detector compound type, environment and neutron energy. For neutron dosimetry purposes, the neutron and gamma ray dose contribution must be separated by using two different detector types of TLD. The first one should be sensitive to gamma and the other should be sensitive to neutrons plus gamma (as LiF-700 and LiF-600) [1, 2].
The response of fast neutrons depends on the cross-section for the interaction in TLD material and the relative TL efficiency, which depends on the linear energy transfer (LET) of the reaction products in the first place. The response to intermediate-energy depends mainly on the cross-section of the reaction, which may take place with the composite material of the TLD.
1.1 TLD applications in neutron and gamma ray dosimetry
Generally, there are three types of TLD used for neutron dosimetry as follow:
1.1.1 Albedo neutron dosimeter
A considerable fraction of intermediate and fast neutrons can be slowed down to epithermal neutron energy and backscattered in the human body, interacting with the sensitive TL material. An albedo neutron dosimeter is a type of neutron monitor and is typically used in the neutron energy range of 0.2 eV to around 0.5 MeV. The slow neutrons interact with TL material, usually through 6Li (n,α) 3H reaction, and the resulting induced charged particles to stimulate the TL material. Recently, some of albedo TLD dosimeters depend on 10B (n, α) 7Li reactions. Because neutron TL sensitive material responds to gamma radiation, and neutrons are accompanied by this gamma radiation, another TLD is usually utilized in conjunction with TLD with a gamma ray.
The neutron albedo dosimeter measures (a) direct fast neutrons, (b) direct thermal neutrons, and (c) albedo neutrons reflected from the body. This type of dosimeter uses Lexan polycarbonate and/or CR-39 foils, as well as two 10B (n, γ) 7Li converters in a cadmium cover, to efficiently measure the three neutron dosage components independently [3, 4, 5]. Fast neutron dose is assessed in CR-39 by counting proton recoil tracks, while thermal neutron dose is determined by counting α particles created during the process. Because the albedo dosimeter has a sensitivity range of 0.3–30 mSv, it is advised that it be used as a backup dosimeter to assist in the assessment of high dose values in the event of accidents or patients receiving neutron therapy.
In another application, the 10B (n, α) 7Li reactions with the backscattered albedo neutrons employed with Electret’s ionization chamber proposed by Seifert et al. [6, 7]. In this chamber, induced 7Li from the ionization of the gas in the chamber worn on the body’s surface in the above reaction instance. Under saturation conditions, produced charge carriers with the corresponding polarity travel to the surface of the electret. As a result, the change in the electrets voltage is a direct measure of albedo neutron fluence and an indirect estimate of primary neutron fluence. In general, the advantages of albedo TLD dosimeter are: they are relatively inexpensive and can be reused, easily fabricated, lightweight to wear, Readout is simple and can be automated, Insensitive to humidity.
While their disadvantages are: Some of TLD exhibit fading, TLD is sensitive to gamma-ray, they must be worm properly or serious errors can be resulted, the measured values of TLD does not give permanent record as the track detectors, their sensitivity is highly dependent on the angle and energy of incidence radiation.
1.1.2 Hydrogenous radiator TLDs
In this type of dosimeters, the fast neutrons knock out protons from hydrogenous material mixed with the phosphor, and the protons dispel their energy in the dosimeter. In this method, the hydrogenous substances are called proton radiators [8]. This technique has demonstrated that TL materials mixed with hydrogenous material can detect fast neutrons, but the sensitivity needs to be improved by one order of magnitude before using in personnel neutron dosimetry.
1.1.3 LET-dependent deep trap TLD glow peaks
The fast neutron interacts directly with the TL material as calcium fluoride (CaF2:Tm) which is commercially called TLD-300. This type has a glow curve with two glow peaks and the peak temperature Tm centered 150 and 250°C, respectively. The higher temperature peak (250°C) has a greater response to the fast neutrons. TLD-300 dosimeter CaF2: Tm (0.35 Mol. %) showed a lower detection limit of about 0.3 mSv from 241Am-Be source.
2. Characteristic of TLD phosphors
2.1 The glow curve
The term “Glow curve” refers to the graph of TL as a function either of temperature or of time as shown in Figure 1.
Figure 1.
TLD glow curve and time–temperature profile (TTP).
Glow curves have the following features:-
The glow curve of a certain phosphor probably best characterizes that phosphor. For example, the appearance of glow peaks only at low temperatures implies that the phosphor loses its stored TL with time, and therefore would be unsuitable for long-term measurements.
A peak at very high temperatures indicates a phosphor that will produce infrared radiation at the temperature necessary to release the TL. This is a problem for the instrumentation.
A glow curve without well-defined peaks makes the selection of the appropriate end for integration difficult. Ideally then, a glow curve should reveal only a single thermoluminescent peak, which occurs at a temperature high enough to ensure room temperature stability but not so high as to present instrumental problems. However, the temperature at which a TL peak appears is quite affected by the heating rate.
The following factors may affect the shape of the glow curve:
2.2 TL sensitivity
The sensitivity of TLD should be evaluated for competitor’s materials to determine the dose linearity, sub linearity or supralinearity behavior of phosphors. The sensitivity and thermal stability of glass samples were found to be dependent on both the starting materials and the method of preparation in Refs. [9, 10, 11, 12, 13].
2.3 Dose rate dependence
TL dosimeters, in general, have demonstrated no dose rate effects over a wide range.
2.4 Stability
TL is the release, in the form of visible light, of energy absorbed from previous irradiation. The rate at which this energy is released is dependent upon the phosphor temperature and increases sharply at a higher temperature. Even though the concept of “glow peak temperature” that temperature at which the maximum of the glow peak occurs, is both useful and easily demonstrated. It should be remembered that a finite rate of loss of stored energy exists even for much lower temperatures. If a phosphor shows an insignificant loss of TL at room temperature, it is said to have good stability.
3. TL kinetics
The physical process leading to the emission of TL from a sample is related in most cases to the traffic of charge carriers, usually electrons and holes, between different imperfection states in the solid sample. Studying the kinetics of the TL process means the investigation of electron–hole transitions between energy states in cases of both the irradiation of the TL sample and the readout processes. Although, in most experimental situations the TL curve consists of several overlapping peaks, it is appropriate to start the discussion by dealing with a single peak to understand the basic process. For most purposes, it is not necessary to assume that the glow curve consists of only one peak. The analysis of a single peak may just be valid if a series of peaks occur, provided that the peak of interest is sufficiently separated from others, either because it appears separately or because we have an efficient method to isolate it from the rest of the curve.
3.1 First kinetics order
If n is the number of trapped electrons in the sample, which is maintained at constant temperature T, n decreases with time t as:
The rate of photon emission, and hence the rate of release of electrons from traps to their rate of arrival at luminescence centers, determine the strength of the TL glow peak [14].
Iα−dndt→I=−Cdndt=nCSexp−EKTE3
Where C is a luminescence efficiency constant.
When the dosimeter is heated with rate β =dT/dt. Then we may write dn/dt as:
It should be noted that I(T) in Eq. (6) dependents on two physical parameters, the activation energy E, and frequency factor S, and the heating rate β. The activation energy is the minimum energy required to release the electrons from their traps. Differentiation of Eq. (6) with respect to the temperature gives:
∂I∂T=noSCexp−EKTexpfT∂fT∂T+expfTexp−EKTEKT2
Where, fT=−Sβ∫Texp−EKTdT
At T=Tm→∂I∂T=o
→sβexp−EKTm=EKTm2E7
where Tm is peak position or the temperature at maximum intensity.
Equation (7) describes the condition of the occurrence of the maximum intensity and the determination of the corresponding temperature, which we call, Tm. The reduction in the second exponential function is faster than the growth in the first exponential function above this temperature, and the product function decreases until the traps are fully depopulated. This accounts for the end of the peak. A theoretical (calculated) glow peak plotted using Eq. (6) is shown in Figure 2. The main feature of the first-order peak is that the asymmetric, is such that at temperatures over Tm, the reduction is faster than the rise at low temperatures.
Figure 2.
Theoretical glow peak plotted using the first kinetics order equation.
The initial concentration no appears in the first kinetics order acts only as a constant multiplying the temperature-dependent factors. In this particular case of the first kinetics order, changing the initial concentration no has no effect on the curve’s form because adjusting the intensity at each temperature has the same proportional effect. Figure 3 shows several glow peaks with different no. One of the aspects of this fact is that Tm is independent of the initial concentration no.
Figure 3.
Glow curves plotted using the first-order kinetics equation for different no.
This appears well in the condition of the Tm described by Eq. (7), where no does not appear in the equation. This property of the independent of Tm on no is specified to the first-order case, and will not occur for most of the other kinetics possibilities [13]. Eq. (7) can be written in the following form:
βEK=STm2exp−EKTmE8
We see that changing the heating rate β must change Tm in a such way that equality still holds. The term Tm2exp−EKT is monotonically increasing with Tm, therefore increasing the rate β will immediately cause Tm to increase. Since Tm2exp−EKT is a very rapidly increasing function of Tm, only a small change of Tm may accompany a large variation in the heating rate β, this variation is usually rather easily observable.
3.1.1 Second kinetics order
One assumption made up by Randall and Wilkins [14] which led to the first kinetics order was that once a charge carrier is thermally elevated into the band, it is bound to recombine rather quickly with an opposite sign carrier trapped in a recombination center. Gralick and Gibson [15] considered another case in which the free carriers may re-trap with equal retrapping recombination probabilities with the further assumption that the concentration of electrons in traps and holes in recombination centers are equal during the entire process. Denoting the total number of traps of the given type (free electrons or holes) by N, they found the kinetics equation:
I=−dndt=SNn2exp−EKTE9
where (S/N) is a constant having units of m3s−1, which we may denote by S′. Then we have
I=−dndt=S′n2exp−EKTE10
where S′ is called “pre-exponential factor” which does not have the same meaning of “frequency factor” as was in the first kinetics order.
where Eq. (12) represents the intensity of a glow peak according to the second kinetics order model. At high temperature, the second decreasing function dominates so that the product function is decreasing. Somewhere between two regions the glow curve, therefore, reaches its maximum. Figure 4 Displays a hypothetical glow peak plotted using Eq. (12).
Figure 4.
Theoretical glow peak plotted using the second-order kinetics equation.
