WorldWideScience

Sample records for cancer planning procedures

  1. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... that are at risk of harboring some cancerous cells. So this is an operation that is done ... that are at risk of harboring invisible cancer cells. And so that's why the Whipple procedure is ...

  2. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... chemotherapy, radiation, and surgery. And one of the benefits of having an integrated cancer center is that ... procedure is done that I will have the benefit of considerable expertise here at the cancer center ...

  3. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... then it means that this operation we're planning to do for him this morning is not ... re certain that the procedure that we're planning on doing this morning is one that we ...

  4. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... for this procedure. This gentleman is an otherwise healthy and very pleasant 62-year-old who went ... lining of the abdominal cavity is smooth and healthy. There's no indication of any spread of cancer ...

  5. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available WHIPPLE PROCEDURE FOR PANCREATIC CANCER UNIVERSITY OF MARYLAND MEDICAL CENTER BALTIMORE, MD January 7, 2008 00:00: ... During this webcast from the University of Maryland Medical Center, you'll be able to watch the ...

  6. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... was impressed by the caliber of our own cancer treatment program here. Our radiation therapists were instrumental in ... little bit more about this procedure and the treatment for pancreas cancer. So on behalf of everyone here in the ...

  7. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available WHIPPLE PROCEDURE FOR PANCREATIC CANCER UNIVERSITY OF MARYLAND MEDICAL CENTER BALTIMORE, MD January 7, 2008 00:00:11 ANNOUNCER: This year, an estimated 37,000 new cases of pancreatic cancer will be diagnosed in this country. Since there ...

  8. Radiological Work Planning and Procedures

    CERN Document Server

    Kurtz, J E

    2000-01-01

    Each facility is tasked with maintaining personnel radiation exposure as low as reasonably achievable (ALARA). A continued effort is required to meet this goal by developing and implementing improvements to technical work documents (TWDs) and work performance. A review of selected TWDs from most facilities shows there is a need to incorporate more radiological control requirements into the TWD. The Radioactive Work Permit (RWP) provides a mechanism to place some of the requirements but does not provide all the information needed by the worker as he/she is accomplishing the steps of the TWD. Requiring the engineers, planners and procedure writers to put the radiological control requirements in the work steps would be very easy if all personnel had a strong background in radiological work planning and radiological controls. Unfortunately, many of these personnel do not have the background necessary to include these requirements without assistance by the Radiological Control organization at each facility. In add...

  9. Palliative Procedures in Lung Cancer

    OpenAIRE

    Masuda, Emi; Sista, Akhilesh K.; Pua, Bradley B.; Madoff, David C.

    2013-01-01

    Palliative care aims to optimize comfort and function when cure is not possible. Image-guided interventions for palliative treatment of lung cancer is aimed at local control of advanced disease in the affected lung, adjacent mediastinal structures, or distant metastatic sites. These procedures include endovascular therapy for superior vena cava syndrome, bronchial artery embolization for hemoptysis associated with lung cancer, and ablation of osseous metastasis. Pathophysiology, clinical pres...

  10. Radiological Work Planning and Procedures

    International Nuclear Information System (INIS)

    Each facility is tasked with maintaining personnel radiation exposure as low as reasonably achievable (ALARA). A continued effort is required to meet this goal by developing and implementing improvements to technical work documents (TWDs) and work performance. A review of selected TWDs from most facilities shows there is a need to incorporate more radiological control requirements into the TWD. The Radioactive Work Permit (RWP) provides a mechanism to place some of the requirements but does not provide all the information needed by the worker as he/she is accomplishing the steps of the TWD. Requiring the engineers, planners and procedure writers to put the radiological control requirements in the work steps would be very easy if all personnel had a strong background in radiological work planning and radiological controls. Unfortunately, many of these personnel do not have the background necessary to include these requirements without assistance by the Radiological Control organization at each facility. In addition, there seems to be confusion as to what should be and what should not be included in the TWD

  11. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... MD: In the list of cancers that cause death in this country, pancreas cancer is number four. ... it is the fourth leading cause of cancer death, principally because it is a very tough cancer ...

  12. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... country. Since there is no screening test for pancreas cancer, it is rarely detected in the early ... of cancers that cause death in this country, pancreas cancer is number four. It is not the ...

  13. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... immediate vicinity of the cancer that are at risk of harboring some cancerous cells. So this is ... not there is a higher versus a lower risk of a recurrence from this cancer. And based ...

  14. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... cause of cancer death, principally because it is a very tough cancer to treat effectively. People who ... the cancer has not spread beyond the pancreas, a pancreaticoduodenectomy, more commonly known as a Whipple, could ...

  15. 33 CFR 273.14 - Planning procedures.

    Science.gov (United States)

    2010-07-01

    ... to include physical, chemical and biological methods of control. Priority will be given to biological... control project programs which involve pest control operations, such as aquatic plant control, and affect... DEFENSE AQUATIC PLANT CONTROL § 273.14 Planning procedures. Investigation of new problems...

  16. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... the early stages. 00:00:24 H. RICHARD ALEXANDER, MD: In the list of cancers that cause ... be an option. 00:00:57 H. RICHARD ALEXANDER, MD: It involves removing not only the cancer ...

  17. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... it. 00:00:49 ANNOUNCER: If the cancer has not spread beyond the pancreas, a pancreaticoduodenectomy, more ... there is any indication that this cancerous growth has spread to sites in the abdomen that we ...

  18. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... there is no screening test for pancreas cancer, it is rarely detected in the early stages. 00: ... in this country, pancreas cancer is number four. It is not the fourth most common but it ...

  19. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... 00:49 ANNOUNCER: If the cancer has not spread beyond the pancreas, a pancreaticoduodenectomy, more commonly known ... not have any indication that this growth had spread outside of the region of the pancreas and ...

  20. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... cause death in this country, pancreas cancer is number four. It is not the fourth most common ... wall of the intestine. We've placed a number of these sutures, as you can see, into ...

  1. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... MD January 7, 2008 00:00:11 ANNOUNCER: This year, an estimated 37,000 new cases of pancreatic cancer will be diagnosed in this country. Since there is no screening test for ...

  2. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... in this country. Since there is no screening test for pancreas cancer, it is rarely detected in ... screen and open the door to informed medical care. Now let's join Dr. Richard Alexander at the ...

  3. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... an appropriate operation. The cancer certainly has the capacity to spread little tentacles into the tissues in ... we'll do further diagnostic studies on the lungs or the heart to make certain that they ...

  4. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... an appropriate operation. The cancer certainly has the capacity to spread little tentacles into the tissues in ... would say that we qualify as a high-volume center and probably have upwards of 50 or ...

  5. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... cancer, it is rarely detected in the early stages. 00:00:24 H. RICHARD ALEXANDER, MD: In ... diagnosis are very commonly diagnosed late in the stage of the disease, when it's very difficult to ...

  6. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... painless jaundice. He underwent a series of diagnostic studies which indicated that he had a pancreatic head ... a cancer of the head of pancreas. Subsequent studies performed showed that he did not have any ...

  7. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... the pathologist to do a very, very careful analysis of them. We look for a lot of ... recurrence from this cancer. And based upon that analysis, we very frequently will recommend that an individual ...

  8. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... 11 ANNOUNCER: This year, an estimated 37,000 new cases of pancreatic cancer will be diagnosed in ... or should not be rushed along. Now, with new technologies - - let me put my hand in there ...

  9. Emergency procedure planning to mitigate event progression

    International Nuclear Information System (INIS)

    The emergency procedure guidelines (EPGs) specify actions to control key parameters symptomatically, using every possible system to mitigate event response. When EPGs are implemented as plant-specific emergency operating procedures (EOPs), alternate system instructions are incorporated in addition to standard emergency system instructions. These alternative systems were previously excluded because their event mitigation potential had not been considered. However, pre-planning with the DOP implementation program allows the alternate systems to be available to back up emergency systems if needed, so that if the plant gets to extraordinary or unusual conditions, the operator will have appropriate response instructions and methods. These alternative systems are used to maintain adequate core cooling and decay heat removal, thereby preventing an event from progressing to a severe accident to the maximum extent possible

  10. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... as he describes a Whipple procedure for you. Right here we are in the mastery center, which ... morning as we get through the abdominal wall. Right now we're cutting through the skin and ...

  11. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... cut edge of the common bile duct. That drains bile from the liver into the intestine. And ... procedure. We'll put in a couple of drains and then sew the incision closed. I'm ...

  12. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... not involved with the tumor, then I will review the next steps as we begin to divide ... part of the procedure. So if we just review the anatomy up here a little bit, basically ...

  13. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... as he describes a Whipple procedure for you. Right here we are in the mastery center, which is the University of Maryland Advanced Simulation Training Research and Innovation ...

  14. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... Surgery here at the University of Maryland, where we have on our faculty some of the leading ... describes a Whipple procedure for you. Right here we are in the mastery center, which is the ...

  15. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... the procedure. So if we just review the anatomy up here a little bit, basically we're ... it was influenced by the fact that his anatomy, the arterial anatomy in the porta hepatis region, ...

  16. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... going to sew the front row together slightly differently. Just do one more simple stitch, and then ... like to see a little bit more and learn a little bit more about this procedure and ...

  17. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... these days get treated with a combination of treatments, including chemotherapy, radiation, and surgery. And one of ... up with the best kind of integrated, comprehensive treatment plan for their condition, and that's one of ...

  18. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... commonly diagnosed late in the stage of the disease, when it's very difficult to cure it. 00:00:49 ANNOUNCER: If the cancer has not spread beyond the pancreas, a pancreaticoduodenectomy, more commonly known as a Whipple, ...

  19. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... I'm just going to Bovie the cut edge of the pancreas here. 00:40:26 This ... free of any cancer cells. This is the edge that we'll be staying in, and I ... in a few minutes. And this is the edge of the pancreas right here, which we'll ...

  20. 46 CFR 110.25-3 - Procedure for submitting plans.

    Science.gov (United States)

    2010-10-01

    .... Editorial Note: For Federal Register citations affecting § 110.25-3, see the list of CFR Sections Affected... 46 Shipping 4 2010-10-01 2010-10-01 false Procedure for submitting plans. 110.25-3 Section 110.25... PROVISIONS Plan Submittal § 110.25-3 Procedure for submitting plans. (a) The plans required by §...

  1. Test Plan and Test Procedures Document - Prague Phase II

    OpenAIRE

    Jakobi, Jörn

    2003-01-01

    This document, D16a-TPP, is the output of BETA WP5100 and describes the specific test procedures for Prague airport. It is one of three parts of the “Test Plan and Test Procedures” series of documents. A document is available for each of the test airports to be used in the BETA project: • D16a-TPP Test Plan and Test Procedures document, test procedures for Prague (PRG). • D16b-TPP Test Plan and Test Procedures document, test procedures for Hamburg (HAM). • D16c-TPP Test Plan and Tes...

  2. Virtual occlusion in planning orthognathic surgical procedures.

    NARCIS (Netherlands)

    Nadjmi, N.; Mollemans, W.; Daelemans, A.; Hemelen, G. Van; Schutyser, F.A.C.; Berge, S.J.

    2010-01-01

    Accurate preoperative planning is mandatory for orthognathic surgery. One of the most important aims of this planning process is obtaining good postoperative dental occlusion. Recently, 3D image-based planning systems have been introduced that enable a surgeon to define different osteotomy planes pr

  3. Virtual occlusion in planning orthognathic surgical procedures.

    Science.gov (United States)

    Nadjmi, N; Mollemans, W; Daelemans, A; Van Hemelen, G; Schutyser, F; Bergé, S

    2010-05-01

    Accurate preoperative planning is mandatory for orthognathic surgery. One of the most important aims of this planning process is obtaining good postoperative dental occlusion. Recently, 3D image-based planning systems have been introduced that enable a surgeon to define different osteotomy planes preoperatively and to assess the result of moving different bone fragments in a 3D virtual environment, even for soft tissue simulation of the face. Although the use of these systems is becoming more accepted in orthognathic surgery, few solutions have been proposed for determining optimal occlusion in the 3D planning process. In this study, a 3D virtual occlusion tool is presented that calculates a realistic interaction between upper and lower dentitions. It enables the surgeon to obtain an optimal and physically possible occlusion easily. A validation study, including 11 patient data sets, demonstrates that the differences between manually and virtually defined occlusions are small, therefore the presented system can be used in clinical practice.

  4. Agency procedures for the NRC incident response plan. Final report

    International Nuclear Information System (INIS)

    The NRC Incident Response Plan, NUREG-0728/MC 0502 describes the functions of the NRC during an incident and the kinds of actions that comprise an NRC response. The NRC response plan will be activated in accordance with threshold criteria described in the plan for incidents occurring at nuclear reactors and fuel facilities involving materials licensees; during transportation of licensed material, and for threats against facilities or licensed material. In contrast to the general overview provided by the Plan, the purpose of these agency procedures is to delineate the manner in which each planned response function is performed; the criteria for making those response decisions which can be preplanned; and the information and other resources needed during a response. An inexperienced but qualified person should be able to perform functions assigned by the Plan and make necessary decisions, given the specified information, by becoming familiar with these procedures. This rule of thumb has been used to determine the amount of detail in which the agency procedures are described. These procedures form a foundation for the training of response personnel both in their normal working environment and during planned emergency exercises. These procedures also form a ready reference or reminder checklist for technical team members and managers during a response

  5. Quality Assurance Plan for the AL3 Test Procedure

    CERN Document Server

    Béjar-Alonso, Isabel

    1999-01-01

    This paper describes the new quality assurance plan for the Alarms-of-Level-3 (AL3) test. The aim of the plan is to introduce engineering techniques and to standardise and simplify the procedures for carrying out tests following Safety Instruction 37 (IS37). The procedures are to co-ordinate all the services involved (fire brigade, maintenance and computer support) and to create a consistent documentation. When the procedures are implemented, it will be possible to determine with confidence how field actions are carried out and to measure actual performance. The focus will be on personnel training and documentation. It is important however to keep documentation and procedures to a reasonable level that can be maintained at appropriate intervals. The plan is the result of an internal requirement from ST/MC and a formal request from Installations Nucléaires de Base (INB).

  6. Standard Review Plan Maintenance Program implementing procedures document

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-11-01

    The implementing Procedures Document (IPD) was developed by the Inspection Program Projects Branch, Office of Nuclear Reactor Regulation, with assistance from Pacific Northwest National Laboratory, for the Standard Review Plan Maintenance Program (SRP-MP). The SRP-MP was established to maintain the Standard Review Plan (SRP) on an on-going basis. The IPD provides guidance, including an overall approach and procedures, for SRP-MP tasks. The objective of the IPD is to ensure that modifications to SRP need to reflect current NRC requirements and guidance are identified and that a consistent methodology is used to develop and revise SRP sections.