The condition of the maximum is found by setting the derivative of Eq. (12) to zero (dI/dT = zero) [16], then we may find:
Multiply by 1+S´βno∫Tmexp−EKTmdT3 and rearrange, one gets
1+S´βno∫Tmexp−EKTmdT=2KTm2S´noβEexp−EKTmE13
Then Eq. (13) represents the condition of the peak maximum according to the second kinetics order. As can see no appears in the equation and therefore we expect that Tm will depend on no. It can be shown numerically or analytically, that increasing no causes Tm to decrease. An exception to this rule of the shift of a second-order peak with no can be found by Wrzesinska [17], who writes Eq. (10) with S′=Sno. The resulting peak has all the regular features of a second-order peak (e.g., symmetry properties) except one can write S instead of noS’ and thus Eq. (10) turns out to be independent of no. The ensuring Tm is, therefore independent of no. It is not clear, however, what physical circumstances result in S′ being equal to S/no [17]. Other aspects of the dependence of the glow curve on the initial concentration no are paramount importance when we are interested in a TL as a dosimetric tool. In many cases, one associated the initial concentration with the imparted dose and then the dependence of different parts of the glow peak on no is important. In the first kinetics order, since the intensity at each point is multiplied by the same factor while changing no, the total area varies with the same amount so that the total area is proportional to no. Its occurrence in second-order peak can be illustrated by integrating Eq. (9) with respect to time from zero to infinity;
∫0∞Itdt=−∫nondn=no−n∞=noE14
Both in the first order and second order, as well as other cases, n∞ is zero and therefore the integral, which represents the area under the glow peak is equal (in appropriate units) to no.
Now we can consider the dependence of different portions of the second-order peak on no. First, we shall study the dependence of I on no for a given temperature T. In the initial rise range, Eq. (12) reduces to:
IT≅no2S′exp−EKTE15
This shows immediately that for a given temperature in this range the dependence of I on no is superlinear, namely I α no. It is to be emphasized that it is true only in the initial rise region; as already shown the total area is proportional to no and different dependencies are expected on other portions of the curve. Using the maximum condition equation and approximation to ∫Texp−E/KTdT, it can be shown that the two terms in the brackets in Eq. (12), namely unity and noS′βToexp−E/KTdT are more or less equal at T = Tm. At higher temperature, the latter term increases substantially and the unity can be neglected so that we obtain:
I≅S′no2exp−EKTS′βno∫Texp−EKTdT−2
yields→I≅S′exp−EKTS′β∫Texp−EKTdT−2E16
The main point in Eq. (18) is that the term includes no cancel. This means that at a higher temperature range the TL intensity is independent of no for any given temperature [17].
Figure 5 shows plotted glow peaks using Eq. (12) for different no. In the low-temperature range, the TL intensity appears to depend on no. As no increases, Tm decreases which makes the peaks appear to be shifted to the low-temperature side. As the temperature increases the effect of no on the peak starts to decrease which makes the peaks approach each other’s on the high-temperature side.
Figure 5.
Plotted glow peaks using the second-order kinetics equation for different no.
3.1.2 A single TL peak analysis
As seen in Figure 6, the concentration of the trapping state is denoted by N (m−3), with n(t) (m−3) being filled by electrons at time t(s). These electrons can be thermally elevated into the conduction band by crossing an energy barrier of E (eV) at a rate proportional to exp.(−E/kT), resulting in a concentration of free electrons nc(t) (m−3). Following that, these can be retrapped in a similar trap with a re-trapping probability An or recombined with a trapped hole in a center with a recombination center probability Am, generating a photon with the recombination center energy h. A set of three simultaneous differential equations governs this operation. The following factors influence the recombination process:
Iαncmyields→I=−dmdt=AmncmE17
where n, m, and nc are the trapped electron, hole in the center, and free-electron concentrations, respectively, and (dm/dt) is the recombination rate. This means that the amount of light emitted is proportional to the pace at which m decreases. The rate of recombination is proportional to both the instantaneous concentration of free electrons nc and the concentration of hole centers m, the proportional constant Am (m3 s−1). The product of cross-section recombination σ (m2) and thermal velocity is commonly used to calculate this value (m.s−1). The second equation is concerned with the movement of electrons that have been thermally liberated from the trapped condition. The rate of release of these electrons –dn/dt is proportional to the trapped electron concentration n (m−3) and the Boltzman constant exp.(−E/KT), with S serving as the proportional constant (s−1).
Figure 6.
A general treatment of the charge carriers’ transitions in the TL sample.
However, the actual rate of change of n is also related to the retraping term. The rate of retraping is proportional to the concentration of free electrons nc, and the unoccupied trapping states N-n, the proportional factor being the recombination probability An(m3s−1). Thus, the second combined equation is given by:
−dndt=Snexp−EKT−AnncN−nE18
The third equation is that of charge neutrality. In its simplest form, it should read m = n + nc. Taking the first derivative with respect to time, the charge neutrality condition can be written as:
dmdt=dndt+dncdtE19
yields→dncdt=Snexp−EKT−ncmAm+N−nAnE20
This equation has been given by Adirovitch [18] for phosphorescence and by Halperin and Braner [19].
Now let us discuss the kinetics of the process in more general terms and see how the simplified cases of first, second, and more general cases emerge from Eqs. (17)–(20). Two simplifying assumptions were first made by Adirovitch [18] and later by many other investigators [19, 20, 21, 22, 23]. These are related to the relation between the concentration of the electrons in the conduction band and in traps and to the rate of change of these concentrations, namely:
dddt≪dndt,nc≪nE21
Although, it seems to be the same connection between these two conditions, basically they are two separate relations and the occurrence of one does not necessarily imply the other. With these assumptions, Helperin and Braner [19] found the expression:
I=−dmdt=mAmmAm+AnN−nSnexp−EKTE22
Since this equation contains two unknown functions, n(t) and m(t), it cannot be solved without further assumption. As mentioned, Randall and Wilkins [14] wrote their first-order equation assuming strong recombination. This can be expressed in more specific terms. If we assume with relation to Eq. (22) that:
mAm≫N−nAn
The condition of Eq. (22) is the relation between functions rather than parameters. It is, therefore, possible that at the low-temperature range of a glow peak, the strong inequality holds, and at higher temperatures where m and n decreases, the inequality “weakens” may be inverted. This may result in a shift from first-order behavior to non-first-order behavior within the same peak [24].
Then we see that Eq. (23) takes the same form of Eq. (3). For linear heating rate function, the general solution of Eq. (23) is given by Eq. (24):
I=noSexp−EKTexp−Sβ∫Texp−EKTdTE24
Then from Eq. (22) with Randall and Wilkins [14] assumptions, we reached the first kinetics order equation.
The abovementioned second kinetics order, resulting from different assumptions associated with Eq. (22). In one set of assumptions, one can take n(t) = m(t) which is not very different from the parametric equality no = mo once the assumption nc≪n is made.
In addition, we have to assert the retraping dominates [15]
AnN−n≫mAmE25
We also suppose that the trap is far from being saturated, i.e., the retrapping duration.
Alternatively, one can assume, in addition to the concentration equality, that An = Am [18] which yields:
I=−dmdt=SNn2exp−EKTE31
Then Eq. (22) takes the same form of Eq. (8) which is found by Gralick and Gibson [15]. Where Eq. (30) sums up both these possibilities by employing the parameter S′ (m3s−1), the pre-exponential factor that replaces AmSAnN in one case and S/N in the other. The solution of Eq. (30) is given by Eq. (32)
I=S′no2exp−EKT1+S′βno∫Texp−EKTdT−2E32
It should be emphasized that two cases discussed so far, namely first and second kinetics order, are only special cases in a sense, extreme cases and the general case described by equations Eq. (17) through Eq. (19) may be neither first nor second order even if the simplifying conditions of Eq. (21) are assumed to be general. The resulting Eq. (20) consists of many intermediate cases that do not have a distinct kinetics order. Although, some researchers still attempt to determine for every TL peak a first or second kinetics order [25].
Several attempts [16, 26] have been made to add a third parameter to the two basic ones, the activation energy E and the pre-exponential constant S′ (or S), all the attempts extend the “order parameter” implied when talking about first or second-order peak. The order parameters considered so far as a discrete magnitude assuming the value of 1 and 2 can be extended to be a continuous parameter. It is to be noted, however, that the addition of a third parameter is in principle one step in the right direction since the general treatment should include eight parameters (E, S, Am, An, N, no, mo, nc). The best-known way of including the third parameter is that of general kinetics order, b, according to which one can assume that the glow peak is governed by [25].
I=−dndt=S′nbexp−EKTE33
The kinetics order, b, is normally considered to be between 1 and 2, but it can occasionally exceed this range [13]. The rationale behind writing Eq. (33) is as follows: it is readily seen that a first-order peak is asymmetric, where a second order peak is nearly symmetric. Following Halperin and Braner [19] and Chen [16] we can define the symmetry factor μg as:
μg=δωE34
where δ=T2−Tm,ω=T2−T1 as it is shown in Figure 7, and T1 and T2 are the low and high temperatures on half- maximum intensity, respectively. It has been shown [16] that for the first kinetics order, μg≅0.42 and the second kinetics order, μg≅0.52.
Figure 7.
Parameters used in the calculation of the symmetry factor.
Of course, intermediate symmetries represented by different values of μg are found and the simplest way to present them by taking 1<b<2 in Eq. (30). Chen [16] has shown that μg changes from 0.42 to 0.52 as b increasing from 1 to 2. The solution of Eq. (33) for linear heating rate β, is given by:
I=Snoexp−EKTb−1Sβ∫ToTexp−EKTdt+1−bb−1E35
where S=S′nob−1.Eq. (35) represents glow peak intensity according to the general kinetics order.
A few words of caution are in order with respect to this treatment. First, although Eq. (34) has been shown to quite accurately described measured TL peaks [27, 28], it is to be noted that in most cases it is only an empirical presentation and is not based on the three differential equations [Eqs. (17) up to (19)], seem to be more physically significant. However, the general order case is still important because it can handle intermediate circumstances and smooth the first and second-order cases as b1 and b2, respectively.