  7. Standard Review Plan Update and Development Program. Implementing Procedures Document

    Energy Technology Data Exchange (ETDEWEB)

    1992-05-01

    This implementing procedures document (IPD) was prepared for use in implementing tasks under the standard review plan update and development program (SRP-UDP). The IPD provides comprehensive guidance and detailed procedures for SRP-UDP tasks. The IPD is mandatory for contractors performing work for the SRP-UDP. It is guidance for the staff. At the completion of the SRP-UDP, the IPD will be revised (to remove the UDP aspects) and will replace NRR Office Letter No. 800 as long-term maintenance procedures.

  8. 49 CFR 193.2017 - Plans and procedures.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 3 2010-10-01 2010-10-01 false Plans and procedures. 193.2017 Section 193.2017 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) PIPELINE SAFETY LIQUEFIED NATURAL GAS...

  9. 75 FR 53171 - Prohibited Transaction Exemption Procedures; Employee Benefit Plans

    Science.gov (United States)

    2010-08-30

    ... Employee Benefits Security Administration 29 CFR Part 2570 Prohibited Transaction Exemption Procedures; Employee Benefit Plans; Proposed Rule #0;#0;Federal Register / Vol. 75, No. 167 / Monday, August 30, 2010 / Proposed Rules#0;#0; ] DEPARTMENT OF LABOR Employee Benefits Security Administration 29 CFR Part 2570...

  10. 75 FR 54542 - Prohibited Transaction Exemption Procedures; Employee Benefit Plans

    Science.gov (United States)

    2010-09-08

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF LABOR Employee Benefits Security Administration 29 CFR Part 2570 RIN 1210-AA98 Prohibited Transaction Exemption Procedures; Employee Benefit Plans Correction In proposed rule document 2010-21073 beginning on page 53172 in the...

  11. 45 CFR 98.81 - Application and Plan procedures.

    Science.gov (United States)

    2010-10-01

    ... DEVELOPMENT FUND Indian Tribes § 98.81 Application and Plan procedures. (a) In order to receive CCDF funds, a... defined: (i) Indian child; and (ii) Indian reservation or tribal service area. (3) The Tribal Lead Agency... to § 98.82; and (ii) In the case of an applicant located in a State other than Alaska, California,...

  12. ENTERPRISE RESOURCE PLANNING: COMPARISON IMPLEMANTATION PROCEDURES OF TWO COMPANIES

    Directory of Open Access Journals (Sweden)

    Mehmet SAHIN

    2008-10-01

    Full Text Available Advanced information technologies became absolutely necessary part of the companies in today’s competition and velocity environment. The emergence of new information technologies is rapidly changing. One of the new information technologies is Enterprise Resource Planning (ERP system. Companies adapt Enterprise Resource Planning because they want to decrease cost and increase the quality of their product and services. They also try to adapt their processes to more customer-oriented approach and effective customer reaction. The study aims to find out how adopt Enterprise Resource Planning implementation procedures is applied by two companies in Eskisehir province. Also, it identifies success factors, software selection steps, and implementation procedures critical to a successful implementation.

  13. Radiation protection for the sentinel node procedure in breast cancer

    NARCIS (Netherlands)

    de Kanter, AY; Arends, PPAM; Eggermont, AMM; Wiggers, T

    2003-01-01

    Aims: The purpose of our study was to determine the radiation dose for those who are involved in the sentinel node procedure in breast cancer patients and testing of a theoretical model. Methods: We studied 12 consecutive breast cancer patients undergoing breast surgery, and a sentinel node dissecti

  14. Chemical Compatibility Testing Final Report Including Test Plans and Procedures

    International Nuclear Information System (INIS)

    This report provides an independent assessment of information on mixed waste streams, chemical compatibility information on polymers, and standard test methods for polymer properties. It includes a technology review of mixed low-level waste (LLW) streams and material compatibilities, validation for the plan to test the compatibility of simulated mixed wastes with potential seal and liner materials, and the test plan itself. Potential packaging materials were reviewed and evaluated for compatibility with expected hazardous wastes. The chemical and physical property measurements required for testing container materials were determined. Test methodologies for evaluating compatibility were collected and reviewed for applicability. A test plan to meet US Department of Energy and Environmental Protection Agency requirements was developed. The expected wastes were compared with the chemical resistances of polymers, the top-ranking polymers were selected for testing, and the most applicable test methods for candidate seal and liner materials were determined. Five recommended solutions to simulate mixed LLW streams are described. The test plan includes descriptions of test materials, test procedures, data collection protocols, safety and environmental considerations, and quality assurance procedures. The recommended order of testing to be conducted is specified

  15. Heuristic procedures for transmission planning in competitive electricity markets

    International Nuclear Information System (INIS)

    The network structure of the power system, in an electricity market under the pool model, may have severe impacts on market performance, reducing market efficiency considerably, especially when producers bid strategically. In this context network re-enforcement plays a major role and proper strategies of transmission planning need to be devised. This paper presents, for pool-model electricity markets, two heuristic procedures to select the most effective subset of lines that would reduce the impacts on the market, from a set of predefined candidate lines and within the allowed budget for network expansion. A set of indices that account for the economic impacts of the re-enforcing of the candidate lines, both in terms of construction cost and market efficiency, are proposed and used as sensitivity indices in the heuristic procedure. The proposed methods are applied and compared with reference to an 18-bus test system. (author)

  16. Preoperative Planning of Orthopedic Procedures using Digitalized Software Systems.

    Science.gov (United States)

    Steinberg, Ely L; Segev, Eitan; Drexler, Michael; Ben-Tov, Tomer; Nimrod, Snir

    2016-06-01

    The progression from standard celluloid films to digitalized technology led to the development of new software programs to fulfill the needs of preoperative planning. We describe here preoperative digitalized programs and the variety of conditions for which those programs can be used to facilitate preparation for surgery. A PubMed search using the keywords "digitalized software programs," "preoperative planning" and "total joint arthroplasty" was performed for all studies regarding preoperative planning of orthopedic procedures that were published from 1989 to 2014 in English. Digitalized software programs are enabled to import and export all picture archiving communication system (PACS) files (i.e., X-rays, computerized tomograms, magnetic resonance images) from either the local working station or from any remote PACS. Two-dimension (2D) and 3D CT scans were found to be reliable tools with a high preoperative predicting accuracy for implants. The short learning curve, user-friendly features, accurate prediction of implant size, decreased implant stocks and low-cost maintenance makes digitalized software programs an attractive tool in preoperative planning of total joint replacement, fracture fixation, limb deformity repair and pediatric skeletal disorders.

  17. Diagnostic and treatment procedures induced by cervical cancer screening

    NARCIS (Netherlands)

    M. van Ballegooijen (Marjolein); M.A. Koopmanschap (Marc); G.J. van Oortmarssen (Gerrit); J.D.F. Habbema (Dik); N. van der Lubbe (Nils); H.M.A. van Agt (H. M A)

    1990-01-01

    markdownabstractAbstract The amount of diagnostic and treatment procedures induced by cervical cancer screening has been assessed prospectively and related to mortality reduction. Assumptions are based on data from Dutch screening programmes and on a scenario for future developments. With 5 invita

  18. HEMP emergency planning and operating procedures for electric power systems

    Energy Technology Data Exchange (ETDEWEB)

    Reddoch, T.W.; Markel, L.C. (Electrotek Concepts, Inc., Knoxville, TN (United States))

    1991-01-01

    Investigations of the impact of high-altitude electromagnetic pulse (HEMP) on electric power systems and electrical equipment have revealed that HEMP creates both misoperation and failures. These events result from both the early time E[sub 1] (steep-front pulse) component and the late time E[sub 3] (geomagnetic perturbations) component of HEMP. In this report a HEMP event is viewed in terms of its marginal impact over classical power system disturbances by considering the unique properties and consequences of HEMP. This report focuses on system-wide electrical component failures and their potential consequences from HEMP. In particular, the effectiveness of planning and operating procedures for electric systems is evaluated while under the influence of HEMP. This assessment relies on published data and characterizes utilities using the North American Electric Reliability Council's regions and guidelines to model electric power system planning and operations. Key issues addressed by the report include how electric power systems are affected by HEMP and what actions electric utilities can initiate to reduce the consequences of HEMP. The report also reviews the salient features of earlier HEMP studies and projects, examines technology trends in the electric power industry which are affected by HEMP, characterizes the vulnerability of power systems to HEMP, and explores the capability of electric systems to recover from a HEMP event.

  19. Review of State Comprehensive Cancer Control Plans for Genomics Content

    Directory of Open Access Journals (Sweden)

    Robert C. Millikan, DVM, PhD

    2005-03-01

    Full Text Available Introduction The goals of this study were to determine U.S. states with Comprehensive Cancer Control plans that include genomics in some capacity and to review successes with and barriers to implementation of genomics-related cancer control initiatives. Methods This study was conducted in two phases. Phase one included a content analysis of written state Comprehensive Cancer Control plans (n = 30 for terms related to genomics, or “genomic components” (n = 18. The second phase involved telephone interviews with the Comprehensive Cancer Control plan coordinators in states with plans that contained genomic components (n = 16. The interview was designed to gather more detailed information about the genomics-related initiatives within the state’s Comprehensive Cancer Control plan and the successes with and barriers to plan implementation, as defined by each state. Results Eighteen of the 30 Comprehensive Cancer Control plans analyzed contained genomics components. We noted a large variability among these 18 plans in the types of genomics components included. Nine (56% of the 16 states interviewed had begun to implement the genomics components in their plan. Most states emphasized educating health care providers and the public about the role of genomics in cancer control. Many states consider awareness of family history to be an important aspect of their Comprehensive Cancer Control plan. Approximately 67% of states with family history components in their plans had begun to implement these goals. Virtually all states reported they would benefit from additional training in cancer genetics and general public health genomics. Conclusion The number of states incorporating genomics into their Comprehensive Cancer Control plans is increasing. Family history is a public health application of genomics that could be implemented more fully into Comprehensive Cancer Control plans.

  20. 78 FR 57639 - Request for Comments on Pediatric Planned Procedure Algorithm

    Science.gov (United States)

    2013-09-19

    ... Procedure Algorithm AGENCY: Agency for Healthcare Research and Quality (AHRQ), HHS. ACTION: Notice of request for comments on pediatric planned procedure algorithm from the members of the public. SUMMARY... from the public on an algorithm for identifying pediatric planned procedures as part of the...

  1. 14 CFR 151.123 - Procedures: Offer; amendment; acceptance; advance planning agreement.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Procedures: Offer; amendment; acceptance... Planning and Engineering Proposals § 151.123 Procedures: Offer; amendment; acceptance; advance planning.... FAA's offer and the sponsor's acceptance constitute an advance planning grant agreement between...

  2. Effectiveness of arterial embolization procedure in uterine cancer patients.

    Science.gov (United States)

    Hayashi, M; Murakami, A; Iwasaki, N; Yaoi, Y

    1999-01-01

    Patients with late stage gynecologic malignancies occasionally develop massive pelvic hemorrhage, and management of the hemorrhage is often difficult. Transcatheter arterial embolization with an absorbable gelatin sponge following the Seldinger method was performed to control hemorrhage in five patients with cancer of the uterine cervix. Pelvic arteriograms of five patients showed no further extravasation and their bleeding ceased. No patients died of pelvic hemorrhage, and all of them eventually died as a result of the original disease within two years of the procedure. As for complications of this procedure, slight fever (3/5) and minimal lumbar pain (2/5) were noticed, which were easily controlled by an indomethacin suppository. Based on these findings, this therapeutic embolization method proved to be useful in the management of massive pelvic hemorrhage in patients with cervical cancer. PMID:17312676

  3. Spatial Heterogeneity in Cancer Control Planning and Cancer Screening Behavior.

    Science.gov (United States)

    Mobley, Lee R; Kuo, Tzy-Mey; Urato, Matthew; Subramanian, Sujha; Watson, Lisa; Anselin, Luc

    2012-01-01

    Each state is autonomous in its comprehensive cancer control (CCC) program, and considerable heterogeneity exists in the program plans. However, researchers often focus on the concept of nationally representative data and pool observations across states using regression analysis to come up with average effects when interpreting results. Due to considerable state autonomy and heterogeneity in various dimensions-including culture, politics, historical precedent, regulatory environment, and CCC efforts-it is important to examine states separately and to use geographic analysis to translate findings in place and time. We used 100 percent population data for Medicare-insured persons aged 65 or older and examined predictors of breast cancer (BC) and colorectal cancer (CRC) screening from 2001-2005. Examining BC and CRC screening behavior separately in each state, we performed 100 multilevel regressions. We summarize the state-specific findings of racial disparities in screening for either cancer in a single bivariate map of the 50 states, producing a separate map for African American and for Hispanic disparities in each state relative to whites. The maps serve to spatially translate the voluminous regression findings regarding statistically significant disparities between whites and minorities in cancer screening within states. Qualitative comparisons can be made of the states' disparity environments or for a state against a national benchmark using the bivariate maps. We find that African Americans in Michigan and Hispanics in New Jersey are significantly more likely than whites to utilize CRC screening and that Hispanics in 6 states are significantly and persistently more likely to utilize mammography than whites. We stress the importance of spatial translation research for informing and evaluating CCC activities within states and over time. PMID:24944346

  4. Review of State Comprehensive Cancer Control Plans for Genomics Content

    OpenAIRE

    Robert C. Millikan, DVM, PhD; Tejinder Rakhra-Burris, MA; Erin Shaughnessy Zuiker, MPH; Debra E. Irwin, PhD, MSPH

    2005-01-01

    Introduction The goals of this study were to determine U.S. states with Comprehensive Cancer Control plans that include genomics in some capacity and to review successes with and barriers to implementation of genomics-related cancer control initiatives. Methods This study was conducted in two phases. Phase one included a content analysis of written state Comprehensive Cancer Control plans (n = 30) for terms related to genomics, or genomic components (n = 18). The second phase involved te...

  5. 76 FR 66637 - Prohibited Transaction Exemption Procedures; Employee Benefit Plans

    Science.gov (United States)

    2011-10-27

    ...; Employee Benefit Plans AGENCY: Employee Benefits Security Administration, Labor. ACTION: Final rule... FURTHER INFORMATION CONTACT: Eric A. Raps, Office of Exemption Determinations, Employee Benefits Security... relating to employee benefit plans, or provisions of FERSA relating to the Federal Thrift Savings...

  6. 20 CFR 411.595 - What oversight procedures are planned for the EN payment systems?

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false What oversight procedures are planned for the EN payment systems? 411.595 Section 411.595 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE... procedures are planned for the EN payment systems? We use audits, reviews, studies and observation of...

  7. 40 CFR 93.114 - Criteria and procedures: Currently conforming transportation plan and TIP.

    Science.gov (United States)

    2010-07-01

    ... conforming transportation plan and TIP. 93.114 Section 93.114 Protection of Environment ENVIRONMENTAL....114 Criteria and procedures: Currently conforming transportation plan and TIP. There must be a currently conforming transportation plan and currently conforming TIP at the time of project approval, or...

  8. Program Development: Procedures for Long-Range Planning.

    Science.gov (United States)

    Gile, Mary Stuart; And Others

    Intended particularly to help educators meet the requirements of Title I of the Elementary and Secondary Education Act, this handbook on long-range planning was also designed to be used by anyone needing to relate student needs to information gathered through planning and needs assessment activities. The first chapter describes the intent of…

  9. Parent Caregiver Self-Efficacy and Child Reactions to Pediatric Cancer Treatment Procedures

    OpenAIRE

    Peterson, Amy M.; Harper, Felicity W.K.; Albrecht, Terrance L.; Taub, Jeffrey W; Orom, Heather; Phipps, Sean; Penner, Louis A.

    2013-01-01

    This study examined how parents’ sense of self-efficacy specific to caregiving for their child during cancer treatment procedures affected children’s distress and cooperation during procedures. Potential correlates of caregiver self-efficacy (ie, demographics, child clinical characteristics, parent dispositional attributes, and social support) were also examined. Participants were 119 children undergoing cancer treatment procedures and their parents. Parents’ self-efficacy about 6 procedure-s...

  10. Pajarito Plan for Radiation Emergency. Standard operating procedures

    International Nuclear Information System (INIS)

    The Pajarito Plan for Radiation Emergency identifies possible accidents specific to the operations of the Los Alamos Critical Assemblies Facility, specifies the appropriate actions to take in the event of an accident, and assigns responsibility for those actions

  11. Procedure guidelines for radioiodine therapy of differentiated thyroid cancer (version 3)

    International Nuclear Information System (INIS)

    The procedure guideline for radioiodine therapy (RIT) of differentiated thyroid cancer (version 3) is the counterpart to the procedure guideline for 131I whole-body scintigraphy (version 3) and specify the interdisciplinary guideline for thyroid cancer of the Deutsche Krebsgesellschaft concerning the nuclear medicine part. Recommendation for ablative 131I therapy is given for all differentiated thyroid carcinoma (DTC) >1 cm. Regarding DTC ≤1 cm 131I ablation may be helpful in an individual constellation. Preparation for 131I ablation requires low iodine diet for two weeks and TSH stimulation by withdrawal of thyroid hormone medication or by use of recombinant human TSH (rhTSH). The advantages of rhTSH (no symptoms of hypothyroidism, lowerblood activity) and the advantages of endogenous TSH stimulation (necessary for 131I-therapy in patients with metastases, higher sensitivity of 131I whole-body scan) are discussed. In most centers standard activities are used for 131I ablation. If pretherapeutic dosimetry is planned, the diagnostic administration of 131I should not exceed 1-10MBq, alternative tracers are 123I or 124I. The recommendations for contraception and family planning are harmonized with the recommendation of ATA and ETA. Regarding the best possible protection of salivary glands the evidence is insufficient to recommend a specific setting. To minimize the risk of dental caries due to xerostomia patients should use preventive strategies for dental hygiene. (orig.)

  12. Forward Intensity-Modulated Radiotherapy Planning in Breast Cancer to Improve Dose Homogeneity: Feasibility of Class Solutions

    International Nuclear Information System (INIS)

    Purpose: To explore forward planning methods for breast cancer treatment to obtain homogeneous dose distributions (using International Commission on Radiation Units and Measurements criteria) within normal tissue constraints and to determine the feasibility of class solutions. Methods and Materials: Treatment plans were optimized in a stepwise procedure for 60 patients referred for postlumpectomy irradiation using strict dose constraints: planning target volume (PTV)95% of >99%; V107% of 5Gy of 10Gy of 23.6 cm, additional beams were always required.

  13. Managing Health Care After Cancer Treatment: A Wellness Plan

    OpenAIRE

    Moye, Jennifer; Langdon, Maura; Jones, Janice M.; Haggstrom, David; Naik, Aanand D.

    2014-01-01

    Many patients and health care providers lack awareness of both the existence of, and treatments for, lingering distress and disability after treatment. A cancer survivorship wellness plan can help ensure that any referral needs for psychosocial and other restorative care after cancer treatment are identified.

  14. Timeliness of Diagnosing Lung Cancer: Number of Procedures and Time Needed to Establish Diagnosis

    OpenAIRE

    Verma, Akash; Lim, Albert Y. H.; Dessmon Y.H. Tai; Goh, Soon Keng; Kor, Ai Ching; A., Dokeu Basheer A.; Chopra, Akhil; Abisheganaden, John

    2015-01-01

    Abstract To study number of procedures and time to diagnose lung cancer and factors affecting the timeliness of clinching this diagnosis. Retrospective cohort study of lung cancer patients who consecutively underwent diagnostic bronchoscopy in 1 year (October 2013 to September 2014). Out of 101 patients diagnosed with lung cancer from bronchoscopy, average time interval between first abnormal computed tomogram (CT) scan-to-1st procedure, 1st procedure-to-diagnosis, and 1st abnormal CT scan-to...

  15. Brookhaven National Laboratory meteorological services instrument calibration plan and procedures

    Energy Technology Data Exchange (ETDEWEB)

    Heiser .

    2013-02-16

    This document describes the Meteorological Services (Met Services) Calibration and Maintenance Schedule and Procedures, The purpose is to establish the frequency and mechanism for the calibration and maintenance of the network of meteorological instrumentation operated by Met Services. The goal is to maintain the network in a manner that will result in accurate, precise and reliable readings from the instrumentation.

  16. HISTORICAL PROCEDURES AND G-DSG METHOD BASED MANUFACTURING PLANNING

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Oriented to CAD/CAM seamless integration, this paper presents an idea for synthetically considering the qualitative history model, which represents the whole course of modeling, and the quantitative geometry model, which contains the extended Brep model, CSG and feature pedigree. History model building captures in background the dynamic interactive definition of engineering requirement and then explicitly conveys the original intention to successive application layers, which is conductive to the decision support of manufacturing planning in not only automatic geometry re-constructing but also machining set-up. G-DSG theory as an earlier achievement is applied to generate the topology-independent generalized mid-model as an input to manufacturing planning, which is therefore simplified and its accuracy is simultaneously improved. Manufacturing planning lays emphasis on optimizing the mapping in both geometry and function from part itself to detail machining scheme. Comparatively, process planning pays more attention to the mapping to those items like tool, fixture, etc. Theoretically, such an idea is also beneficial to realizing the parametric NC machining trajectory generation and maintaining its dynamic consistency with the update of the design model.

  17. Environmental Monitoring Plan: Environmental Monitoring Section. Appendix A, Procedures

    International Nuclear Information System (INIS)

    This document presents information about the environmental monitoring program at Lawrence Livermore National Laboratory. Topics discussed include: air sampling; air tritium calibrations; storm water discharge; non-storm water discharge; sampling locations; ground water sampling; noise and blast forecasting; analytical laboratory auditing; document retention; procedure writing; quality assurance programs for sampling; soil and sediment sampling; sewage sampling; diversion facility tank sampling; vegetation and foodstuff sampling; and radiological dose assessments

  18. Environmental Monitoring Plan: Environmental Monitoring Section. Appendix A, Procedures

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-02-01

    This document presents information about the environmental monitoring program at Lawrence Livermore National Laboratory. Topics discussed include: air sampling; air tritium calibrations; storm water discharge; non-storm water discharge; sampling locations; ground water sampling; noise and blast forecasting; analytical laboratory auditing; document retention; procedure writing; quality assurance programs for sampling; soil and sediment sampling; sewage sampling; diversion facility tank sampling; vegetation and foodstuff sampling; and radiological dose assessments.

  19. Breast cancer prevention and theory of planned behavior

    OpenAIRE

    Tsounis A.; Sarafis P.

    2014-01-01

    Introduction:Breast cancer is considered to be one of the highest of all forms of cancer among women.Understanding the factors that influence the adoption of preventive behaviors in this particular area is very important. Aim:the aim of the present study is to identify the factors associated with mammography screening, according to the theory of the Planned Behavior framework. Method: the methodology which was used included a literature review of Greek and international bibliograp...

  20. Comparing Treatment Plan in All Locations of Esophageal Cancer

    OpenAIRE

    Lin, Jang-Chun; Tsai, Jo-Ting; Chang, Chih-Chieh; Jen, Yee-Min; Li, Ming-Hsien; Liu, Wei-Hsiu

    2015-01-01

    Abstract The aim of this study was to compare treatment plans of volumetric modulated arc therapy (VMAT) with intensity-modulated radiotherapy (IMRT) for all esophageal cancer (EC) tumor locations. This retrospective study from July 2009 to June 2014 included 20 patients with EC who received definitive concurrent chemoradiotherapy with radiation doses >50.4 Gy. Version 9.2 of Pinnacle3 with SmartArc was used for treatment planning. Dosimetric quality was evaluated based on doses to several or...

  1. Pancreatic cancer planning: Complex conformal vs modulated therapies.

    Science.gov (United States)

    Chapman, Katherine L; Witek, Matthew E; Chen, Hongyu; Showalter, Timothy N; Bar-Ad, Voichita; Harrison, Amy S

    2016-01-01

    To compare the roles of intensity-modulated radiation therapy (IMRT) and volumetric- modulated arc therapy (VMAT) therapy as compared to simple and complex 3-dimensional chemoradiotherpy (3DCRT) planning for resectable and borderline resectable pancreatic cancer. In all, 12 patients who received postoperative radiotherapy (8) or neoadjuvant concurrent chemoradiotherapy (4) were evaluated retrospectively. Radiotherapy planning was performed for 4 treatment techniques: simple 4-field box, complex 5-field 3DCRT, 5 to 6-field IMRT, and single-arc VMAT. All volumes were approved by a single observer in accordance with Radiation Therapy Oncology Group (RTOG) Pancreas Contouring Atlas. Plans included tumor/tumor bed and regional lymph nodes to 45Gy; with tumor/tumor bed boosted to 50.4Gy, at least 95% of planning target volume (PTV) received the prescription dose. Dose-volume histograms (DVH) for multiple end points, treatment planning, and delivery time were assessed. Complex 3DCRT, IMRT, and VMAT plans significantly (p plans that are most commonly reported in the literature. IMRT plans resulted in decreased mean liver dose, liver (V35), and left kidney (V15, V18, V20). VMAT plans decreased small bowel (D10%, D15%), small bowel (V35, V45), stomach (D10%, D15%), stomach (V35, V45), mean liver dose, liver (V35), left kidney (V15, V18, V20), and right kidney (V18, V20). VMAT plans significantly decreased small bowel (D10%, D15%), left kidney (V20), and stomach (V45) as compared with IMRT plans. Treatment planning and delivery times were most efficient for simple 4-field box and VMAT. Excluding patient setup and imaging, average treatment delivery was within 10minutes for simple and complex 3DCRT, IMRT, and VMAT treatments. This article shows significant improvements in 3D plan performance with complex planning over the more frequently compared 3- or 4-field simple 3D planning techniques. VMAT plans continue to demonstrate potential for the most organ sparing. However

  2. State-of-the-art endoscopic procedures for pancreatic cancer.

    Science.gov (United States)

    Coronel, Emmanuel; Waxman, Irving

    2016-09-01

    Pancreatic cancer is the twelfth most common cancer worldwide, taking the fourth place in cancer-related mortality in western countries. Despite significant efforts in understanding the tumor biology of pancreatic cancer and introducing new technologies and therapies to improve the detection, staging and treatment of this disease, pancreatic cancer continues to have a high and almost unchanged mortality. In the last few decades, the development of techniques such as endoscopic retrograde cholangio pancreatography and endoscopic ultrasound have allowed us to directly access the pancreaticobiliary system and fight pancreatic cancer and its complications from different fronts. Our goal with this review is to discuss the most cutting-edge endoscopic techniques available in our armamentarium to diagnose, stage and treat pancreatic cancer. PMID:27339021

  3. Advanced Treatment Planning in Cancer Thermal Therapies

    Institute of Scientific and Technical Information of China (English)

    Theodoros SAMARAS; Esra NEUFELD; Niels KUSTER

    2016-01-01

    CEM43 thermal dose is a very common concept in thermal oncology. Thermal dose is the maximum amount of energy that can be transmitted during hyperthermia therapy conducted on temperature-sensitive tissue. Thermal dose is also the maximum value of local energy accumulation in human bodies, which can lead to tissue injury and pain. Thermal dose can also decrease the ifnishing temperature and reduce the energy to the tolerable range. There are two functions of the individualized hyperthermia treatment plan: it determines the setting and location that can realize the best tumor hyperthermia therapy; at the same time, it can decrease the effect of hyperthermia therapy on healthy tissues. There are four steps in the treatment plan of hyperthermia therapy for tumors: the ifrst step is to establish a three dimensional human body model and its corresponding an atomical structure that can be used in numerical algorithmvia medical imaging resources; the second step is to determine the volume of the electromagnetic energy accumulation. Based on the peculiarity of frequency and materials, even full-wave electromagnetic wave or quasi-static technique can be used to determine the tissue distribution. Evaluation of the therapy can be conducted based on thermal dose and the corresponding tissue damage model; the third step is to use Arrhenius model to provide direct evaluation of tissues in the thermal ablation zone, solidiifcation zone, as well as the necrotic area; the last step is the optimization of the treatment plan.

  4. Development of criteria and procedures for the evaluation of the European Action Plan for Organic Agriculture

    OpenAIRE

    Schmid, Otto; Lampkin, Nicolas; Dabbert, Stephan; Zanoli, Raffaele; Michelsen, Johannes; Gonzalvez, Victor

    2008-01-01

    This final report provides a synthesis of the results of the EU-funded ORGAP project, with the title “European Action Plan of Organic Food and Farming - Development of criteria and procedures for the evaluation of the EU Action Plan for Organic Agriculture”. This project started in May 2005 and was completed in April 2008. The overall objective of this project was to give scientific support to the implementation of the EU Organic Action Plan (EUOAP) by the development of an evaluation toolbox...

  5. [Review As You Go: Oklahoma City Public Schools' Plan Using Saxon's Procedures.