3.1.3 General-order kinetics
May and Partridge supposed the empirical equation that has been suggested to explain the thermoluminescence glow peak if the first or second-order kinetics do not describe the glow peak. The equation is namely the general- order kinetics and written by:
I=n0s′′exp−E/KT1+b−1s′′/β∫T0Texp−E/T′KdT′bb−1
Hence s′′=sNn0 is called the pre-exponential factor, b the order of kinetics and the rang supposed between 1 and 2 but sometimes this rang has able to be greater than those. The pre-exponential factor s′′ is constant for given the dose, however, it differs with changing the absorbed dose withn0.
3.1.4 Trap parameters evaluation techniques
3.1.4.1 Empirical methods
We can deduce that the higher the peak temperature Tm, the higher the activation energy Urbach [29], and Urbach [30] found empirically for KCl crystals:
EeV=TmK500E36
This can also be written as E = 23KTm and it differs according to the types of the sample. Halperin [19] deduced E = 38 KTm for NACL samples, and Miller and Bube [31] arrived at E = 39 KTm for LiF.
The maximum intensity of the peak, according to Randall and Wilkins [12, 13], occurs around the temperature where the electron escape probability is 1 s-1. As a result of Eq. (1), we have:
P=Sexp−EKTm=1yields→E=KTmlnSE37
3.1.4.2 Initial rise method
According to Eqs. (6), (12) and (3), we can say that at the start of the glow peak (initial rise region) the TL intensity is proportional to exp−E/kT, irrespective of whether the first kinetics order is obeyed or not [32]. This temperature relationship persists until the quantity of trapped electrons is drastically reduced. Hence, by plotting Log (I) versus 1/T, the value of E can be obtained from the slope of the straight line obtained. As a result, using the equation: it is possible to calculate E without knowing the frequency factor S:
E=−KlnI1TE38
From Eq. (6), we see that when T is slightly greater than Tm, the argument of the second exponential is very small and therefore the value of the exponential function is close to unity and varies very slowly with temperature. The temperature dependence of I(t) is therefore dominated by the first exponential function, however the second exponential function decreases with increasing temperature and at higher temperatures it decreases very rapidly [13].
Therefore, the range of the initial rise must be chosen in which the second exponential function has minimum influence on the TL intensity temperature dependence. Therefore, it is necessary to restrict the temperature range such that the TL intensity does not exceed one-tenth of the maximum intensity [32].
Between temperatures T1 and T2 (both < Tm) corresponding to values equal to a1Im and a2Im respectively as in Figure 8, where:
Figure 8.
Extracted parameters from “Christodoulides expression” are to correct the value of the activation energy evaluated by the initial rise method.
a2≤0.5,a2a1≥5E39
On the temperature scale, a series of points were taken at equal intervals and plotted as ln(I) versus (1/T). The value Ec can then be calculated from the slope of the straight line as the energy determined by the initial rise technique; this value is smaller than the real activation energy E by the amount that grows as a1 and a2 increase. Christodoulides [33] devised the following expression for the corrected energy E in terms of the measured values Ec, a1, and a2:
E=1+0.74a1+0.082a2Ec−2a1+0.22a2Tm11605E40
The range of applicability of this equation is restricted by:
10≪EKTm≪100E41
3.1.4.3 Peak shape method
Grossweiner [34] established the first peak shape approach for first-order peaks, writing:
E=1.41KTmT1τE42
Where: Tm is the temperature at the maximum intensity, T1 is the temperature at the half of the maximum intensity in low-temperature side, τ=Tm−T1 as in Figure 9. Grossweiner used the coefficient 1.51, which was later [20] amended to 1.41. Lushchik [35] developed a method for evaluating the activation energy by utilizing the high-temperature half width δ=T2−T1 for first peaks he suggested:
Figure 9.
Peak shape method used to calculate the activation energy.
E=KTm2δE43
and for second-order peak:
E=2KTm2δE44
Chen [16] improved these equations by adding a factor of 0.976 in front of the former and replacing the factor 2 by 1.71 in the latter.
Halperin and Braner [19] have derived their equations for both first [Eq. (45)] and second kinetics orders [Eq. (46)]:
E=1.51KTm2τ−3.16KTmE45
E=1.81KTm2τ−4KTmE46
Chen [16] managed to establish expressions for general kinetics order, which is dependent on the geometry factor of the glow peak which is defined by Eq. (35):
E=CφKTm2φ−bφ2KTmE47
Where φ stands for τ,δ,ω and the values of Cφ and bφ for the three methods are:
Cτ=3μg−0.42+1.51E48
Cδ=7.3μg−0.42+0.976E49
Cω=10.2μg−0.42+2.52E50
bτ=4.2μg−0.42+1.58E51
bω=1E52
bδ=0E53
whereμgis geometrical shape factor that equalδω.
3.1.4.4 Various heating rates method
As mentioned above about Eq. (7), Tm changes with the heating rateβ, writing Eq. (7) twice for heating rate β1 and β2 with maximum temperatures Tm1 and Tm2 we get [36]:
E=kTm1Tm2Tm2−Tm1lnβ1β2−lnTm12Tm22E54
The activation energy that will be evaluated from Eq. (54) will be of course in accord with the first kinetics order only. However, Chen and Winer [37], Chen and Kirsh [38] showed that it can be used as a very good approximation for nonfirst-order cases as well.
The maximum condition, Eq. (16), can also take the following form:
−lnβTm2=EK1Tm+lnESK
According to this equation, Hoogenstraaten [39] suggested using several heating rates, a plot of ln(β/T2m) vs. (1/Tm) should yield a straight line of slope E/K, so that the activation energy is evaluated. Extrapolation to 1/Tm → 0 gives the value of ln(E/SK) from which the frequency factor is immediately found. It was shown that a plot of ln(Im) versus 1/Tm for various heating rates usually yields a straight line too and the activation energy can be extracted similarly. It is to be noted from the theoretical point of view that β should be varied in as board a range as possible. However, this may cause various experimental difficulties. At very low heating rates, the maximum intensity will be low and in fact, the peak smeared, thus not allowing effective extraction of the experimental parameters. At high heating rates, a delay between the sample temperature and that of the measuring device impairs the temperature measurement. Moreover, temperature gradients within the sample usually occur at high heating rates which result in a smearing effect of a different kind. In practice, one should therefore compromise on a relatively narrow range of heating rates [10].
3.1.5 Three points method
A new technique was developed by Rasheedy [25], to evaluate the trap parameters from the measured glow curve according to the general kinetics order.
The behavior of a phosphor’s TL intensity is determined by the following equation, [40], for generic kinetics order.
I=−dndt=nbNb−1Sexp−EKTE55
Where I is the intensity of the TL, n (cm−3), is the electron concentration trapped at time t(s), N (cm−3) is the traps concentration and K (eV/oK) is the Boltzman constant. Eq. (55) is more general than the two equations describing the first and second kinetics orders.
Eq. (55) is a modification of Eq. (33) in which the pre-exponential factor is defined as: S′=SNb−1 instead of ′=Snob−1 .The solution of Eq. (55) is given by Rasheedy [40]:
I=noS"exp−EKT1+b−1S"β∫ToTexp−EKTdTbb−1E56
Where the pre-exponential factor S″ = S(no/N)b−1 which is constant for a given dose but it varies with changes in the absorbed dose, i.e., with n0.
This method is based on the proportional of the concentration of populated traps during the running of the TL to the area under the glow peak.
Ix is the TL intensity at temperature Tx at any portion of the glow peak as shown in Figure 10, then Eq. (55) becomes:
Figure 10.
Three points method used by Rasheedy [25] to investigate the equations used to calculate the trap parameters.
Ix=AxbNb−1Sexp−EKTxE57
Where Ax is the area under the glow peak between the temperatures Tx and Tf (the final temperature of glow peak). Similarly, we have:
Iy=Ixy=AybNb−1Sexp−EKTyE58
Iz=Ixz=AzbNb−1Sexp−EKTzE59
Where Iy and Iz are the TL intensities at temperatures Ty and Tz, respectively.
Then, the order of kinetics b can be obtained from Eq. (62). Once the order of kinetics b is determined, the activation energy E(eV) can be determined by using Eq. (60) or Eq. (61).
Since, at T=Tmyields→∂I∂T=0
From Eq. (56) and using Eq. (59) leads to the following expression [41]:
S"=βEexpEKTmbKTm2−b−1EexpEKTm∫ToTmexp−EKTdTE63
A simple analytical method has been developed to obtain the relative value of no in the case of general kinetics order [41]:
no=ImexpEKTmS´E64
where Tm, and Im can be obtained from the shape of the glow peak.
Thus, by calculating the kinetics order b, the activation energy E, and the initial trapped electrons number for many points that cover sufficient range on the glow peak, and taking the average value for each parameter, one can determine the trap parameters according to the general kinetics order.
3.1.6 Glow curve analysis (peak shape methods)
A review of the expression used in an intercomparison of glow curve analysis computer programs to evaluate TLD-100 glow curve is given in Ref. [42] where I(T) is written in the following form:
IT=ASexp−EKT1+Sb−1β∫ToTexp−EKTdtb1−bE65
where: A = area (counts); b = kinetics order; E = activation energy; I = intensity (counts per s, counts per K); S = frequency factor (s−1).
On the other hand, Eq. (66) is based on first order kinetics which was used by Puchalska, [43], to develop glow-curve analysis software, in the following form:-
where the constants a0, a1 … and b0, b1 … are listed in the followings: -
ao=0.26777bo=3.9584
a1=8.63476b1=21.099653
a2=18.05901b2=25.63295
a3=8.573328b3=9.573322
Equation (68) will be used throughout our results which give better fitting to the resultant deconvoluted peaks. Different software was developed by Ratovonjanahary et al. [32], which uses the first kinetics order with an approximation of the second kinetics order. In this software the following equation was used:
IT=Imexp1+EKTT−TmTm−T2Tm2expEKT−T−TmTm1−∆−∆mE68
where,
∆=2KTE,∆m=2KTmE
Such a technique was also developed to analyze the glow curve using Eq. (53) by Rasheedy [41], which used the value of the trap parameters obtained by the three points method.