    Science.gov (United States)

    Hartzler, Stan

    This document consists of three related items. The first brief paper describes the components of a cumulative daily review program and its origins, rationale, and outcomes. The review-as-you-go (RAYG) format entails planning cumulative examinations and providing review problems each day. The procedure once was routinely used; today it is…

  6. Preparedness strategy and procedures. Annual report 1996. Plans for 1997; Beredskabsstrategi og -procedure. Aarsrapport 1996. Planer for 1997

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-01-01

    EKO-3 Preparedness Strategy and Procedures, a title that covers the subjects - collection, quality assurance, and the use of data in a preparedness situation. The term data is used here in its widest sense covering measurements, samples, radioecological background information, etc. The following sub-projects are part of EKO-3: EKO-3.1 Mobile measurements; EKO-3.2 Quality Assurance in sampling and analysis; EKO-3.3 Operational intervention levels; EKO-3.4 Measurement strategy, basis for decisions, and interventions in agriculture. EKO-3.1 which was the first started project is more or less completed. The sub-project will, however, continue with reference to a common NKS-EU follow-up exercise on RESUME-95 in 1998 - RESUME-98. In 1996 most funds has been given to EKO-3.2. The different parts of the project have been launched and the first of them are approaching their conclusion, this is the case for for example Quality assurance in gamma spectroscopy with accreditation as a goal. For 1997 a number of `typical` Nordic scenarios is planned. EKO-3.4 too has proceeded as planned in 1996. Also in this project the work has partly been on planning. The project work proceeds well and a draft version of the final report is expected ultimo 1996. (EG).

  7. Procedure guideline for iodine-131 whole-body scintigraphy for differentiated thyroid cancer. Version 2

    International Nuclear Information System (INIS)

    The version 2 of the procedure guideline for iodine-131 whole-body scintigraphy for differentiated thyroid cancer is an update of the procedure guideline published in 1999. The following statements are added or modified: The two alternatives of an endogenous TSH-stimulation by the withdrawal of the thyroidal hormone medication and of an exogenous TSH-stimulation by the injection of the recombinant human TSH (rhTSH) have an equal sensitivity for the diagnostic use of radioiodine and for the measurement of thyroglobulin. Image acquisition under rhTSH is obtained approximately 48 h after the radioiodine administration, while an interval of about 72 h is preferred under endogenous TSH-stimulation. If iodine-negative metastases are expected, the feasibility of scintigraphy using 99mTc sestamibi or preferably positron emission tomography using 18F-fluorodeoxyglucose should be considered. The sensitivity of FDG-PET is increased by TSH-stimulation. Before planning the iodine-131 scintigraphy the patient has to avoid iodine-containing medication and the possibility of additives of iodine in vitamin- and electrolyte-supplementation has to be considered. (orig.)

  8. Surgical Procedures for Breast Cancer - Mastectomy and Breast Conserving Therapy (Beyond the Basics)

    Science.gov (United States)

    ... performed BCT procedure in the United States and Canada. (See "Breast conserving therapy" .) Radiation therapy Invasive breast ... breast cancer The following organizations also provide reliable health ... and undertakings, oral or written, are hereby expressly superseded and canceled. ...

  9. An efficient procedure for tomotherapy treatment plan verification using the on-board detector

    International Nuclear Information System (INIS)

    In this work, a fast and simple procedure for tomotherapy treatment plan verification using the on-board detector (OBD) has been developed. This procedure allows verification of plans with static and dynamic jaws (TomoEDGE). A convolution-based calculation model has been derived in order to link the leaf control sinogram from the treatment planning system to the data acquired by the OBD during a static couch procedure. The convolution kernel has been optimized using simple plans calculated in the Tomotherapy Cheese phantom. The optimal kernel has been found to be a lorentzian function, whose parameter Γ is 0.186 for the 1 cm jaw opening, 0.232 for the 2.5 cm jaw opening and 0.373 for the 5 cm jaw opening. The evaluation has been performed with a γ-index analysis. The dose criterion was 3% of the 95th percentile of the dose distribution and the distance-to-agreement criterion is 2 mm. In order to validate the procedure, it has been applied to around 50 clinical treatment plans, which had already been validated by the Delta4 phantom (Scandidos, Sweden). 96% of the tested plans have passed the criteria. Concerning the other 4%, significant discrepancies between the leaf pattern in the leaf control sinogram and the OBD data have been shown, which might be due to differences in the leaf open time. This corresponds also to a higher sensitivity of this method over the Delta4, adding the possibility of better monitoring the treatment delivery. (paper)

  10. Planned Cardiac Reexploration in the Intensive Care Unit Is a Safe Procedure

    Science.gov (United States)

    LaPar, Damien J.; Isbell, James M.; Mulloy, Daniel P.; Stone, Matthew L.; Kern, John A.; Ailawadi, Gorav; Kron, Irving L.

    2015-01-01

    Background Cardiac surgical reexploration is necessary in approximately 5% of all patients. However, the impact of routine, planned reexploration performed in the intensive care unit (ICU) remains poorly defined. This study evaluated postoperative outcomes after cardiac reexplorations to determine the safety and efficacy of a planned approach in the ICU. Methods All patients undergoing ICU cardiac reexplorations (2000 to 2011) at a single institution were stratified according to a routine, planned ICU approach to reexploration (planned) versus unplanned ICU or operating room reexploration. Patient risk and outcomes were compared by univariate and multivariate analyses. Results 8,151 total patients underwent cardiac operations, including 267 (3.2%) reexplorations (planned ICU = 75% and unplanned ICU = 18%). Among planned ICU reexplorations, 38% of patients had an identifiable surgical bleeding source, and 60% underwent reexploration less than 12 hours after the index procedure. Unplanned ICU reexplorations had a higher Society of Thoracic Surgeons (STS) predicted mortality (5% vs 3%, p < 0.001) and incurred higher observed mortality (37% vs 6%, p < 0.001) and morbidity. Sternal wound infections were rare and were similar between groups (p = 0.81). Furthermore, upon STS mortality risk adjustment, unplanned ICU reexplorations were associated with significantly increased odds of mortality (OR = 26.6 [7.1, 99.7], p < 0.001) compared with planned ICU reexplorations. Conclusions Planned reexploration in the ICU is a safe procedure with acceptable mortality and morbidity and low infection rates. Unplanned reexplorations, however, increase postoperative risk and are associated with high mortality and morbidity. These data argue for coordinated, routine approaches to planned ICU reexploration to avoid delay in treatment for postoperative hemorrhage. PMID:25173720

  11. Hypnosis as an Adjunct Treatment for Distress Associated with Pediatric Cancer Procedures.

    Science.gov (United States)

    White, Jerre Lee

    This paper reviews research literature pertaining to the pain and anxiety associated with pediatric cancer and the use of hypnosis as an adjunct treatment. It is noted that pain and anxiety are most often associated with the procedural treatment of cancer, and that the literature suggests that both pain and anxiety are multi-faceted constructs.…

  12. Reporting practices of pharmacodynamic studies involving invasive research procedures in cancer trials

    OpenAIRE

    Freeman, G A; Kimmelman, J; Dancey, J; Monzon, J G

    2013-01-01

    Background: Tumour biopsy for pharmacodynamic (PD) study is increasingly common in early-phase cancer trials. As they are non-diagnostic, the ethical justification for such procedures rests on their knowledge value. On the premise that knowledge value is related to reporting practices and outcome diversity, we assessed in a sample of recent invasive PD studies within cancer trials. Methods: We assessed reporting practices and outcomes for PD studies in a convenience sample of cancer trials pu...

  13. Investigating VMAT planning technique to reduce rectal and bladder dose in prostate cancer treatment plans

    Directory of Open Access Journals (Sweden)

    Suresh B Rana

    2013-01-01

    Full Text Available Background: RapidArc is a volumetric modulated arc therapy (VMAT technique that can deliver conformal dose distribution to the target while minimizing dose to critical structures. The main purpose of this study was to compare dosimetric quality of full double arc (full DA, full single arc (full SA, and partial double arc (partial DA techniques in RapidArc planning of prostate cancer. Materials and Methods: Twelve cases of prostate cancer involving seminal vesicles were selected for this retrospective study. For each case, RapidArc plans were created using full DA (two full arcs, full SA (one full arc, and partial DA (two partial arcs with anterior and posterior avoidance sectors techniques. For planning target volume (PTV, the maximum and mean doses, conformity, and inhomogeneity indices were evaluated. For bladder and rectum, volumes that received 70, 50, 40, and 20 Gy (V 70Gy , V 50Gy , V 40Gy and V 20Gy , respectively, and mean dose were compared. For femoral heads, V 40Gy , V 20Gy , and mean dose were evaluated. Additionally, an integral dose and monitor units (MUs were compared for each treatment plan. Results: In comparison to full DA and full SA techniques, the partial DA technique was better in sparing of rectum and bladder but delivered higher femoral head dose, which was nonetheless within the planning criteria. No clear dosimetric differences were found between full DA and partial DA plans for dose conformity and target homogeneity. The number of MUs and integral dose were largest with the partial DA technique and lowest with the full SA technique. Conclusion: The partial DA technique provides an alternative RapidArc planning approach for low risk prostate cancer.

  14. Procedures for risk-stratification of lung cancer using buccal nanocytology

    Science.gov (United States)

    Subramanian, H.; Viswanathan, P.; Cherkezyan, L.; Iyengar, R.; Rozhok, S.; Verleye, M.; Derbas, J.; Czarnecki, J.; Roy, H. K.; Backman, V.

    2016-01-01

    Lung cancer is the leading cause of cancer deaths in the U.S. with survival dramatically depending on stage at diagnosis. We had earlier reported that nanocytology of buccal cells can accurately risk-stratify smokers for the presence of early and late-stage lung cancer. To translate the technique into clinical practice, standardization of operating procedures is necessary to consistently yield precise and repeatable results. Here, we develop and validate simple, robust, and easily implementable procedures for specimen collection, processing, etc. in addition to a commercially-viable instrument prototype. Results of this work enable translation of the technology from academic lab to physicians’ office. PMID:27699138

  15. State and local planning procedures dealing with social and economic impacts from nuclear power plants

    International Nuclear Information System (INIS)

    The roles of state and local agencies in planning for and managing social and economic impacts of nuclear power plants are studied. In order to be effective in these roles state and local agencies must work with each other as well as the NRC. A comparative case study approach is used which analyzes six sites in three West Coast states. The case studies included plants in operation, plants under construction, and plants still in the planning stages. In contrast to some states, all three of these states have moderately centralized procedures for siting power plants, and all have strong environmental laws

  16. A heuristic procedure to aggregate containers onto pallets and plan the loading of pallets into trucks

    OpenAIRE

    Adams, David J.

    1996-01-01

    Approved for public release; distribution is unlimited. A heuristic procedure is presented which aggregates containers of multiple products onto pallets and then plans the loading of these pallets into trucks. The efficient loading of products onto pallets and pallets into trucks is an economic fundamental. In 1993 the value of products shipped by truck in the United States exceeded 4.6 trillion dollars or about 75.6 percent of gross domestic product. Industry sources estimate that 98% of ...

  17. A Case Study of the South Puget Intertribal Planning Agency’s Comprehensive Cancer Control Planning and Community Mobilization Process

    Directory of Open Access Journals (Sweden)

    Carrie Nass, MPH, CHES

    2008-04-01

    Full Text Available Background The high rates of cancer among American Indians and Alaska Natives are of growing concern.Context In response to high cancer rates, national, state, and tribal organizations have worked to assess knowledge, attitudes, beliefs, and screening practices related to cancer in American Indian and Alaska Native communities and to increase awareness and use of cancer screening. The National Comprehensive Cancer Control Program (NCCCP of the Centers for Disease Control and Prevention is one such effort. NCCCP’s comprehensive cancer control (CCC planning process provides a new approach to planning and implementing cancer control programs. The CCC process and components for American Indians and Alaska Natives are not yet fully understood because this is a fairly new approach for these communities. Therefore, the purpose of our case study was to describe the CCC process and its outcomes and successes as applied to these communities and to identify key components and lessons learned from the South Puget Intertribal Planning Agency’s (SPIPA’s CCC planning and community mobilization process.Methods We used interviews, document reviews, and observations to collect data on SPIPA’s CCC planning and community mobilization process.Consequences We identified the key components of SPIPA’s CCC as funding and hiring key staff, partnering with outside organizations, developing a project management plan and a core planning team, creating community cancer orientations, conducting community cancer surveys, developing a community advisory committee, ongoing training and engaging of the community advisory committee, and supporting the leadership of the communities involved.Interpretation The CCC planning process is a practicable model, even for groups with little experience or few resources. The principles identified in this case study can be applied to the cancer control planning process for other tribes.

  18. Planning procedure for public lighting; Toshi kokyo shomei no keikaku sakutei tejun

    Energy Technology Data Exchange (ETDEWEB)

    Iuchi, M.; Yamaoto, K. [Central Research Inst. of Electric Power Industry, Tokyo (Japan)

    1991-04-01

    A framework for the planning procedure is proposed to establish plans for lighting a city as a whole including the daily living space for residents to realize affluent national life and achieve well balanced public lighting in urban areas. The consciousness of urban residents to night-time environment comprises agreeableness with beauty and good atmosphere, static acativeness like quietness and composure, and attractiveness including intimacy and joyfulness. A questionnaire survey result reveals that most residents want such lighting be arranged in nearby squares or parks that enables calm and pleasant night-time activities. It is important to establish a lighting plan balanced both in regional and city scales, based on these needs of the residents. Also critical is to select the most effective business system including implementation systems and related organizations, and discuss specific processes in advance, including regulation and guidance of neon sign and signboard installations. 14 refs., 22 figs., 8 tabs.