4. Modern clinical applications of TLD
TLD is widely used in various clinical fields for different purposes. The key reasons are undoubtedly their widespread availability, well-studied dosimetric characteristics, and applicability across a broad dose range. Imaging and Radiation Oncology Core-Houston IROC-H conducts remote dosimetry audits on MV photon and electron beams. IROC-H usually used integration between TLD-100 and other dosimetry system like nanoDot or diode systems for achieving the dose commissioning and calibrating dosimetry systems in an acrylic mini-phantom [44]. The failure rate was recorded in dose curves after modeling of the TPS (RayStation-Elekta Inc.) using phantom tests, which was not observed by patient-specific IMRT QA. Such failure was related to little changes in the MLC leaf-tip offset rather than leaf-tip width. Koger and his team [45] in IROC-H prosed four labeled TLD distributed in an anthropomorphic head-and-neck phantom for correcting such failure, (see Figure 11). It was utilized a 3D diode array were used in addition to assess the detectability of modeling mistakes [45].
Figure 11.
TLDs were labeled in head-and-neck phantom at IROC-H [45].
Another crucial issue is to increase the staff’s awareness about radiation safety and enhance radiation protection against unnecessary radiation doses. For such purpose, TLD-100 was recently used to validate occupational doses both inside and outside the nuclear medicine department, radiation protection purposes as well as the dose rate distribution around the positron emission tomography or computed tomography (PET/CT) [46].
Some recent studies were envisaged to see how the department compared to reports from other centers across the world in terms of the annual number of procedures and exposure limits, and to see if there was an opportunity for further radiation protection enhancements. As an example, personal TLD was calibrated to estimate the personal equivalent dose Hp (10) and Hp (0.07) at PET/CT. It was used for assessing the employee’s exposure [47]. On the other hand, TLD rings personal dosimeters were worn by surgeons in their fingers through sentinel node biopsy procedure to measure personal doses Hp(10) and Hp(0.07), as well as ambiental dose for operating theater and during injection [48]. This will assure that personal equivalent doses are within the acceptable annual determined limits [49].
Other important recent TLD application in diagnostics is using an anthropomorphic phantom that modeled the reference person to get a conversion coefficient connecting dose area product (DAP) to effective patient dosage. They concluded that the effective dosage at the clinical dark-field radiography system, which generates both attenuation and dark-field pictures, is within the range of chest radiography standard dose values [50].
TLDs showed to be an excellent choice for skin dosimetry. Omojola et al. [51] used TLD in measurements of 3D skin dosimetry and verify their results using TPS planning verification at specific spots in the phantom. A full perspective of the dose distribution was achieved; however, they revealed that regions outside the PTV require special attention [52, 53, 54].
In addition, in the field of proton therapy, a novel tissue-equivalent TLD-sheet of manganese doped lithium triborate showed a valuable and effective dosimetry technique. It may also be a great in vivo skin dosimetry instrument for proton treatment due to its flexible and reusable properties. Despite the presence of significant energy dependences in the Bragg peak region, the response properties studied in this work, including as reproducibility, fading effects, dosage linearity and dose homogeneity are acceptable [55].
Monte Carlo (MC) simulation is considered a good tool to understand well the TLD [56]. Some algorithm methods based on MC as if pencil beam could be involved in accurate dose in MV radiotherapy calculations. It could be useful to calculate the spectrum inside the detector based on four categories primary photon and electrons and secondary photon and electrons [57].
On the other hand, Low-energy (100 keV) photons (x-rays and gamma) have been widely employed in biological research and medical applications for more than a century, including mammography, fluoroscopy, general radiography, computed tomography, and brachytherapy treatment, among others. The majority of electrons created by low photon energy beams have energies below 10 keV, according to research. The physical processes through which these low-energy electrons interact with matter, on the other hand, are still unknown. Furthermore, it is commonly thought that all energy put within a dosimeter-sensitive volume is converted into a response. However, this assumption could be inaccurate because some of the deposited energy could be utilized to build flaws or damages at the molecular and atomic levels [58].
The hybrid-functional density theory (H-DFT) has shown to be a promising tool for localizing secondary electrons within a dosimeter volume and calculating the energy spent on creating defects or colors centers, among other things, when it comes to the relationship between the energy deposited and the response of a dosimeter. Following that, the quantity of energy that can be truly turned into a dosimeter response following exposure to ionizing radiation would be more accurately determined.
5. Conclusion
The aim of this chapter is concerned with TLD materials, measurements and recent various applications in clinical and industrial fields. TL kinetics are also covered in details due to their importance in knowing traps parameters and band structure-related phenomena that are responsible for TL phenomena. Modern clinical applications of TLD are also covered like quality assurance purposes for proton, x-ray and gamma radiotherapy based on phantom tests. In addition, we shed spot on using TLD for recent accurate methods for skin dose evaluation under IMRT/VMAT radiotherapy. Special attention should be oriented to hybrid-functional density theory Monte Carlo simulation to model TL dosimeters. Recent studies proved a promising tool for localizing secondary electrons within a dosimeter volume and calculating the energy spent on creating defects or colors centers, among other things, when it comes to the relationship between the energy deposited and the response of a dosimeter. Such methods could give knowledge about misunderstanding behaviors of some TLD and could eliminate its disadvantages like missing TL signal or fading; angle and energy of incidence ionizing radiation. In general, the properties of TLD like its inexpensive cost and reusability; easily fabricated, lightweight to wear, readout is simple and can be automated, insensitive to humidity make it advantageous in different clinical and radiation safety applications.
\n',keywords:"TLD, TL kinetics, radiotherapy, hybrid-functional density theory, modern clinical applications",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/80975.pdf",chapterXML:"https://mts.intechopen.com/source/xml/80975.xml",downloadPdfUrl:"/chapter/pdf-download/80975",previewPdfUrl:"/chapter/pdf-preview/80975",totalDownloads:28,totalViews:0,totalCrossrefCites:0,dateSubmitted:"December 29th 2021",dateReviewed:"January 17th 2022",datePrePublished:"March 25th 2022",datePublished:null,dateFinished:"March 25th 2022",readingETA:"0",abstract:"Due to the risk of radiation exposure, radiation dosimetry is performed regularly to ensure the occupational safety of personnel and radiation workers. Therefore, various dosimeters are widely used to detect neutrons, gamma, X-ray, and proton irradiation fields. As an example, in medical applications, routine personal dosimetry is used to monitor and limit workers’ long-term occupational exposure. Radiation workers who undertake X-ray diagnostic, radiotherapy operations, in clinical and industrial application. Although, the overheads of running an in-house TLD (Thermoluminescent dosimetry) service for monitoring doses to eyes, pacemakers and so on seems rather high for the benefits conferred, however, it is still widely used for reporting doses accurately in various medical centers over the world. TLD also is widely used for measuring entrance doses on a handful of patients to validate a new LINAC/TPS combination. As well as in the industrial field as if petroleum, companies or nuclear reactor, RSO (radiation safety officer) used TLD badges to report delivered doses. In this chapter, we focus on the TLD technique for measuring doses of various ionizing radiation detection. Different methods for evaluations of TL Kinetics are covered. Modern TLD applications in the clinical field are also investigated. Some recommendations on advance dosimetry failure of TLD are concluded.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/80975",risUrl:"/chapter/ris/80975",signatures:"Hossam Donya",book:{id:"11247",type:"book",title:"Dosimetry",subtitle:null,fullTitle:"Dosimetry",slug:null,publishedDate:null,bookSignature:"Dr. Thomas J. FitzGerald",coverURL:"https://cdn.intechopen.com/books/images_new/11247.jpg",licenceType:"CC BY 3.0",editedByType:null,isbn:"978-1-80355-460-0",printIsbn:"978-1-80355-459-4",pdfIsbn:"978-1-80355-461-7",isAvailableForWebshopOrdering:!0,editors:[{id:"241806",title:"Dr.",name:"Thomas J.",middleName:null,surname:"FitzGerald",slug:"thomas-j.-fitzgerald",fullName:"Thomas J. FitzGerald"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"297802",title:"Dr.",name:"Hossam",middleName:null,surname:"Donya",fullName:"Hossam Donya",slug:"hossam-donya",email:"hdunia@kau.edu.sa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/297802/images/17391_n.jpg",institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_1_2",title:"1.1 TLD applications in neutron and gamma ray dosimetry",level:"2"},{id:"sec_1_3",title:"1.1.1 Albedo neutron dosimeter",level:"3"},{id:"sec_2_3",title:"1.1.2 Hydrogenous radiator TLDs",level:"3"},{id:"sec_3_3",title:"1.1.3 LET-dependent deep trap TLD glow peaks",level:"3"},{id:"sec_6",title:"2. Characteristic of TLD phosphors",level:"1"},{id:"sec_6_2",title:"2.1 The glow curve",level:"2"},{id:"sec_7_2",title:"2.2 TL sensitivity",level:"2"},{id:"sec_8_2",title:"2.3 Dose rate dependence",level:"2"},{id:"sec_9_2",title:"2.4 Stability",level:"2"},{id:"sec_11",title:"3. TL kinetics",level:"1"},{id:"sec_11_2",title:"3.1 First kinetics order",level:"2"},{id:"sec_11_3",title:"3.1.1 Second kinetics order",level:"3"},{id:"sec_12_3",title:"3.1.2 A single TL peak analysis",level:"3"},{id:"sec_13_3",title:"3.1.3 General-order kinetics",level:"3"},{id:"sec_14_3",title:"3.1.4 Trap parameters evaluation techniques",level:"3"},{id:"sec_14_4",title:"3.1.4.1 Empirical methods",level:"4"},{id:"sec_15_4",title:"3.1.4.2 Initial rise method",level:"4"},{id:"sec_16_4",title:"3.1.4.3 Peak shape method",level:"4"},{id:"sec_17_4",title:"3.1.4.4 Various heating rates method",level:"4"},{id:"sec_19_3",title:"3.1.5 Three points method",level:"3"},{id:"sec_20_3",title:"3.1.6 Glow curve analysis (peak shape methods)",level:"3"},{id:"sec_23",title:"4. Modern clinical applications of TLD",level:"1"},{id:"sec_24",title:"5. Conclusion",level:"1"}],chapterReferences:[{id:"B1",body:'Furuta Y, Tanaka S. Response of 6LiF and 7LiF thermoluminescence dosimeters to fast neutrons. 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Results in Physics. 2021;25:104222'},{id:"B11",body:'Begum M, Rahman AM, Abdul-Rashid HA, Yusoff Z, Nawi SN, Khandaker MU, et al. Photonic crystal fibre as a potential medium for radiotherapy dosimetry. Applied Radiation and Isotopes. 2021;174:109771'},{id:"B12",body:'Saray AA, Kaviani P, Shahbazi-Gahrouei D. Dosimetric characteristics of lithium triborate (LiB3O5) nanophosphor for medical applications. Radiation Measurements. 2021;140:106502'},{id:"B13",body:'Horowitz YS, Yossian D. Computerised glow curve deconvolution: Application to thermoluminescence dosimetry. Radiation Protection Dosimetry. 1995;60(1):1-114'},{id:"B14",body:'Randall JT, Wilkins MHF. Phosphorescence and electron traps II. The interpretation of long-period phosphorescence. Proceedings of the Royal Society of London. Series A. Mathematical and Physical Sciences. 1945;184(999):390-407'},{id:"B15",body:'Garlick GFJ, Wilkins MHF. Short period phosphorescence and electron traps. Proceedings of the Royal Society of London. Series A. Mathematical and Physical Sciences. 1945;184(999):408-433'},{id:"B16",body:'Chen R. On the calculation of activation energies and frequency factors from glow curves. Journal of Applied Physics. 1969;40(2):570-585'},{id:"B17",body:'Wrzesińska A. Their production and thermoluminescence curves. Acta Physica Polonica. 1956;15:151'},{id:"B18",body:'Adirovitch EI. La formule de Becquerel et la loi élémentaire du déclin de la luminescence des phosphores cristallins. Journal de Physique et le Radium. 1956;17(8-9):705-707'},{id:"B19",body:'Halperin A, Braner AA, Ben-Zvi A, Kristianpoller N. Thermal activation energies in NaCl and KCl crystals. Physical Review. 1960;117(2):416'},{id:"B20",body:'Dussel GA, Bube RH. Theory of thermally stimulated conductivity in a previously photoexcited crystal. Physical Review. 1967;155(3):764'},{id:"B21",body:'Saunders IJ. The thermally stimulated luminescence and conductivity of insulators. Journal of Physics C: Solid State Physics. 1969;2(12):2181'},{id:"B22",body:'De Muer D. Development of a universal method for calculating the thermoluminescence parameters. Physica. 1970;48(1):1-12'},{id:"B23",body:'Bräunlich P, Kelly P, Fillard JP. Thermally stimulated luminescence and conductivity. In: Thermally Stimulated Relaxation in Solids. Berlin, Heidelberg: Springer; 1979. pp. 35-92'},{id:"B24",body:'Moharil SV. On the general‐order kinetics in thermoluminescence. Physica Status Solidi A: Applications and Materials Science. 1982;73(2):509-514'},{id:"B25",body:'Rasheedy MS. A new evaluation technique for analyzing the thermoluminescence glow curve and calculating the trap parameters. Thermochimica Acta. 2005;429(2):143-147'},{id:"B26",body:'May CE, Partridge JA. Thermoluminescent kinetics of alpha‐irradiated alkali halides. The Journal of Chemical Physics. 1964;40(5):1401-1409'},{id:"B27",body:'Prokić M. Analysis of the thermoluminescence glow curves of natural barite. Journal of Physics and Chemistry of Solids. 1977;38(6):617-622'},{id:"B28",body:'De Blasi C, Gallassini S, Manfredotti C, Micocci G, Ruggiero L, Tepore A. Trapping levels in PbI2. Solid State Communications. 1978;25(3):149-153'},{id:"B29",body:'Urbach R. Zur lumineszenz der alkalihalogenide. Sitzungsberichte Akad. der Wiss. Wien. 1930;139:363-372'},{id:"B30",body:'Urbach F. Storage and Release of Light by Phosphors. Vol. 115. New York: John Wiley and Sons; 1948'},{id:"B31",body:'Miller LD, Bube RH. Luminescence, trapping, and F centers in lithium fluoride crystals. Journal of Applied Physics. 1970;41(9):3687-3697'},{id:"B32",body:'Ratovonjanahary AJF, Raboanary R, Andriambololona R. Quartz Glow-Peaks Lifetime Analysis: TL Glow-Curve Deconvolution Functions for First Order of Kinetic Compared to Initial Rise Method. In: HEPMAD 04 Conference, Madagascar, 27 Sep-01 Oct. 2004'},{id:"B33",body:'Christodoulides C. Errors involved in the determination of activation energies in TL and TSDC by the initial rise method. Journal of Physics D: Applied Physics. 1985;18(8):1665'},{id:"B34",body:'Grossweiner LI. A note on the analysis of first‐order glow curves. Journal of Applied Physics. 1953;24(10):1306-1307'},{id:"B35",body:'Lushchik CB. The investigation of trapping centers in crystals by the method of thermal bleaching. Soviet Physics Jetp-USSR. 1956;3(3):390-399'},{id:"B36",body:'Booth AH. Calculation of electron trap depths from thermoluminescence maxima. Canadian Journal of Chemistry. 1954;32(2):214-215'},{id:"B37",body:'Chen R, Winer SAA. Effects of various heating rates on glow curves. Journal of Applied Physics. 1970;41(13):5227-5232'},{id:"B38",body:'Chen R, Kirsh Y. Analysis of Thermally Stimulated Process. Oxford: Pergamon Press; 1981'},{id:"B39",body:'Hoogenstraaten W. Electron traps in zinc sulphide phosphors. Philips Research Reports. 1958;13:515-693'},{id:"B40",body:'Rasheedy MS. On the general-order kinetics of the thermoluminescence glow peak. Journal of Physics: Condensed Matter. 1993;5(5):633'},{id:"B41",body:'Rasheedy MSRMS. A complete system for obtaining the trap parameters of thermoluminescence glow peak. Japanese Journal of Applied Physics. 1996;35(2R):634'},{id:"B42",body:'Bos AJJ, Piters TM, Gómez-Ros JM, Delgado A. An intercomparison of glow curve analysis computer programs: I. Synthetic glow curves. Radiation Protection Dosimetry. 1993;47(1-4):473-477'},{id:"B43",body:'Puchalska M, Bilski P. GlowFit—A new tool for thermoluminescence glow-curve deconvolution. Radiation Measurements. 2006;41(6):659-664'},{id:"B44",body:'Alvarez P, Kry SF, Stingo F, Followill D. TLD and OSLD dosimetry systems for remote audits of radiotherapy external beam calibration. Radiation Measurements. 2017;106:412-415'},{id:"B45",body:'Koger B, Price R, Wang D, Toomeh D, Geneser S, Ford E. Impact of the MLC leaf-tip model in a commercial TPS: Dose calculation limitations and IROC-H phantom failures. Journal of Applied Clinical Medical Physics. 2020;21(2):82-88'},{id:"B46",body:'Nilsson I, Himmelman J, Khan J, Dalmo J. The potential to use Tld measurements to validate the occupational radiation protection at the Department of Nuclear Medicine. Radiation Protection Dosimetry. 2021;195(3-4):355-362'},{id:"B47",body:'Pavičar B, Davidović J, Petrović B, Vuleta G, Trivić S, Šajinović V, et al. Nuclear medicine staff exposure to ionising radiation in 18F-FDG PET/CT practice: A preliminary retrospective study. Arhiv za Higijenu Rada i Toksikologiju. 2021;72(3):216-223'},{id:"B48",body:'Petrovic B, Vicko F, Radovanovic D, Samac J, Tot A, Radovanovic Z, et al. Occupational radiation dose of personnel involved in sentinel node biopsy procedure. Journal of Medical Physics. 2021;91:117-120'},{id:"B49",body:'Ali W, Sulieman A, Tamam N, Boshara N, Aldhebaib A, Alkhorayef M, et al. Estimation of patients organ doses and staff exposure during bone scan examination. Radiation Physics and Chemistry. 2021;188:109693'},{id:"B50",body:'Frank M, Urban T, Willer K, Noichl W, De Marco F, Schick R, et al. Dosimetry on first clinical dark-field chest radiography. Medical Physics. 2021;48(10):6152-6159'},{id:"B51",body:'Omojola AD, Akpochafor MO, Adeneye SO, Akala IO, Agboje AA. Chest X-rays of newborns in a medical facility: Variation between the entrance skin dose measurements using the indirect and direct methods for clinical dose audit. Japanese Journal of Radiology. 2021;40(2):1-7'},{id:"B52",body:'Moradi F, Khandaker MU, Mahdiraji GA, Ung NM, Bradley DA. Dose mapping inside a gamma irradiator measured with doped silica fibre dosimetry and Monte Carlo simulation. Radiation Physics and Chemistry. 2017;140:107-111'},{id:"B53",body:'Moradi F, Ung NM, Mahdiraji GA, Khandaker MU, Entezam A, See MH, et al. Angular dependence of optical fibre thermoluminescent dosimeters irradiated using kilo- and megavoltage X-rays. Radiation Physics and Chemistry. 2017;135:4-10'},{id:"B54",body:'Moradi F, Mahdiraji GA, Dermosesian E, Khandaker MU, Ung NM, Mahamd Adikan FR, et al. Influence of dose history on thermoluminescence response of Ge-doped silica optical fibre dosimeters. Radiation Physics and Chemistry. 2017;134:62-70'},{id:"B55",body:'Kato T, Sagara T, Komori S, Kato R, Takeuchi A, Narita Y. Dosimetric properties of a newly developed thermoluminescent sheet-type dosimeter for clinical proton beams. Journal of Applied Clinical Medical Physics. 2021;22(4):158-165'},{id:"B56",body:'Donya H, Seniwal B, Darwesh R, Fonseca TC. Prospective Monte Carlo simulation for choosing high efficient detectors for small-field dosimetry. In: Theory, Application, and Implementation of Monte Carlo Method in Science and Technology. London: IntechOpen; 2019'},{id:"B57",body:'Donya H. Pencil-beam fluence evaluation based on Monte Carlo simulations algorithm of high energetic treatment photons. Journal of Medical Signals and Sensors. 2018;8(2):81'},{id:"B58",body:'Massillon-JL G. Future directions on low-energy radiation dosimetry. Scientific Reports. 2021;11:10569. DOI: 10.1038/s41598-021-90152-3'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Hossam Donya",address:"hdunia@kau.edu.sa",affiliation:'
Faculty of Science, Department of Physics, King Abdulaziz University, Saudi Arabia
Faculty of Science, Physics Department, Menoufia University, Egypt
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Antibacterial photodynamic therapy (aPDT) has drawn increasing attention from the scientific society for its potential to kill multidrug‐resistant pathogenic bacteria and for its low tendency to induce drug resistance. In this chapter, we summarize the mechanism of action of aPDT, the photosensitizers, as well the current developments in terms of treating Gram‐positive and Gram‐negative bacteria. The chapter also describes the recent progress relating to photomedicine for preventing bacterial infections and biofilm formation. We focus on the laser device used in aPDT and on the light‐treatment parameters that may have a strong impact on the results of aPDT experiments. In the last part of this chapter, we survey on the various nanoparticles delivering photoactive molecules, and photoactive‐nanoparticles that can potentially enhance the antimicrobial action of aPDT.",signatures:"Nora Bloise, Paolo Minzioni, Marcello Imbriani and Livia Visai",authors:[{id:"188428",title:"Dr.",name:"Nora",surname:"Bloise",fullName:"Nora Bloise",slug:"nora-bloise",email:"nora.bloise@unipv.it"},{id:"194755",title:"Dr.",name:"Paolo",surname:"Minzoni",fullName:"Paolo Minzoni",slug:"paolo-minzoni",email:"paolo.minzioni@unipv.it"},{id:"194756",title:"Prof.",name:"Marcello",surname:"Imbriani",fullName:"Marcello Imbriani",slug:"marcello-imbriani",email:"marcello.imbriani@unipv.it"},{id:"194757",title:"Prof.",name:"Livia",surname:"Visai",fullName:"Livia Visai",slug:"livia-visai",email:"livia.visai@unipv.it"}],book:{id:"5398",title:"Photomedicine",slug:"photomedicine-advances-in-clinical-practice",productType:{id:"1",title:"Edited Volume"}}}],collaborators:[{id:"30935",title:"Prof.",name:"Vladan",surname:"Koncar",slug:"vladan-koncar",fullName:"Vladan Koncar",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"46034",title:"Mr.",name:"Cedric",surname:"Cochrane",slug:"cedric-cochrane",fullName:"Cedric