  19. Procedure guidelines for radioiodine therapy of differentiated thyroid cancer (version 3); Verfahrensanweisung zur Radioiodtherapie (RIT) beim differenzierten Schilddruesenkarzinom (Version 3)

    Energy Technology Data Exchange (ETDEWEB)

    Dietlein, M.; Schicha, H. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Koeln Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Dressler, J. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Nuklearmedizinsiche Klinik der Henriettenstiftung, Hannover (Germany); Eschner, W. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Deutsche Gesellschaft fuer Medizinische Physik (DGMP) (Germany); Koeln Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Gruenwald, F. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Frankfurt Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Lassmann, M. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Deutsche Gesellschaft fuer Medizinische Physik (DGMP) (Germany); Wuerzburg Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Leisner, B. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Allgemeines Krankenhaus St. Georg, Hamburg (Germany); Luster, M.; Reiners, C. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Wuerzburg Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Moser, E. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Radiologische Universitaetsklinik Freiburg (Germany); Schober, O. [Deutsche Gesellschaft fuer Nuklearmedizin (DGN) (Germany); Muenster Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin

    2007-07-01

    The procedure guideline for radioiodine therapy (RIT) of differentiated thyroid cancer (version 3) is the counterpart to the procedure guideline for {sup 131}I whole-body scintigraphy (version 3) and specify the interdisciplinary guideline for thyroid cancer of the Deutsche Krebsgesellschaft concerning the nuclear medicine part. Recommendation for ablative {sup 131}I therapy is given for all differentiated thyroid carcinoma (DTC) >1 cm. Regarding DTC {<=}1 cm {sup 131}I ablation may be helpful in an individual constellation. Preparation for {sup 131}I ablation requires low iodine diet for two weeks and TSH stimulation by withdrawal of thyroid hormone medication or by use of recombinant human TSH (rhTSH). The advantages of rhTSH (no symptoms of hypothyroidism, lowerblood activity) and the advantages of endogenous TSH stimulation (necessary for {sup 131}I-therapy in patients with metastases, higher sensitivity of {sup 131}I whole-body scan) are discussed. In most centers standard activities are used for {sup 131}I ablation. If pretherapeutic dosimetry is planned, the diagnostic administration of {sup 131}I should not exceed 1-10MBq, alternative tracers are {sup 123}I or {sup 124}I. The recommendations for contraception and family planning are harmonized with the recommendation of ATA and ETA. Regarding the best possible protection of salivary glands the evidence is insufficient to recommend a specific setting. To minimize the risk of dental caries due to xerostomia patients should use preventive strategies for dental hygiene. (orig.)

  20. Strategic environmental assessment and national development plans in Turkey: Towards legal framework and operational procedure

    International Nuclear Information System (INIS)

    National development plans were started to be prepared in Turkey in 1963. These plans are mandatory for public investments and guiding principles for private investments. They have a quality which guides and sets objectives for other plans in the country. Therefore, they can be evaluated as the main reason of successes and failures of sectoral investments or the problems that they cause directly or indirectly. Turkey is undergoing rapid industrialization, urbanization and population growth, thus environmental problems are on the increase. Although Environmental Impact Assessment (EIA) has been applied to individual investments in Turkey since 1993, natural environment has continued to be affected because of human activities. Today, parallel to the developments in the world, it has been discussed that it is necessary to strengthen project-level Environmental Assessment (EA) and to practice Strategic Environmental Assessment (SEA). The interest in SEA, that is, EA at the level of proposed policies, plans and programs has grown significantly since 2000 in the country. Discussions and preparations have started about regulation which provides the legal and institutional framework for SEA in The Ministry of Environment and Forestry. However, since the scientific approach into the subject is very new in Turkey, it will take time to answer the questions about how and in what fields to practice. This research project aims at analyzing the possible practice opportunities of SEA in Turkey and the practicability of SEA into the National Five-Year Development Plan (FYDP) which is assumed at the highest level of planning hierarchy in the country. The research is conducted on two sections. In the first section, procedural approaches to SEA on national development plans are investigated and a framework for these approaches is adapted at the institutional level. In the second section, SEA form for energy sector in the development plans is developed. In this article, the findings

  1. Radon Control Activities for Lung Cancer Prevention in National Comprehensive Cancer Control Program Plans, 2005–2011

    OpenAIRE

    Antonio Neri, MD, MPH; Sherri L. Stewart, PhD; William Angell, MS

    2013-01-01

    Introduction Radon is the second leading cause of lung cancer among smokers and the leading cause among nonsmokers. The US Environmental Protection Agency recommends that every home be tested for radon. Comprehensive Cancer Control (CCC) programs develop cancer coalitions that coordinate funding and resources to focus on cancer activities that are recorded in cancer plans. Radon tests, remediation, and radon mitigation techniques are relatively inexpensive, but it is unclear whether coalition...

  2. Hypnosis for the management of chronic and cancer procedure-related pain in children.

    Science.gov (United States)

    Tomé-Pires, Catarina; Miró, Jordi

    2012-01-01

    The aim of this study was to review published controlled trials of hypnotic treatments for chronic and cancer procedure-related pain in children. Trials were included if participants were 18 years of age or below, were randomized and had populations with chronic pain or cancer procedure-related pain. After the studies were assessed, 12 were selected for review. Although the evidence is limited, the findings indicate that hypnosis is an effective pain-control technique when used with children suffering from cancer procedure-related pain or chronic pain. Further research into the use of hypnosis to manage chronic pain in children should be a priority so that empirically based conclusions can be drawn about the effects of hypnosis on children. PMID:22917107

  3. IMRT treatment plans and functional planning with functional lung imaging from 4D-CT for thoracic cancer patients

    OpenAIRE

    Huang Tzung-Chi; Hsiao Chien-Yi; Chien Chun-Ru; Liang Ji-An; Shih Tzu-Ching; Zhang Geoffrey G

    2013-01-01

    Abstract Background and purpose Currently, the inhomogeneity of the pulmonary function is not considered when treatment plans are generated in thoracic cancer radiotherapy. This study evaluates the dose of treatment plans on highly-functional volumes and performs functional treatment planning by incorporation of ventilation data from 4D-CT. Materials and methods Eleven patients were included in this retrospective study. Ventilation was calculated using 4D-CT. Two treatment plans were generate...

  4. Developing Tsunami Evacuation Plans, Maps, And Procedures: Pilot Project in Central America

    Science.gov (United States)

    Arcos, N. P.; Kong, L. S. L.; Arcas, D.; Aliaga, B.; Coetzee, D.; Leonard, J.

    2015-12-01

    In the End-to-End tsunami warning chain, once a forecast is provided and a warning alert issued, communities must know what to do and where to go. The 'where to' answer would be reliable and practical community-level tsunami evacuation maps. Following the Exercise Pacific Wave 2011, a questionnaire was sent to the 46 Member States of Pacific Tsunami Warning System (PTWS). The results revealed over 42 percent of Member States lacked tsunami mass coastal evacuation plans. Additionally, a significant gap in mapping was exposed as over 55 percent of Member States lacked tsunami evacuation maps, routes, signs and assembly points. Thereby, a significant portion of countries in the Pacific lack appropriate tsunami planning and mapping for their at-risk coastal communities. While a variety of tools exist to establish tsunami inundation areas, these are inconsistent while a methodology has not been developed to assist countries develop tsunami evacuation maps, plans, and procedures. The International Tsunami Information Center (ITIC) and partners is leading a Pilot Project in Honduras demonstrating that globally standardized tools and methodologies can be applied by a country, with minimal tsunami warning and mitigation resources, towards the determination of tsunami inundation areas and subsequently community-owned tsunami evacuation maps and plans for at-risk communities. The Pilot involves a 1- to 2-year long process centered on a series of linked tsunami training workshops on: evacuation planning, evacuation map development, inundation modeling and map creation, tsunami warning & emergency response Standard Operating Procedures (SOPs), and conducting tsunami exercises (including evacuation). The Pilot's completion is capped with a UNESCO/IOC document so that other countries can replicate the process in their tsunami-prone communities.

  5. Brachytherapy for prostate cancer: Comparative characteristics of procedures

    Directory of Open Access Journals (Sweden)

    S. V. Kanaev

    2015-01-01

    Full Text Available The introduction of interstitial radiation sources is the «youngest» of the radical method of treatment of patients with prostate cancer (PC. The high level of efficiency comparable to prostatectomy at a significantly lower rate of complications causes rapid growth of clinical use of brachytherapy (BT. Depending on the radiation source and the mode of administration into the prostate gland are two types BT – high-dose rate (temporary (HDR-BT and low-dose rate (permanent (LDR-BT brachytherapy. At the heart of these two methods are based on a single principle of direct effect of the quantum gamma radiation on the area of interest. However, the differences between the characteristics of isotopes used and technical aspects of the techniques cause the difference in performance and complication rates for expression HDR-BT and LDR-BT.

  6. Cancer risk estimation caused by radiation exposure during endovascular procedure

    Science.gov (United States)

    Kang, Y. H.; Cho, J. H.; Yun, W. S.; Park, K. H.; Kim, H. G.; Kwon, S. M.

    2014-05-01

    The objective of this study was to identify the radiation exposure dose of patients, as well as staff caused by fluoroscopy for C-arm-assisted vascular surgical operation and to estimate carcinogenic risk due to such exposure dose. The study was conducted in 71 patients (53 men and 18 women) who had undergone vascular surgical intervention at the division of vascular surgery in the University Hospital from November of 2011 to April of 2012. It had used a mobile C-arm device and calculated the radiation exposure dose of patient (dose-area product, DAP). Effective dose was measured by attaching optically stimulated luminescence on the radiation protectors of staff who participates in the surgery to measure the radiation exposure dose of staff during the vascular surgical operation. From the study results, DAP value of patients was 308.7 Gy cm2 in average, and the maximum value was 3085 Gy cm2. When converted to the effective dose, the resulted mean was 6.2 m Gy and the maximum effective dose was 61.7 milliSievert (mSv). The effective dose of staff was 3.85 mSv; while the radiation technician was 1.04 mSv, the nurse was 1.31 mSv. All cancer incidences of operator are corresponding to 2355 persons per 100,000 persons, which deemed 1 of 42 persons is likely to have all cancer incidences. In conclusion, the vascular surgeons should keep the radiation protection for patient, staff, and all participants in the intervention in mind as supervisor of fluoroscopy while trying to understand the effects by radiation by themselves to prevent invisible danger during the intervention and to minimize the harm.

  7. Decisions in licensing and plan approval procedures, investigated from the viewpoint of legal reservation

    International Nuclear Information System (INIS)

    Starting from the basic idea that also in the field of environmental law, (constitutional) system immanent problem solution is possible only after basic constitutional questions have been clarified, this study in hand is an attempt towards defining the constitutional approach for an adequate use of the various types of action of the executive in the procedures for approval and licensing of privately owned plant or equipment. The study goes into the problems encountered with the legal reservation with regard to licensing and plan approval decisions. The basic types of action of the executive are subdivided according to intent, i.e. assigned to the supervisory or the planning intents, and are examined for a possible scope of discretion opened up for the administration. The decisive question in this context is the scope of action that may be given to the administration by the legislation, and to what extent such 'freedom' will stand the acceptance test by the courts. (orig./HSCH)

  8. Randomized interventions for needle procedures in children with cancer.

    Science.gov (United States)

    Hedén, L; VON Essen, L; Ljungman, G

    2009-07-01

    The aim of this study was to examine whether children experience less fear, distress and pain connected to a routine needle insertion in an intravenous port when subjected to an intervention: blowing soap bubbles or having a heated pillow vs. standard care. Twenty-eight children, 2-7 years, cared for at a paediatric oncology unit, undergoing a routine needle insertion in an intravenous port were included consecutively. All children were subjected to two needle insertions; at the first they received standard care, and at the second standard care + a randomized intervention. Parents and nurses assessed children's fear, distress and pain on 0-100 mm visual analogue scales. According to parents' report, children experienced less fear when subjected to intervention vs. standard care reported by parents (P soap bubbles vs. standard care (n = 14), and less fear when subjected to standard care + heated pillow vs. standard care (P soap bubbles or having a heated pillow is more effective than standard care in reducing children's fear and distress in needle procedures, according to parents' report. PMID:19040458

  9. The sentinel node procedure in early stage cervical cancer, taking the next step; a diagnostic review

    NARCIS (Netherlands)

    Tax, C.; Rovers, M.M.; Graaf, C. de; Zusterzeel, P.L.M.; Bekkers, R.L.M.

    2015-01-01

    OBJECTIVE: Recent reviews on the sentinel lymph node (SLN) procedure in cervical cancer have shown that bilateral SLN detection and ultra staging are safe and superior options compared to a unilateral detection, frozen section and H&E analysis. So far, nobody identified a subgroup of patients in who

  10. Behavioral Distress in Children with Cancer Undergoing Medical Procedures: Developmental Considerations.

    Science.gov (United States)

    Katz, Ernest R.; And Others

    1980-01-01

    The amount of anxiety suggested the need for clinical intervention to reduce procedure-related distress in children with cancer. Younger children exhibited consistently higher levels of distress than older children and displayed a greater variety of anxious responses over a longer time span. (Author/BEF)

  11. Evaluation procedure of software safety plan for digital I and C of KNGR

    International Nuclear Information System (INIS)

    The development, use, and regulation of computer systems in nuclear reactor instrumentation and control (I and C) systems to enhance reliability and safety is a complex issue. This report is one of a series of reports from the Korean next generation reactor (KNGR) software safety verification and validation (SSVV) task, Korea Atomic Energy Research Institute, which investigates different aspects of computer software in reactor I and C systems, and describes the engineering procedures for developing such a software. The purpose of this guideline is to give the software safety evaluator the trail map between the code and standards layer and the design methodology and documents layer for the software important to safety in nuclear power plants. Recently, the safety planning for safety-critical software systems is being recognized as the most important phase in the software life cycle, and being developed new regulatory positions and standards by the regulatory and the standardization organizations. The requirements for software important to safety of nuclear reactor are described in such positions and standards, for example, the new standard review plan (SRP), IEC 880 supplements, IEEE standard 1228-1994, IEEE standard 7-4.3.2-1993, and IAEA safety series No. 50-SG-D3 and D8. We presented the guidance for evaluating the safety plan of the software in the KNGR protection systems. The guideline consists of the regulatory requirements for software safety in chapter 2, the evaluation checklist of software safety plan in chapter3, and the evaluation results of KNGR software safety plan in chapter 4

  12. Evaluation procedure of software safety plan for digital I and C of KNGR

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jang Soo; Park, Jong Kyun; Lee, Ki Young; Kwon, Ki Choon; Kim, Jang Yeol; Cheon, Se Woo

    2000-05-01

    The development, use, and regulation of computer systems in nuclear reactor instrumentation and control (I and C) systems to enhance reliability and safety is a complex issue. This report is one of a series of reports from the Korean next generation reactor (KNGR) software safety verification and validation (SSVV) task, Korea Atomic Energy Research Institute, which investigates different aspects of computer software in reactor I and C systems, and describes the engineering procedures for developing such a software. The purpose of this guideline is to give the software safety evaluator the trail map between the code and standards layer and the design methodology and documents layer for the software important to safety in nuclear power plants. Recently, the safety planning for safety-critical software systems is being recognized as the most important phase in the software life cycle, and being developed new regulatory positions and standards by the regulatory and the standardization organizations. The requirements for software important to safety of nuclear reactor are described in such positions and standards, for example, the new standard review plan (SRP), IEC 880 supplements, IEEE standard 1228-1994, IEEE standard 7-4.3.2-1993, and IAEA safety series No. 50-SG-D3 and D8. We presented the guidance for evaluating the safety plan of the software in the KNGR protection systems. The guideline consists of the regulatory requirements for software safety in chapter 2, the evaluation checklist of software safety plan in chapter3, and the evaluation results of KNGR software safety plan in chapter 4.