Cochrane",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"187787",title:"Dr.",name:"Paola",surname:"Savoia",slug:"paola-savoia",fullName:"Paola Savoia",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Eastern Piedmont Amadeo Avogadro",institutionURL:null,country:{name:"Italy"}}},{id:"187875",title:"Ph.D. Student",name:"Yesim",surname:"Oguz",slug:"yesim-oguz",fullName:"Yesim Oguz",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Lille Nord de France",institutionURL:null,country:{name:"France"}}},{id:"188428",title:"Dr.",name:"Nora",surname:"Bloise",slug:"nora-bloise",fullName:"Nora Bloise",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},{id:"188512",title:"Prof.",name:"Toshihiro",surname:"Kushibiki",slug:"toshihiro-kushibiki",fullName:"Toshihiro Kushibiki",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"National Defense Medical College",institutionURL:null,country:{name:"Japan"}}},{id:"188619",title:"Dr.",name:"Giorgio",surname:"Delrosso",slug:"giorgio-delrosso",fullName:"Giorgio Delrosso",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"194310",title:"Prof.",name:"Serge",surname:"Mordon",slug:"serge-mordon",fullName:"Serge Mordon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"194756",title:"Prof.",name:"Marcello",surname:"Imbriani",slug:"marcello-imbriani",fullName:"Marcello Imbriani",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"194757",title:"Prof.",name:"Livia",surname:"Visai",slug:"livia-visai",fullName:"Livia Visai",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null}]},generic:{page:{slug:"retraction-and-correction-policy",title:"Retraction and Correction Policy",intro:"
IntechOpen implements a robust policy to minimize and deal with instances of fraud or misconduct. As part of our general commitment to transparency and openness, and in order to maintain high scientific standards, we have a well-defined editorial policy regarding Retractions and Corrections.
",metaTitle:"Retraction and Correction Policy",metaDescription:"Retraction and Correction Policy",metaKeywords:null,canonicalURL:"/page/retraction-and-correction-policy",contentRaw:'[{"type":"htmlEditorComponent","content":"
IntechOpen’s Retraction and Correction Policy has been developed in accordance with the Committee on Publication Ethics (COPE) publication guidelines relating to scientific misconduct and research ethics:
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1. RETRACTIONS
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A Retraction of a Chapter will be issued by the Academic Editor, either following an Author’s request to do so or when there is a 3rd party report of scientific misconduct. Upon receipt of a report by a 3rd party, the Academic Editor will investigate any allegations of scientific misconduct, working in cooperation with the Author(s) and their institution(s).
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A formal Retraction will be issued when there is clear and conclusive evidence of any of the following:
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Data fabrication
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Data recycling in a purportedly original research article
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Severe plagiarism - whether or not the plagiarism is to be deemed severe will be determined by the Academic Editor and verified by plagiarism checking software
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Double publication
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Copyright infringement - for example, if a Chapter uses copyrighted figures without permission.
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Unreliable findings
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Unethical research practices
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Any other practice or act considered potentially harmful to the scientific community.
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Publishing of a Retraction Notice will adhere to the following guidelines:
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All relevant bibliographic information about a retracted Chapter will be given in the title.
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A Retraction Notice will be published as a regular book Chapter and will be given its own Chapter number.
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Authors shall be required to approve a proposed retraction of their Chapter. If Authors maintain that their Chapter should not be retracted, the Academic Editor may issue a Statement of Concern (see 2. below).
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1.2. REMOVALS AND CANCELLATIONS
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Additionally, a Chapter retracted on grounds of copyright infringement (e.g. double publication) may be Removed by the publisher should the original copyright owner request such action. A Chapter retracted on grounds of its potential to harm the scientific community, for example, when a Chapter is defamatory in nature, may also be subject to removal.
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No formal Removal Notice will be published but a notice citing the reason for removal will be prominently displayed in place of a retracted and subsequently removed Chapter.
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Chapters published due to inadvertent production mistakes shall be canceled and the cancellation notice will be published.
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\\n\\n
2. STATEMENTS OF CONCERN
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A Statement of Concern detailing alleged misconduct will be issued by the Academic Editor or publisher following a 3rd party report of scientific misconduct when:
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\\n\\t
Authors refuse to approve a retraction proposed by the Academic Editor
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There is inconclusive evidence of scientific misconduct
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Authors and their respective institutions fail or refuse to provide adequate assistance in an investigation
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The publication of a Statement of Concern will adhere to the Retraction Notice guidelines outlined above
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An article PDF for which a Statement of Concern is published will remain available online without being edited or watermarked
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IntechOpen believes that the number of occasions on which a Statement of Concern is issued will be very few in number. In all cases when such a decision has been taken by the Academic Editor the decision will be reviewed by another editor to whom the author can make representations.
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3. CORRECTIONS
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A Correction will be issued by the Academic Editor when:
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Only a small portion of a Chapter is flawed in a way that does not severely affect any findings.
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It is determined that the scientific community would be better served by a Correction rather than a Retraction.
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Corrections will be issued in one of two distinct forms -- ERRATUM or CORRIGENDUM, depending on the origin of a mistake.
\\n
\\n\\n
3.1. ERRATUM
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An Erratum will be issued by the Academic Editor when it is determined that a mistake in a Chapter originates from the production process handled by the publisher.
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A published Erratum will adhere to the Retraction Notice publishing guidelines outlined above.
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3.2. CORRIGENDUM
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A Corrigendum will be issued by the Academic Editor when it is determined that a mistake in a Chapter is a result of an Author’s miscalculation or oversight. A published Corrigendum will adhere to the Retraction Notice publishing guidelines outlined above.
\\n\\n
4. FINAL REMARKS
\\n\\n
IntechOpen wishes to emphasize that the final decision on whether a Retraction, Statement of Concern, or a Correction will be issued rests with the Academic Editor. The publisher is obliged to act upon any reports of scientific misconduct in its publications and to make a reasonable effort to facilitate any subsequent investigation of such claims.
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In the case of Retraction or removal of the Work, the publisher will be under no obligation to refund the APC.
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The general principles set out above apply to Retractions and Corrections issued in all IntechOpen publications.
IntechOpen’s Retraction and Correction Policy has been developed in accordance with the Committee on Publication Ethics (COPE) publication guidelines relating to scientific misconduct and research ethics:
\n\n
1. RETRACTIONS
\n\n
A Retraction of a Chapter will be issued by the Academic Editor, either following an Author’s request to do so or when there is a 3rd party report of scientific misconduct. Upon receipt of a report by a 3rd party, the Academic Editor will investigate any allegations of scientific misconduct, working in cooperation with the Author(s) and their institution(s).
\n\n
A formal Retraction will be issued when there is clear and conclusive evidence of any of the following:
\n\n
\n\t
Data fabrication
\n\t
Data recycling in a purportedly original research article
\n\t
Severe plagiarism - whether or not the plagiarism is to be deemed severe will be determined by the Academic Editor and verified by plagiarism checking software
\n\t
Double publication
\n\t
Copyright infringement - for example, if a Chapter uses copyrighted figures without permission.
\n\t
Unreliable findings
\n\t
Unethical research practices
\n\t
Any other practice or act considered potentially harmful to the scientific community.
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\n\n
Publishing of a Retraction Notice will adhere to the following guidelines:
\n\n\n\t
All relevant bibliographic information about a retracted Chapter will be given in the title.
\n\t
A Retraction Notice will be published as a regular book Chapter and will be given its own Chapter number.
\n\n\n
\n\t
Authors shall be required to approve a proposed retraction of their Chapter. If Authors maintain that their Chapter should not be retracted, the Academic Editor may issue a Statement of Concern (see 2. below).
\n
\n\n
1.2. REMOVALS AND CANCELLATIONS
\n\n
\n\t
Additionally, a Chapter retracted on grounds of copyright infringement (e.g. double publication) may be Removed by the publisher should the original copyright owner request such action. A Chapter retracted on grounds of its potential to harm the scientific community, for example, when a Chapter is defamatory in nature, may also be subject to removal.