  13. A comparison of quality of life between vulvar cancer patients after sentinel lymph node procedure only and inguinofemoral lymphadenectomy

    NARCIS (Netherlands)

    Oonk, M. H. M.; van Os, M. A.; de Bock, G. H.; de Hullu, J. A.; Ansink, A. C.; van der Zee, A. G. J.

    2009-01-01

    Objectives. The SLN-procedure has been introduced in vulvar cancer treatment to reduce morbidity and thereby improve quality of life. Aim of this study was to compare quality of life in vulvar cancer patients who were treated with a SLN-procedure only to those who underwent inguinofemoral lymphadene

  14. A comparison of quality of life between vulvar cancer patients after sentinel lymph node procedure only and inguinofemoral lymphadenectomy.

    NARCIS (Netherlands)

    Oonk, M.H.; Os, M.A. van; Bock, G.H. de; Hullu, J.A. de; Ansink, A.C.; Zee, A.G. van der

    2009-01-01

    OBJECTIVES: The SLN-procedure has been introduced in vulvar cancer treatment to reduce morbidity and thereby improve quality of life. Aim of this study was to compare quality of life in vulvar cancer patients who were treated with a SLN-procedure only to those who underwent inguinofemoral lymphadene

  15. IMRT treatment plans and functional planning with functional lung imaging from 4D-CT for thoracic cancer patients

    Directory of Open Access Journals (Sweden)

    Huang Tzung-Chi

    2013-01-01

    Full Text Available Abstract Background and purpose Currently, the inhomogeneity of the pulmonary function is not considered when treatment plans are generated in thoracic cancer radiotherapy. This study evaluates the dose of treatment plans on highly-functional volumes and performs functional treatment planning by incorporation of ventilation data from 4D-CT. Materials and methods Eleven patients were included in this retrospective study. Ventilation was calculated using 4D-CT. Two treatment plans were generated for each case, the first one without the incorporation of the ventilation and the second with it. The dose of the first plans was overlapped with the ventilation and analyzed. Highly-functional regions were avoided in the second treatment plans. Results For small targets in the first plans (PTV  Conclusion Radiation treatments affect functional lung more seriously in large tumor cases. With compromise of dose to other critical organs, functional treatment planning to reduce dose in highly-functional lung volumes can be achieved

  16. Sentinel-lymph node procedure in breast, uterine cervix, prostate, vulva and penile cancers: Practical methodology

    International Nuclear Information System (INIS)

    The nodal status is the strongest prognostic factor in early stage cancers. The sentinel-lymph node (S.L.N.) is defined as the first draining lymph node of an organ; the lymph node status is determined by the histological results of S.L.N.. The lymphadenectomy, with high morbidity, is realised only in case of metastatic S.L.N.. The S.L.N. identification, in most of cases, is performed using the combination of blue dye and radiocolloid 99mTc injections. The purpose of this article is to give some practical details about the S.L.N. isotopic procedure in breast cancer, vulva and penile cancer, uterine cervix and prostate cancer. (author)

  17. Second primary cancers after radiation for prostate cancer: a review of data from planning studies

    International Nuclear Information System (INIS)

    A review of planning studies was undertaken to evaluate estimated risks of radiation induced second primary cancers (RISPC) associated with different prostate radiotherapy techniques for localised prostate cancer. A total of 83 publications were identified which employed a variety of methods to estimate RISPC risk. Of these, the 16 planning studies which specifically addressed absolute or relative second cancer risk using dose–response models were selected for inclusion within this review. There are uncertainties and limitations related to all the different methods for estimating RISPC risk. Whether or not dose models include the effects of the primary radiation beam, as well as out-of-field regions, influences estimated risks. Regarding the impact of IMRT compared to 3D-CRT, at equivalent energies, several studies suggest an increase in risk related to increased leakage contributing to out-of-field RISPC risk, although in absolute terms this increase in risk may be very small. IMRT also results in increased low dose normal tissue irradiation, but the extent to which this has been estimated to contribute to RISPC risk is variable, and may also be very small. IMRT is often delivered using 6MV photons while conventional radiotherapy often requires higher energies to achieve adequate tissue penetration, and so comparisons between IMRT and older techniques should not be restricted to equivalent energies. Proton and brachytherapy planning studies suggest very low RISPC risks associated with these techniques. Until there is sufficient clinical evidence regarding RISPC risks associated with modern irradiation techniques, the data produced from planning studies is relevant when considering which patients to irradiate, and which technique to employ

  18. 3D printed cardiac phantom for procedural planning of a transcatheter native mitral valve replacement

    Science.gov (United States)

    Izzo, Richard L.; O'Hara, Ryan P.; Iyer, Vijay; Hansen, Rose; Meess, Karen M.; Nagesh, S. V. Setlur; Rudin, Stephen; Siddiqui, Adnan H.; Springer, Michael; Ionita, Ciprian N.

    2016-03-01

    3D printing an anatomically accurate, functional flow loop phantom of a patient's cardiac vasculature was used to assist in the surgical planning of one of the first native transcatheter mitral valve replacement (TMVR) procedures. CTA scans were acquired from a patient about to undergo the first minimally-invasive native TMVR procedure at the Gates Vascular Institute in Buffalo, NY. A python scripting library, the Vascular Modeling Toolkit (VMTK), was used to segment the 3D geometry of the patient's cardiac chambers and mitral valve with severe stenosis, calcific in nature. A stereolithographic (STL) mesh was generated and AutoDesk Meshmixer was used to transform the vascular surface into a functioning closed flow loop. A Stratasys Objet 500 Connex3 multi-material printer was used to fabricate the phantom with distinguishable material features of the vasculature and calcified valve. The interventional team performed a mock procedure on the phantom, embedding valve cages in the model and imaging the phantom with a Toshiba Infinix INFX-8000V 5-axis Carm bi-Plane angiography system. Results: After performing the mock-procedure on the cardiac phantom, the cardiologists optimized their transapical surgical approach. The mitral valve stenosis and calcification were clearly visible. The phantom was used to inform the sizing of the valve to be implanted. Conclusion: With advances in image processing and 3D printing technology, it is possible to create realistic patientspecific phantoms which can act as a guide for the interventional team. Using 3D printed phantoms as a valve sizing method shows potential as a more informative technique than typical CTA reconstruction alone.

  19. Optimization of prostate cancer treatment plans using the adjoint transport method and discrete ordinates codes

    Energy Technology Data Exchange (ETDEWEB)

    Yoo, S.; Henderson, D.L. [Dept. of Medical Physics, Madison, WI (United States); Thomadsen, B.R. [Dept. of Medical Physics and Dept. of Human Oncology, Madison (United States)

    2001-07-01

    Interstitial brachytherapy is a type of radiation in which radioactive sources are implanted directly into cancerous tissue. Determination of dose delivered to tissue by photons emitted from implanted seeds is an important step in the treatment plan process. In this paper we will investigate the use of the discrete ordinates method and the adjoint method to calculate absorbed dose in the regions of interest. MIP (mixed-integer programming) is used to determine the optimal seed distribution that conforms the prescribed dose to the tumor and delivers minimal dose to the sensitive structures. The patient treatment procedure consists of three steps: (1) image acquisition with the transrectal ultrasound (TRUS) and assessing the region of interest, (2) adjoint flux computation with discrete ordinate code for inverse dose calculation, and (3) optimization with the MIP branch-and-bound method.

  20. 3-Dimentional radiotherapy versus conventional treatment plans for gastric cancer

    Directory of Open Access Journals (Sweden)

    Aghili M

    2010-11-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: The current standard of adjuvant management for gastric cancer after curative resection based on the results of intergroup 0116 is concurrent chemoradiation. Current guidelines for designing these challenging fields still include two-dimensional simulation with simple AP-PA parallel opposed design. However, the implementation of radiotherapy (RT remains a concern. Our objective was to compare three-dimensional (3D techniques to the more commonly used AP-PA technique."n"nMethods: A total of 24 patients with stages II-IV adenocarcinoma of the stomach were treated with adjuvant postoperative chemoradiation with simple AP-PA technique, using Cobalt-60. Total radiation dose was 50.4Gy. Landmark-based fields were simulated to assess PTV coverage. For each patient, three additional radiotherapy treatment plans were generated using three-dimensional (3D technique. The four treatment plans were then compared for target volume coverage and dose to normal tissues (liver, spinal cord, kidneys using dose volume histogram (DVH analysis."n"nResults: The three-dimensional planning techniques provided 10% superior PTV coverage compared to conventional AP-PA fields (p<0.001. Comparative DVHs for the right kidney, left kidney

  1. Procedure for creating a three-dimensional (3D) model for superficial hyperthermia treatment planning

    Energy Technology Data Exchange (ETDEWEB)

    Linthorst, Marianne; Drizdal, Tomas; Joosten, Hans; Rhoon, Gerard C. van; Zee, Jacoba van der [Hyperthermia Unit, Rotterdam (Netherlands). Erasmus MC Rotterdam

    2011-12-15

    To make a patient- and treatment-specific computed tomography (CT) scan and to create a three-dimensional (3D) patient model for superficial hyperthermia treatment planning (SHTP). Patients with recurrent breast adenocarcinoma in previously irradiated areas referred for radiotherapy (RT) and hyperthermia (HT) treatment and giving informed consent were included. After insertion of the thermometry catheters in the treatment area, a CT scan in the treatment position was made. A total of 26 patients have been, thus far, included in the study. During the study period, five types of adjustments were made to the procedure: (1) marking the RT field with radioopaque markers, (2) making the CT scan after the first HT treatment instead of before, (3) using an air- and foam-filled (dummy) water bolus, (4) a change to radiolucent catheters for which radioopaque markers were needed, and (5) marking the visible/palpable extent of the tumor with radioopaque markers, if necessary. With these adjustments, all necessary information is visible on the CT scan. Each CT slice was automatically segmented into muscle, fat, bone, and air. RT field, catheters, applicators, and tumor lesions, if indicated, were outlined manually using the segmentation program iSeg. Next the model was imported into SEMCAD X, a 3D electromagnetic field simulator. Using the final procedure to obtain a patient- and treatment-specific CT scan, it is possible to create a 3D model for SHTP.

  2. HEMP emergency planning and operating procedures for electric power systems. Power Systems Technology Program

    Energy Technology Data Exchange (ETDEWEB)

    Reddoch, T.W.; Markel, L.C. [Electrotek Concepts, Inc., Knoxville, TN (United States)

    1991-12-31

    Investigations of the impact of high-altitude electromagnetic pulse (HEMP) on electric power systems and electrical equipment have revealed that HEMP creates both misoperation and failures. These events result from both the early time E{sub 1} (steep-front pulse) component and the late time E{sub 3} (geomagnetic perturbations) component of HEMP. In this report a HEMP event is viewed in terms of its marginal impact over classical power system disturbances by considering the unique properties and consequences of HEMP. This report focuses on system-wide electrical component failures and their potential consequences from HEMP. In particular, the effectiveness of planning and operating procedures for electric systems is evaluated while under the influence of HEMP. This assessment relies on published data and characterizes utilities using the North American Electric Reliability Council`s regions and guidelines to model electric power system planning and operations. Key issues addressed by the report include how electric power systems are affected by HEMP and what actions electric utilities can initiate to reduce the consequences of HEMP. The report also reviews the salient features of earlier HEMP studies and projects, examines technology trends in the electric power industry which are affected by HEMP, characterizes the vulnerability of power systems to HEMP, and explores the capability of electric systems to recover from a HEMP event.

  3. A limited sampling procedure for estimating adriamycin pharmacokinetics in cancer patients.

    OpenAIRE

    Launay, M. C.; Milano, G.; Iliadis, A.; Frenay, M.; Namer, N.

    1989-01-01

    The aim of this study was to find a procedure allowing estimation of individual pharmacokinetic parameters for adriamycin with minimal cost and disturbance for the patient. Twenty-five patients with breast cancer were treated by short infusion of adriamycin at a dose of 12 mg m-2 week-1 (41 courses). Population characteristics were determined on 15 randomly chosen courses (10 patients, group I) in order to define two optimal sampling times (26 min and 24 h) and to perform Bayesian estimation ...

  4. A necessary evil: The experiences of men with prostate cancer undergoing imaging procedures

    Energy Technology Data Exchange (ETDEWEB)

    Mathers, Sandra A., E-mail: s.mathers@rgu.ac.uk [Robert Gordon University, Faculty of Health and Social Care, Garthdee Road, Aberdeen AB10 7QG (United Kingdom); McKenzie, Graham A.; Robertson, Elizabeth M. [Robert Gordon University, Faculty of Health and Social Care, Garthdee Road, Aberdeen AB10 7QG (United Kingdom)

    2011-11-15

    Objective: This study sought to explore the experience of people with a diagnosis of cancer while attending for imaging procedures. The diversity and complexity of the issues described within individual interviews made it impossible to include all cancer groups in one paper. This paper focuses on the cohort of men with prostate cancer. Method: An opportunistic sample of men (n = 8) were recruited from Cancer Support Groups throughout the North-east of Scotland. A qualitative, exploratory and retrospective study design was employed using semi-structured interviews. All interviews were audio taped and full transcripts produced. These were analysed following the recommendations of Miles and Huberman (1994). Main findings: Men were keen to take part in the study, and described experiences from pre-diagnosis to the date of interview. Participants reported different routes to diagnosis, then having a range of diagnostic procedures indicating a very personal journey with no standardised approach. Imaging was not seen as a separate event but part of the whole story. The provision of radiology patient information material was haphazard. Participants could explain why they were having these procedures, and saw them as a 'necessary evil'. The provision of results of their tests was complex and chaotic, and was described as an anxious time. Conclusion: This study provides a unique insight into the experiences of men with prostate cancer relating to their attendance for imaging. Health professionals need to listen to their patients and learn, in order to provide a high quality, patient-centred imaging service.

  5. A methodology for automatic intensity-modulated radiation treatment planning for lung cancer

    Science.gov (United States)

    Zhang, Xiaodong; Li, Xiaoqiang; Quan, Enzhuo M.; Pan, Xiaoning; Li, Yupeng

    2011-07-01

    In intensity-modulated radiotherapy (IMRT), the quality of the treatment plan, which is highly dependent upon the treatment planner's level of experience, greatly affects the potential benefits of the radiotherapy (RT). Furthermore, the planning process is complicated and requires a great deal of iteration, and is often the most time-consuming aspect of the RT process. In this paper, we describe a methodology to automate the IMRT planning process in lung cancer cases, the goal being to improve the quality and consistency of treatment planning. This methodology (1) automatically sets beam angles based on a beam angle automation algorithm, (2) judiciously designs the planning structures, which were shown to be effective for all the lung cancer cases we studied, and (3) automatically adjusts the objectives of the objective function based on a parameter automation algorithm. We compared treatment plans created in this system (mdaccAutoPlan) based on the overall methodology with plans from a clinical trial of IMRT for lung cancer run at our institution. The 'autoplans' were consistently better, or no worse, than the plans produced by experienced medical dosimetrists in terms of tumor coverage and normal tissue sparing. We conclude that the mdaccAutoPlan system can potentially improve the quality and consistency of treatment planning for lung cancer.

  6. The National LGBT Cancer Action Plan: A White Paper of the 2014 National Summit on Cancer in the LGBT Communities

    Science.gov (United States)

    Margolies, Liz; Sigurdsson, Hrafn Oli; Walland, Jonathan; Radix, Asa; Rice, David; Buchting, Francisco O.; Sanchez, Nelson F.; Bare, Michael G.; Boehmer, Ulrike; Cahill, Sean; Griebling, Tomas L.; Bruessow, Diane; Maingi, Shail

    2016-01-01

    Abstract Despite growing social acceptance of lesbians, gay men, bisexuals, and transgender (LGBT) persons and the extension of marriage rights for same-sex couples, LGBT persons experience stigma and discrimination, including within the healthcare system. Each population within the LGBT umbrella term is likely at elevated risk for cancer due to prevalent, significant cancer risk factors, such as tobacco use and human immunodeficiency virus infection; however, cancer incidence and mortality data among LGBT persons are lacking. This absence of cancer incidence data impedes research and policy development, LGBT communities' awareness and activation, and interventions to address cancer disparities. In this context, in 2014, a 2-day National Summit on Cancer in the LGBT Communities was convened by a planning committee for the purpose of accelerating progress in identifying and addressing the LGBT communities' concerns and needs in the spheres of cancer research, clinical cancer care, healthcare policy, and advocacy for cancer survivorship and LGBT health equity. Summit participants were 56 invited persons from the United States, United Kingdom, and Canada, representatives of diverse identities, experiences, and knowledge about LGBT communities and cancer. Participants shared lessons learned and identified gaps and remedies regarding LGBT cancer concerns across the cancer care continuum from prevention to survivorship. This white paper presents background on each of the Summit themes and 16 recommendations covering the following: sexual orientation and gender identity data collection in national and state health surveys and research on LGBT communities and cancer, the clinical care of LGBT persons, and the education and training of healthcare providers.

  7. The effect of photon energy on intensity-modulated radiation therapy (IMRT) plans for prostate cancer

    OpenAIRE

    Sung, Wonmo; Park, Jong Min; Choi, Chang Heon; Ha, Sung Whan; Ye, Sung-Joon

    2012-01-01

    Purpose To evaluate the effect of common three photon energies (6-MV, 10-MV, and 15-MV) on intensity-modulated radiation therapy (IMRT) plans to treat prostate cancer patients. Materials and Methods Twenty patients with prostate cancer treated locally to 81.0 Gy were retrospectively studied. 6-MV, 10-MV, and 15-MV IMRT plans for each patient were generated using suitable planning objectives, dose constraints, and 8-field setting. The plans were analyzed in terms of dose-volume histogram for t...

  8. Comparative accuracy of different techniques in planning radiation therapy of breast cancer

    International Nuclear Information System (INIS)

    The authors report the results of the analysis of several factors contributing to the accuracy of treatment planning in the radiation therapy of breast cancer. Different techniques (non-radiological vs CT-based) were used for the acquisition of patients' data; different methods (manual vs computerized) were employed for dose calculation. As for geometric parameters describing the external outline and target volume, mean differences were lower than 4%. Switching from a completely manual method to a CT-based one with computerized calculation, a 3.56% mean decrease in the value of reference isodose (p<0.01) was observed, togheter with a 3.87% mean increase in the estimated inhomogeneity (p<0.001). The non-CT-based outline of target volume exhibited geographic missing of inner portions of the target in 8/16 patients. Our results demonstarte that treatment planning procedures can be a significant source of clinically relevant inaccuracy, which may affect treatment outcome and tumor control

  9. Use of Bone Scan During Initial Prostate Cancer Workup, Downstream Procedures, and Associated Medicare Costs

    Energy Technology Data Exchange (ETDEWEB)

    Falchook, Aaron D. [Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Salloum, Ramzi G. [Department of Health Services Policy and Management, University of South Carolina, Columbia, South Carolina (United States); Hendrix, Laura H. [Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Chen, Ronald C., E-mail: ronald_chen@med.unc.edu [Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States)

    2014-06-01

    Purpose: For patients with a high likelihood of having metastatic disease (high-risk prostate cancer), bone scan is the standard, guideline-recommended test to look for bony metastasis. We quantified the use of bone scans and downstream procedures, along with associated costs, in patients with high-risk prostate cancer, and their use in low- and intermediate-risk patients for whom these tests are not recommended. Methods and Materials: Patients in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database diagnosed with prostate cancer from 2004 to 2007 were included. Prostate specific antigen (PSA), Gleason score, and clinical T stage were used to define D'Amico risk categories. We report use of bone scans from the date of diagnosis to the earlier of treatment or 6 months. In patients who underwent bone scans, we report use of bone-specific x-ray, computed tomography (CT), and magnetic resonance imaging (MRI) scans, and bone biopsy within 3 months after bone scan. Costs were estimated using 2012 Medicare reimbursement rates. Results: In all, 31% and 48% of patients with apparent low- and intermediate-risk prostate cancer underwent a bone scan; of these patients, 21% underwent subsequent x-rays, 7% CT, and 3% MRI scans. Bone biopsies were uncommon. Overall, <1% of low- and intermediate-risk patients were found to have metastatic disease. The annual estimated Medicare cost for bone scans and downstream procedures was $11,300,000 for low- and intermediate-risk patients. For patients with apparent high-risk disease, only 62% received a bone scan, of whom 14% were found to have metastasis. Conclusions: There is overuse of bone scans in patients with low- and intermediate-risk prostate cancers, which is unlikely to yield clinically actionable information and results in a potential Medicare waste. However, there is underuse of bone scans in high-risk patients for whom metastasis is likely.

  10. Proposal for a procedure to plan an inventory process at Herradura Hotel

    Directory of Open Access Journals (Sweden)

    Yoaima Dickinson González

    2009-12-01

    Full Text Available Today, like years ago, Cuba is involved in a continuous struggle to improve the economy in its numerous sectors withspecific emphasis in tourism industry, which has globally evolved as one of the most increasing phenomena. Cuba,not being exerted from that situation, has placed it as the engine of the economy based on a previous redirection of itseconomic strategy. For this reason, it is necessary to search new managerial alternatives and theories contributing to thisdevelopment. In particular, finance management catches a great attention as a function of enterprise administration, asit is in charge of managing the productive resources in such a way that the organization meets the expected economicand financial results: more efficiency, less risk involved and higher profitability. This important function affects considerablydecision making process in terms of: maintaining appropriate cash flow levels, types of terms of credit to offerto clients or cost-effective inventory levels. All these arguments have led to the main purpose of this investigation andthat is to propose a procedure for inventory planning in hotelier organizations.

  11. SU-E-J-193: Feasibility of MRI-Only Based IMRT Planning for Pancreatic Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Prior, P; Botros, M; Chen, X; Paulson, E; Erickson, B; Li, X [Medical College of Wisconsin, Milwaukee, WI (United States)

    2014-06-01

    Purpose: With the increasing use of MRI simulation and the advent of MRI-guided delivery, it is desirable to use MRI only for treatment planning. In this study, we assess the dosimetric difference between MRI- and CTbased IMRT planning for pancreatic cancer. Methods: Planning CTs and MRIs acquired for a representative pancreatic cancer patient were used. MRI-based planning utilized forced relative electron density (rED) assignment of organ specific values from IRCU report 46, where rED = 1.029 for PTV and a rED = 1.036 for non-specified tissue (NST). Six IMRT plans were generated with clinical dose-volume (DV) constraints using a research Monaco planning system employing Monte Carlo dose calculation with optional perpendicular magnetic field (MF) of 1.5T. The following five plans were generated and compared with the planning CT: 1.) CT plan with MF and dose recalculation without optimization; 2.) MRI (T2) plan with target and OARs redrawn based on MRI, forced rED, no MF, and recalculation without optimization; 3.) Similar as in 2 but with MF; 4.) MRI plan with MF but without optimization; and 5.) Similar as in 4 but with optimization. Results: Generally, noticeable differences in PTV point doses and DV parameters (DVPs) between the CT-and MRI-based plans with and without the MF were observed. These differences between the optimized plans were generally small, mostly within 2%. Larger differences were observed in point doses and mean doses for certain OARs between the CT and MRI plan, mostly due to differences between image acquisition times. Conclusion: MRI only based IMRT planning for pancreatic cancer is feasible. The differences observed between the optimized CT and MRI plans with or without the MF were practically negligible if excluding the differences between MRI and CT defined structures.

  12. Experience on IMRT treatment for prostate cancer. Planning, dosimetry and quality assurance; Experiencia en el tratamiento de IMRT en cancer de prostata. Planificacion, dosimetria y garantia de calidad

    Energy Technology Data Exchange (ETDEWEB)

    Gomez Barrado, A.; Garcia Vicente, F.; Fernandez Bedoya, V.; Zapatero Laborda, A.; Fernandez, I.; Bermudez Luna, R.; Perez Gonzalez, L.; Torres Escobar, J. J.

    2011-07-01

    In this study a revision concerning the treatment of prostate cancer with intensity-modulated radiation therapy (IMRT) is performed. Planning and verification of treatments involving dose calculations and image positioning are considered. A set of 110 patients is analysed concerning dosimetry and 92 considering image verification. Dose calculation is verified both experimentally and by means of a monitor unit (MU) calculation system. Positioning control of the prostate is achieved using intraprostatic fiducial markers and digitally reconstructed radiographs (DRRs) as well as a home-made software. All patients studied were consistent with the specifications of the treatment protocol regarding dose prescription in planning target volume (PTV), organ at risk (OAR) dose limitations, dosimetric quality assurance and positioning control. The procedure includes a learning curve considering every aspect of the treatment. The MU calculation system itself has been proved as an effective and functional tool for treatment verification. (Author) 12 refs.

  13. Procedure-related, false-positive cytology results during EUS-guided FNA in patients with esophageal cancer

    NARCIS (Netherlands)

    van Hemel, Bettien M.; Lamprou, Alexander A.; Weersma, Rinse; Plukker, John T. M.; Suurmeijer, Albert J. H.; van Dullemen, Hendrik M.

    2010-01-01

    Background: EUS is a standard staging procedure in esophageal cancer. For adequate staging, FNA of suspicious lymph nodes is recommended. Based on optimal staging, sophisticated treatment can be applied more properly. The working channel of the endoscope can potentially be contaminated by cancer cel

  14. Using the Theory of Planned Behavior to Understand Cervical Cancer Screening among Latinas

    Science.gov (United States)

    Roncancio, Angelica M.; Ward, Kristy K.; Sanchez, Ingrid A.; Cano, Miguel A.; Byrd, Theresa L.; Vernon, Sally W.; Fernandez-Esquer, Maria Eugenia; Fernandez, Maria E.

    2015-01-01

    To reduce the high incidence of cervical cancer among Latinas in the United States it is important to understand factors that predict screening behavior. The aim of this study was to test the utility of theory of planned behavior in predicting cervical cancer screening among a group of Latinas. A sample of Latinas (N = 614) completed a baseline…

  15. IMRT treatment plans and functional planning with functional lung imaging from 4D-CT for thoracic cancer patients

    International Nuclear Information System (INIS)

    Currently, the inhomogeneity of the pulmonary function is not considered when treatment plans are generated in thoracic cancer radiotherapy. This study evaluates the dose of treatment plans on highly-functional volumes and performs functional treatment planning by incorporation of ventilation data from 4D-CT. Eleven patients were included in this retrospective study. Ventilation was calculated using 4D-CT. Two treatment plans were generated for each case, the first one without the incorporation of the ventilation and the second with it. The dose of the first plans was overlapped with the ventilation and analyzed. Highly-functional regions were avoided in the second treatment plans. For small targets in the first plans (PTV < 400 cc, 6 cases), all V5, V20 and the mean lung dose values for the highly-functional regions were lower than that of the total lung. For large targets, two out of five cases had higher V5 and V20 values for the highly-functional regions. All the second plans were within constraints. Radiation treatments affect functional lung more seriously in large tumor cases. With compromise of dose to other critical organs, functional treatment planning to reduce dose in highly-functional lung volumes can be achieved

  16. Automated generation of IMRT treatment plans for prostate cancer patients with metal hip prostheses: Comparison of different planning strategies

    Energy Technology Data Exchange (ETDEWEB)

    Voet, Peter W. J.; Dirkx, Maarten L. P.; Breedveld, Sebastiaan; Heijmen, Ben J. M. [Erasmus MC - Daniel den Hoed Cancer Center, Department of Radiation Oncology, Groene Hilledijk 301, 3075EA Rotterdam (Netherlands)

    2013-07-15

    Purpose: To compare IMRT planning strategies for prostate cancer patients with metal hip prostheses.Methods: All plans were generated fully automatically (i.e., no human trial-and-error interactions) using iCycle, the authors' in-house developed algorithm for multicriterial selection of beam angles and optimization of fluence profiles, allowing objective comparison of planning strategies. For 18 prostate cancer patients (eight with bilateral hip prostheses, ten with a right-sided unilateral prosthesis), two planning strategies were evaluated: (i) full exclusion of beams containing beamlets that would deliver dose to the target after passing a prosthesis (IMRT{sub remove}) and (ii) exclusion of those beamlets only (IMRT{sub cut}). Plans with optimized coplanar and noncoplanar beam arrangements were generated. Differences in PTV coverage and sparing of organs at risk (OARs) were quantified. The impact of beam number on plan quality was evaluated.Results: Especially for patients with bilateral hip prostheses, IMRT{sub cut} significantly improved rectum and bladder sparing compared to IMRT{sub remove}. For 9-beam coplanar plans, rectum V{sub 60Gy} reduced by 17.5%{+-} 15.0% (maximum 37.4%, p= 0.036) and rectum D{sub mean} by 9.4%{+-} 7.8% (maximum 19.8%, p= 0.036). Further improvements in OAR sparing were achievable by using noncoplanar beam setups, reducing rectum V{sub 60Gy} by another 4.6%{+-} 4.9% (p= 0.012) for noncoplanar 9-beam IMRT{sub cut} plans. Large reductions in rectum dose delivery were also observed when increasing the number of beam directions in the plans. For bilateral implants, the rectum V{sub 60Gy} was 37.3%{+-} 12.1% for coplanar 7-beam plans and reduced on average by 13.5% (maximum 30.1%, p= 0.012) for 15 directions.Conclusions: iCycle was able to automatically generate high quality plans for prostate cancer patients with prostheses. Excluding only beamlets that passed through the prostheses (IMRT{sub cut} strategy) significantly improved