\n\t
No formal Removal Notice will be published but a notice citing the reason for removal will be prominently displayed in place of a retracted and subsequently removed Chapter.
\n\t
Chapters published due to inadvertent production mistakes shall be canceled and the cancellation notice will be published.
\n
\n\n
2. STATEMENTS OF CONCERN
\n\n
A Statement of Concern detailing alleged misconduct will be issued by the Academic Editor or publisher following a 3rd party report of scientific misconduct when:
\n\n
\n\t
Authors refuse to approve a retraction proposed by the Academic Editor
\n\t
There is inconclusive evidence of scientific misconduct
\n\t
Authors and their respective institutions fail or refuse to provide adequate assistance in an investigation
\n\t
The publication of a Statement of Concern will adhere to the Retraction Notice guidelines outlined above
\n\t
An article PDF for which a Statement of Concern is published will remain available online without being edited or watermarked
\n
\n\n
IntechOpen believes that the number of occasions on which a Statement of Concern is issued will be very few in number. In all cases when such a decision has been taken by the Academic Editor the decision will be reviewed by another editor to whom the author can make representations.
\n\n
3. CORRECTIONS
\n\n
A Correction will be issued by the Academic Editor when:
\n\n
\n\t
Only a small portion of a Chapter is flawed in a way that does not severely affect any findings.
\n\t
It is determined that the scientific community would be better served by a Correction rather than a Retraction.
\n\t
Corrections will be issued in one of two distinct forms -- ERRATUM or CORRIGENDUM, depending on the origin of a mistake.
\n
\n\n
3.1. ERRATUM
\n\n
An Erratum will be issued by the Academic Editor when it is determined that a mistake in a Chapter originates from the production process handled by the publisher.
\n\n
A published Erratum will adhere to the Retraction Notice publishing guidelines outlined above.
\n\n
3.2. CORRIGENDUM
\n\n
A Corrigendum will be issued by the Academic Editor when it is determined that a mistake in a Chapter is a result of an Author’s miscalculation or oversight. A published Corrigendum will adhere to the Retraction Notice publishing guidelines outlined above.
\n\n
4. FINAL REMARKS
\n\n
IntechOpen wishes to emphasize that the final decision on whether a Retraction, Statement of Concern, or a Correction will be issued rests with the Academic Editor. The publisher is obliged to act upon any reports of scientific misconduct in its publications and to make a reasonable effort to facilitate any subsequent investigation of such claims.
\n\n
In the case of Retraction or removal of the Work, the publisher will be under no obligation to refund the APC.
\n\n
The general principles set out above apply to Retractions and Corrections issued in all IntechOpen publications.
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ASD is associated with deficiencies in communication and social interaction, as well as restricted and repetitive behavioural patterns, according to the fifth edition of the diagnostic and statistical manual of mental disorders (DSM-5). By using the ISI Web of Knowledge as the reference data basis, we perform a bibliometric study of the use of VR as an educational tool for high-functioning ASD children. By this study we can quantify, on the one hand, the up to day importance of the different types of VR applied to this field: immersive or non-immersive, as well as the use of human or agent avatars. On the other hand, we can also differentiate amongst those interventions that work on emotional and social competences. The analysis of periods of research scarce, research abundance and research trends provides a dynamic view of the strategies used in this field in the last 20 years and suggests future lines of research.",book:{id:"6327",slug:"contemporary-perspective-on-child-psychology-and-education",title:"Contemporary Perspective on Child Psychology and Education",fullTitle:"Contemporary Perspective on Child Psychology and Education"},signatures:"Jorge Fernández-Herrero, Gonzalo Lorenzo-Lledó and Asunción\nLledó Carreres",authors:[{id:"187920",title:"Prof.",name:"Gonzalo",middleName:null,surname:"Lorenzo",slug:"gonzalo-lorenzo",fullName:"Gonzalo Lorenzo"},{id:"189580",title:"Prof.",name:"Asunción",middleName:null,surname:"Lledó",slug:"asuncion-lledo",fullName:"Asunción Lledó"},{id:"213024",title:"Mr.",name:"Jorge",middleName:null,surname:"Fernandez-Herrero",slug:"jorge-fernandez-herrero",fullName:"Jorge Fernandez-Herrero"}]},{id:"68639",doi:"10.5772/intechopen.88569",title:"Social Media and Young People’s Mental Health",slug:"social-media-and-young-people-s-mental-health",totalDownloads:2079,totalCrossrefCites:1,totalDimensionsCites:3,abstract:"Evidence suggests that social media can impact detrimentally on children and young people’s mental health. At the same time, social media use can be beneficial and have positive effects. This chapter outlines the detrimental and positive effects of social media use for young people. Schools play a critical role in educating young people about how to use social media safely and responsibly. However, schools cannot address all the issues and parents, social media and advertising companies also have a responsibility to protect children and young people from harm. This chapter outlines some of the potential solutions to the issues that are identified.",book:{id:"7927",slug:"selected-topics-in-child-and-adolescent-mental-health",title:"Selected Topics in Child and Adolescent Mental Health",fullTitle:"Selected Topics in Child and Adolescent Mental Health"},signatures:"Jonathan Glazzard and Samuel Stones",authors:[{id:"294281",title:"Prof.",name:"Jonathan",middleName:null,surname:"Glazzard",slug:"jonathan-glazzard",fullName:"Jonathan Glazzard"},{id:"309587",title:"Mr.",name:"Samuel",middleName:"Oliver James",surname:"Stones",slug:"samuel-stones",fullName:"Samuel Stones"}]},{id:"57269",doi:"10.5772/intechopen.71265",title:"Enhancing Young Children’s Access to Early Childhood Education and Care in Tanzania",slug:"enhancing-young-children-s-access-to-early-childhood-education-and-care-in-tanzania",totalDownloads:1478,totalCrossrefCites:2,totalDimensionsCites:2,abstract:"This chapter draws on the current situation of limited access of young children to early childhood education and care (ECEC) settings in Tanzania. It offers information and evidence on early childhood education and care (ECEC) from an international perspective to those who are, directly or indirectly, involved with young children and their families. Basically, early childhood education and care in Tanzania is still unsatisfactory. Many children have no access to early childhood settings for various reasons including: lack of parents’ awareness on the importance of early investment in education, lack of support from the government, low socio-economic status of parents, gender discrimination, and traditional norms and cultural values. To improve the situation, there is need for a forging of partnership between the government, parents, and the community. Government policy-makers have to set clear policies regarding how quality early childhood education and care can be equitably funded and conducted throughout the country.",book:{id:"6327",slug:"contemporary-perspective-on-child-psychology-and-education",title:"Contemporary Perspective on Child Psychology and Education",fullTitle:"Contemporary Perspective on Child Psychology and Education"},signatures:"Ignasia Mligo",authors:[{id:"212055",title:"Dr.",name:"Ignasia",middleName:null,surname:"Mligo",slug:"ignasia-mligo",fullName:"Ignasia Mligo"}]},{id:"57391",doi:"10.5772/intechopen.71287",title:"Influence of Parental Divorce on Anxiety Level of Adolescents",slug:"influence-of-parental-divorce-on-anxiety-level-of-adolescents",totalDownloads:1864,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"Family divorce might have an effect on some aspects of child development. Adolescence as a transitional stage is marked by process of seeking identity, the need for intimate relationship, as well as the struggle for psychological independence from family. Anxiety is defined as a state of extreme worry, fear, and uncertainty which results from the expectation of a threatening event or situation. The aims of study are: to explore the differences in anxiety levels among adolescents from divorced and intact families; to explore the level of anxiety of adolescents from divorced and intact families with respect to their genders. A demographic questionnaire was created and The Beck Anxiety Inventory was applied to measure anxiety. The scale was applied with 162 participants who were chosen randomly from 5 different high schools in Istanbul province. The study found out that there are statistically significant differences in anxiety level of adolescents between children from divorced and intact families. Descriptive measures are in range as follows: (17.67 ± 9.645). The adolescents from divorced families had a higher level of anxiety (t = 17.322; p < .05). The result related to the second study aim shows that there are no statistically significant differences in anxiety between male and female adolescents from divorced and intact families (p > .05).",book:{id:"6327",slug:"contemporary-perspective-on-child-psychology-and-education",title:"Contemporary Perspective on Child Psychology and Education",fullTitle:"Contemporary Perspective on Child Psychology and Education"},signatures:"Senija Tahirović and Gokce Demir",authors:[{id:"214445",title:"Dr.",name:"Senija",middleName:null,surname:"Tahirovic",slug:"senija-tahirovic",fullName:"Senija Tahirovic"},{id:"214465",title:"MSc.",name:"Gokce",middleName:null,surname:"Demir",slug:"gokce-demir",fullName:"Gokce Demir"}]},{id:"57686",doi:"10.5772/intechopen.71672",title:"Children and Young People’s Vulnerabilities to Grooming",slug:"children-and-young-people-s-vulnerabilities-to-grooming",totalDownloads:2219,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"Child abuse is evolving, pervasive and complex and children are vulnerable to its widespread reach in many aspects of their lives, from face-to-face interactions to those they have online. This chapter aims to review contemporary literature which outlines the vulnerabilities of children to face-to-face and online grooming as part of a process leading to child abuse and exploitation. The chapter will undertake a review of literature on two aspects of grooming: child sexual exploitation (CSE) and radicalisation. It will draw on contemporary case examples to illustrate grooming drawn from UK Serious Case Reviews (SCR) on CSE and, on radicalisation, the case of the three girls from Bethnal Green who were groomed for travel to Syria. It will then reflect on the push and pull factors of grooming to highlight the similarities between CSE and radicalisation. Moving on, the chapter will then consider how and if interactive social media simulations, linked to an innovative, preventative educational approach and designed with reference to Vygotsky’s social construction theory, have the potential to educate young people to help protect them from being groomed. The chapter will then make reference to the findings of a small pilot study which evaluated the use of this approach with young people.",book:{id:"6327",slug:"contemporary-perspective-on-child-psychology-and-education",title:"Contemporary Perspective on Child Psychology and Education",fullTitle:"Contemporary Perspective on Child Psychology and Education"},signatures:"Jane Reeves, Emma Soutar, Sally Green and Tracy Crowther",authors:[{id:"211328",title:"Prof.",name:"Jane",middleName:null,surname:"Reeves",slug:"jane-reeves",fullName:"Jane Reeves"},{id:"211838",title:"Dr.",name:"Tracy",middleName:null,surname:"Crowther",slug:"tracy-crowther",fullName:"Tracy Crowther"},{id:"211839",title:"Mrs.",name:"Emma",middleName:null,surname:"Soutar",slug:"emma-soutar",fullName:"Emma Soutar"},{id:"211840",title:"Mrs.",name:"Sally",middleName:null,surname:"Green",slug:"sally-green",fullName:"Sally Green"}]}],mostDownloadedChaptersLast30Days:[{id:"57686",title:"Children and Young People’s Vulnerabilities to Grooming",slug:"children-and-young-people-s-vulnerabilities-to-grooming",totalDownloads:2219,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"Child abuse is evolving, pervasive and complex and children are vulnerable to its widespread reach in many aspects of their lives, from face-to-face interactions to those they have online. This chapter aims to review contemporary literature which outlines the vulnerabilities of children to face-to-face and online grooming as part of a process leading to child abuse and exploitation. The chapter will undertake a review of literature on two aspects of grooming: child sexual exploitation (CSE) and radicalisation. It will draw on contemporary case examples to illustrate grooming drawn from UK Serious Case Reviews (SCR) on CSE and, on radicalisation, the case of the three girls from Bethnal Green who were groomed for travel to Syria. It will then reflect on the push and pull factors of grooming to highlight the similarities between CSE and radicalisation. Moving on, the chapter will then consider how and if interactive social media simulations, linked to an innovative, preventative educational approach and designed with reference to Vygotsky’s social construction theory, have the potential to educate young people to help protect them from being groomed. The chapter will then make reference to the findings of a small pilot study which evaluated the use of this approach with young people.",book:{id:"6327",slug:"contemporary-perspective-on-child-psychology-and-education",title:"Contemporary Perspective on Child Psychology and Education",fullTitle:"Contemporary Perspective on Child Psychology and Education"},signatures:"Jane Reeves, Emma Soutar, Sally Green and Tracy Crowther",authors:[{id:"211328",title:"Prof.",name:"Jane",middleName:null,surname:"Reeves",slug:"jane-reeves",fullName:"Jane Reeves"},{id:"211838",title:"Dr.",name:"Tracy",middleName:null,surname:"Crowther",slug:"tracy-crowther",fullName:"Tracy Crowther"},{id:"211839",title:"Mrs.",name:"Emma",middleName:null,surname:"Soutar",slug:"emma-soutar",fullName:"Emma Soutar"},{id:"211840",title:"Mrs.",name:"Sally",middleName:null,surname:"Green",slug:"sally-green",fullName:"Sally Green"}]},{id:"68639",title:"Social Media and Young People’s Mental Health",slug:"social-media-and-young-people-s-mental-health",totalDownloads:2079,totalCrossrefCites:1,totalDimensionsCites:3,abstract:"Evidence suggests that social media can impact detrimentally on children and young people’s mental health. At the same time, social media use can be beneficial and have positive effects. This chapter outlines the detrimental and positive effects of social media use for young people. Schools play a critical role in educating young people about how to use social media safely and responsibly. However, schools cannot address all the issues and parents, social media and advertising companies also have a responsibility to protect children and young people from harm. This chapter outlines some of the potential solutions to the issues that are identified.",book:{id:"7927",slug:"selected-topics-in-child-and-adolescent-mental-health",title:"Selected Topics in Child and Adolescent Mental Health",fullTitle:"Selected Topics in Child and Adolescent Mental Health"},signatures:"Jonathan Glazzard and Samuel Stones",authors:[{id:"294281",title:"Prof.",name:"Jonathan",middleName:null,surname:"Glazzard",slug:"jonathan-glazzard",fullName:"Jonathan Glazzard"},{id:"309587",title:"Mr.",name:"Samuel",middleName:"Oliver James",surname:"Stones",slug:"samuel-stones",fullName:"Samuel Stones"}]},{id:"57391",title:"Influence of Parental Divorce on Anxiety Level of Adolescents",slug:"influence-of-parental-divorce-on-anxiety-level-of-adolescents",totalDownloads:1864,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"Family divorce might have an effect on some aspects of child development. Adolescence as a transitional stage is marked by process of seeking identity, the need for intimate relationship, as well as the struggle for psychological independence from family. Anxiety is defined as a state of extreme worry, fear, and uncertainty which results from the expectation of a threatening event or situation. The aims of study are: to explore the differences in anxiety levels among adolescents from divorced and intact families; to explore the level of anxiety of adolescents from divorced and intact families with respect to their genders. A demographic questionnaire was created and The Beck Anxiety Inventory was applied to measure anxiety. The scale was applied with 162 participants who were chosen randomly from 5 different high schools in Istanbul province. The study found out that there are statistically significant differences in anxiety level of adolescents between children from divorced and intact families. Descriptive measures are in range as follows: (17.67 ± 9.645). The adolescents from divorced families had a higher level of anxiety (t = 17.322; p < .05). The result related to the second study aim shows that there are no statistically significant differences in anxiety between male and female adolescents from divorced and intact families (p > .05).",book:{id:"6327",slug:"contemporary-perspective-on-child-psychology-and-education",title:"Contemporary Perspective on Child Psychology and Education",fullTitle:"Contemporary Perspective on Child Psychology and Education"},signatures:"Senija Tahirović and Gokce Demir",authors:[{id:"214445",title:"Dr.",name:"Senija",middleName:null,surname:"Tahirovic",slug:"senija-tahirovic",fullName:"Senija Tahirovic"},{id:"214465",title:"MSc.",name:"Gokce",middleName:null,surname:"Demir",slug:"gokce-demir",fullName:"Gokce Demir"}]},{id:"57167",title:"The Early Childhood Educators’ Attitudes Towards Innovative Instructional Applications about Digital Learning Activities for Young Children",slug:"the-early-childhood-educators-attitudes-towards-innovative-instructional-applications-about-digital-",totalDownloads:1182,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"The innovative value and practices of digital learning activities assist early childhood educators in employing effective instruction to improve young children’s performance as well as advance their own professional autonomy to implement digital learning activities for young children. This study examined the factors and relationships about early childhood educators’ attitudes towards the integration and behavioral intention of digital learning tools into young children’s innovative pedagogical activities using a questionnaire survey. The questionnaire consisted of five factors, including digital innovative value (DIV), digital innovative practices (DIP), perception of instructional use (PIU), instructional professional autonomy (IPA), and behavioral intention to use (BIU). The researcher used structural equation modeling to analyze the survey data. The results showed that early childhood educators’ perceptions about innovative value and applications of digital learning activities play a key role in the success of young children’s performance and competence in preschool. The early childhood educators with positive attitudes towards the innovative consideration and practical instructional applications of digital learning activities had more behavioral intention to plan and design instructional activities with innovative applications of digital learning tools.",book:{id:"6327",slug:"contemporary-perspective-on-child-psychology-and-education",title:"Contemporary Perspective on Child Psychology and Education",fullTitle:"Contemporary Perspective on Child Psychology and Education"},signatures:"Ru-Si Chen",authors:[{id:"211677",title:"Prof.",name:"Ru-Si",middleName:null,surname:"Chen",slug:"ru-si-chen",fullName:"Ru-Si Chen"}]},{id:"57680",title:"Thinking and Learning Demands in Contemporary Childhood",slug:"thinking-and-learning-demands-in-contemporary-childhood",totalDownloads:1457,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Is today’s childhood is the same as the past’s? Frankly speaking, we cannot answer this question as a clear yes. It is obvious that children today are more into tablet computers, social networks and online games than traditional child games. Besides, our communication styles have been changed significantly for the past years. We, no longer need to meet others face to face to ask for help or to chat. Artificial intelligence, machine learning and robots are another story of the contemporary world. Robots capable of perceiving their surroundings and making decisions have started to deprive many people of their jobs. But what kind of jobs will human beings perform? The increasing emphasis on innovation, cooperation, critical thinking, being creative, problem solving, communication skills and project management is an indicator of what kind of a business world will today’s children meet in the future. This on-going trend also includes clues about how should children be educated. This study is focusing on thinking and learning demands expected contemporary children to meet. 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The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{id:"24",title:"Sustainable Development",doi:"10.5772/intechopen.100361",issn:null,scope:"
\r\n\tTransforming our World: the 2030 Agenda for Sustainable Development endorsed by United Nations and 193 Member States, came into effect on Jan 1, 2016, to guide decision making and actions to the year 2030 and beyond. Central to this Agenda are 17 Goals, 169 associated targets and over 230 indicators that are reviewed annually. The vision envisaged in the implementation of the SDGs is centered on the five Ps: People, Planet, Prosperity, Peace and Partnership. This call for renewed focused efforts ensure we have a safe and healthy planet for current and future generations.
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\r\n\tThis Series focuses on covering research and applied research involving the five Ps through the following topics:
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\r\n\t1. Sustainable Economy and Fair Society that relates to SDG 1 on No Poverty, SDG 2 on Zero Hunger, SDG 8 on Decent Work and Economic Growth, SDG 10 on Reduced Inequalities, SDG 12 on Responsible Consumption and Production, and SDG 17 Partnership for the Goals
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\r\n\t2. Health and Wellbeing focusing on SDG 3 on Good Health and Wellbeing and SDG 6 on Clean Water and Sanitation
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\r\n\t3. Inclusivity and Social Equality involving SDG 4 on Quality Education, SDG 5 on Gender Equality, and SDG 16 on Peace, Justice and Strong Institutions
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\r\n\t
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\r\n\t4. Climate Change and Environmental Sustainability comprising SDG 13 on Climate Action, SDG 14 on Life Below Water, and SDG 15 on Life on Land
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\r\n\t5. Urban Planning and Environmental Management embracing SDG 7 on Affordable Clean Energy, SDG 9 on Industry, Innovation and Infrastructure, and SDG 11 on Sustainable Cities and Communities.
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\r\n\tThe series also seeks to support the use of cross cutting SDGs, as many of the goals listed above, targets and indicators are all interconnected to impact our lives and the decisions we make on a daily basis, making them impossible to tie to a single topic.
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