  17. Automated VMAT treatment planning for stage III lung cancer: how does it compare with IMRT?

    Science.gov (United States)

    Quan, Enzhuo M.; Chang, Joe Y.; Liao, Zhongxing; Xia, Tingyi; Yuan, Zhiyong; Liu, Hui; Li, Xiaoqiang; Wages, Cody A.; Mohan, Radhe; Zhang, Xiaodong

    2012-01-01

    Purpose To compare the quality of volumetric modulated arc therapy (VMAT) or intensity-modulated radiation therapy (IMRT) plans generated by an automated inverse planning system with that of dosimetrist-generated IMRT treatment plans for patients with stage III lung cancer. Methods and Materials Two groups of eight patients with stage III lung cancer were randomly selected. For group I, the dosimetrists spent their best effort in designing IMRT plans to compete with the automated inverse planning system (mdaccAutoPlan); for group II, the dosimetrists were not in competition and spent their regular effort. Five experienced radiation oncologists independently blind-reviewed and ranked the three plans for each patient, a rank of “1” being the best and “3” the worst. Dosimetric measures were also performed to quantitatively evaluate the three types of plans. Results Blind rankings from different oncologists were generally consistent. For group I, the auto-VMAT, auto-IMRT, and manual-IMRT plans received average ranks of 1.6, 2.13, and 2.18, respectively. The auto-VMAT plans in group I had 10% higher PTV conformality and 24% lower esophagus V70 than the manual-IMRT plans; they also resulted in over 20% higher complication-free tumor control probability (p+) than either type of IMRT plans. The auto- and manual-IMRT plans in this group yielded generally comparable dosimetric measures. For group II, the auto-VMAT, auto-IMRT, and manual-IMRT plans received average ranks of 1.55, 1.75, and 2.75, respectively. Compared to the manual-IMRT plans in this group, the auto-VMAT plans and the auto-IMRT plans showed, respectively, 17% and 14% higher PTV dose conformality, 8% and 17% lower mean lung dose, 17% and 26% lower mean heart dose, and 36% and 23% higher p+. Conclusions mdaccAutoPlan is capable of generating high-quality VMAT and IMRT treatment plans for stage III lung cancer. Manual-IMRT plans could achieve quality similar to auto-IMRT plans if best effort were spent

  18. Combined modulated electron and photon beams planned by a Monte-Carlo-based optimization procedure for accelerated partial breast irradiation

    Science.gov (United States)

    Atriana Palma, Bianey; Ureba Sánchez, Ana; Salguero, Francisco Javier; Arráns, Rafael; Míguez Sánchez, Carlos; Walls Zurita, Amadeo; Romero Hermida, María Isabel; Leal, Antonio

    2012-03-01

    The purpose of this study was to present a Monte-Carlo (MC)-based optimization procedure to improve conventional treatment plans for accelerated partial breast irradiation (APBI) using modulated electron beams alone or combined with modulated photon beams, to be delivered by a single collimation device, i.e. a photon multi-leaf collimator (xMLC) already installed in a standard hospital. Five left-sided breast cases were retrospectively planned using modulated photon and/or electron beams with an in-house treatment planning system (TPS), called CARMEN, and based on MC simulations. For comparison, the same cases were also planned by a PINNACLE TPS using conventional inverse intensity modulated radiation therapy (IMRT). Normal tissue complication probability for pericarditis, pneumonitis and breast fibrosis was calculated. CARMEN plans showed similar acceptable planning target volume (PTV) coverage as conventional IMRT plans with 90% of PTV volume covered by the prescribed dose (Dp). Heart and ipsilateral lung receiving 5% Dp and 15% Dp, respectively, was 3.2-3.6 times lower for CARMEN plans. Ipsilateral breast receiving 50% Dp and 100% Dp was an average of 1.4-1.7 times lower for CARMEN plans. Skin and whole body low-dose volume was also reduced. Modulated photon and/or electron beams planned by the CARMEN TPS improve APBI treatments by increasing normal tissue sparing maintaining the same PTV coverage achieved by other techniques. The use of the xMLC, already installed in the linac, to collimate photon and electron beams favors the clinical implementation of APBI with the highest efficiency.

  19. Comparison of forward planning with automated inverse planning for three-dimensional conformal radiotherapy of non-small cell lung cancer without IMRT.

    Science.gov (United States)

    Mendes, Ruheena; Lavrenkov, Konstantin; Bedford, James L; Henrys, Anthony; Ashley, Sue; Brada, Michael

    2006-03-01

    The forward and inverse treatment plans of 10 patients with lung cancer were compared in terms of PTV coverage, sparing of normal lung and time required to generate a plan. The inverse planning produced as good treatment plans as an experienced dosimetrist with considerable reduction in staff time. When translated to other complex sites, inverse non-IMRT planning may have considerable impact on manpower requirements. PMID:16564591

  20. Comparison of forward planning with automated inverse planning for three-dimensional conformal radiotherapy of non-small cell lung cancer without IMRT

    International Nuclear Information System (INIS)

    The forward and inverse treatment plans of 10 patients with lung cancer were compared in terms of PTV coverage, sparing of normal lung and time required to generate a plan. The inverse planning produced as good treatment plans as an experienced dosimetrist with considerable reduction in staff time. When translated to other complex sites, inverse non-IMRT planning may have considerable impact on manpower requirements

  1. Anxiety Around Medical Procedures

    Science.gov (United States)

    ... Kidney/Wilms Tumor Liver Cancer Lymphoma (Non-Hodgkin) Lymphoma (Hodgkin) Neuroblastoma Osteosarcoma Retinoblastoma Rhabdomyosarcoma Skin Cancer Soft Tissue Sarcoma Thyroid Cancer Understanding Children's Cancer Anxiety Around Procedures Childhood Cancer Statistics Late ...

  2. Tests and Procedures

    Science.gov (United States)

    ... procedure is being done. How the results will influence treatment. What your child will experience during the ... Understanding Children’s Cancer About Cancer What is Cancer? Childhood Cancer Statistics Childhood Cancer Statistics Overview Number of ...

  3. My Cancer Care Plan as a Web-Solution.

    Science.gov (United States)

    Westman, Bodil; Cornelius, Birgitta

    2016-01-01

    The Swedish National Cancerplan states that patients should be offered an Individual Care Plan (ICP) for the treatment and survivorship care and rehabilitation planning. As there is no web-solution for ICP available, the project aim is to develop a non-commercial web-solution based on communication between the contact nurse and the patient. PMID:27332410

  4. Planning and implementing an implanted fiducial programme for prostate cancer radiation therapy

    International Nuclear Information System (INIS)

    Full text: Using implanted gold seeds as fiducial markers to verify the position of the prostate in radiation therapy is well accepted and is becoming the standard of practice and requirement for international multicentre trials. In 2006 the decision was made at the Peter MacCallum Caner Centre (Peter Mac) to plan for and implement this process as standard clinical practice for radical dose prostate treatments (74-78 Gy). Before this, programme verification of field placement for prostate cancer radiation treatment was routinely carried out using regular off-line electronic portal imaging with matching of bony anatomy. A small multidisciplinary team investigated and assisted in the implementation of this new practice across the Peter Mac sites at East Melbourne and our three satellite centres. Issues considered included seed size, number and position in the prostate, implant equipment, imaging equipment and procedure and consent and information forms. The use of a custom made fiducial pack, comprehensive patient information and a daily on-line imaging process was implemented. The experience of the first 28 patients at Peter Mac from January 2007 to May 2007 inclusive is reported on.

  5. 78 FR 38989 - New Policies and Procedural Requirements for Electronic Submission of State Plans, and Program...

    Science.gov (United States)

    2013-06-28

    ... HUMAN SERVICES Administration for Children and Families New Policies and Procedural Requirements for... Health and Humans Services (HHS). ACTION: Notice for public comment of new policies and procedural...-425: Federal Financial Report (FFR). Children's Justice Act Form SF-425: Federal Financial Report...

  6. Commissioning of a 3D image-based treatment planning system for high-dose-rate brachytherapy of cervical cancer.

    Science.gov (United States)

    Kim, Yongbok; Modrick, Joseph M; Pennington, Edward C; Kim, Yusung

    2016-01-01

    The objective of this work is to present commissioning procedures to clinically implement a three-dimensional (3D), image-based, treatment-planning system (TPS) for high-dose-rate (HDR) brachytherapy (BT) for gynecological (GYN) cancer. The physical dimensions of the GYN applicators and their values in the virtual applicator library were varied by 0.4 mm of their nominal values. Reconstruction uncertainties of the titanium tandem and ovoids (T&O) were less than 0.4 mm on CT phantom studies and on average between 0.8-1.0 mm on MRI when compared with X-rays. In-house software, HDRCalculator, was developed to check HDR plan parameters such as independently verifying active tandem or cylinder probe length and ovoid or cylinder size, source calibration and treatment date, and differences between average Point A dose and prescription dose. Dose-volume histograms were validated using another independent TPS. Comprehensive procedures to commission volume optimization algorithms and process in 3D image-based planning were presented. For the difference between line and volume optimizations, the average absolute differences as a percentage were 1.4% for total reference air KERMA (TRAK) and 1.1% for Point A dose. Volume optimization consistency tests between versions resulted in average absolute differences in 0.2% for TRAK and 0.9 s (0.2%) for total treatment time. The data revealed that the optimizer should run for at least 1 min in order to avoid more than 0.6% dwell time changes. For clinical GYN T&O cases, three different volume optimization techniques (graphical optimization, pure inverse planning, and hybrid inverse optimization) were investigated by comparing them against a conventional Point A technique. End-to-end testing was performed using a T&O phantom to ensure no errors or inconsistencies occurred from imaging through to planning and delivery. The proposed commissioning procedures provide a clinically safe implementation technique for 3D image-based TPS for HDR

  7. The effect of photon energy on the intensity-modulated radiation therapy plan for prostate cancer: a planning study

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Jin-Beom; Kim, Jae-Sung; Kim, In-Ah [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Lee, Jeong-Woo [Konkuk University Hospital, Seoul (Korea, Republic of); Korea University, Seoul (Korea, Republic of); Cho, Woong; Suh, Tae-Suk [The Catholic University of Korea, Seoul (Korea, Republic of)

    2011-07-15

    In this study, the effect of the beam energy on the intensity modulated radiation therapy (IMRT) plan for prostate cancer was studied for competing IMRT plans optimized for delivery with either 6- or 15-MV photons. This retrospective planning study included 10 patients treated for localized prostate cancer at the Seoul National University Bundang Hospital. A dose of 66 Gy was prescribed in 33 daily fractions of 2 Gy. For inverse IMRT treatment planning, we used a 7-coplanar non-opposed beam arrangement at 0, 50, 100, 150, 210, 260, and 310 degree angles. To ensure that differences among the plans were due only to energy selection, the beam arrangement, number of beam, and dose constraints were kept constant for all plans. The dose volume histograms (DVHs) for the 6- and 15-MV plans were compared for the planning target volume (PTV) and for organs at risk (OAR), such as the rectum, bladder and both femoral heads. The conformal index was defined as the ratio of the 95% isodose volume divided by the PTV volume enclosed by the 95% isodose line, because we selected the 95% isodose line as our reference. Doses received by the 95% and 5% volume of the PTV were less than or equal to 1% for 6-MV compared to the 15-MV IMRT plan for 10 patients. Percentage of doses received by the 10% volume of the bladder and rectum were less than or equal to 1%. Percentage of doses received by the 30 and 50% volume of bladder and rectum were 1 {approx} 2% higher for 6-MV photons. Also, percentage of dose received by the 10% and 50% volume of the right and the left femur heads were 4 {approx} 5% higher for 6-MV photons. The mean homogeneity index for the 6-MV and 15-MV photon plans was 1.06. The mean conformity index of 95% was 1.04 {+-} 0.01 and 1.12 {+-} 0.02 for 6-MV and 15-MV, respectively, but this difference was not statistically significant. The mean monitor unit was 812 {+-} 40 and 716 {+-} 33 for the 6-MV and the 15-MV photon plans, respectively. The 6-MV photon plan delivers 13

  8. An in silico comparison between margin-based and probabilistic target-planning approaches in head and neck cancer patients

    NARCIS (Netherlands)

    Fontanarosa, Davide; van der Laan, Hans Paul; Witte, Marnix; Shakirin, Georgy; Roelofs, Erik; Langendijk, Johannes; Larnbin, Philippe; van Herk, Marcel

    2013-01-01

    Background and purpose: To apply target probabilistic planning (TPP) approach to intensity modulated radiotherapy (IMRT) plans for head and neck cancer (HNC) patients. Material and methods: Twenty plans of HNC patients were re-planned replacing the simultaneous integrated boost IMRT optimization obj

  9. Adaptive radiotherapy for muscle-invasive bladder cancer: optimisation of plan sizes

    International Nuclear Information System (INIS)

    Plan-of-the-day adaptive radiotherapy (ART) that has not been optimally designed may result in inefficient plan sizes. This can lead to unused plans, which may potentially reduce overall conformality. We compared two methods of individualising ART plan sizes for muscle-invasive bladder cancer to determine which provides a more balanced distribution of plan selections. Twenty-seven previously treated patients had small, medium and large ART plans generated from CTV contours on the simulation CT and initial cone beam CTs (CBCT). In the original clinical method, the smallest plan was based on the smallest CTV, while the experimental method used the Boolean summation of the two smallest CTVs. The large plan was identical in both methods. The medium plans were created midway between small and large CTVs. Credentialed treatment staff performed plan selection clinically for the original plans and retrospectively for the experimental plans. A total of 646 CBCTs from 26 patients were included. The small, medium and large adaptive CTVs, and the conventional CTV, were used 29.7%, 45.4%, 22.0% and 2.9% of the time, respectively, compared to the previous 9.8%, 49.2%, 39.5% and 1.5%. The differences were significant between previous and new CTV (small), and CTV (large). The new design method resulted in the three adaptive CTV choices being selected more evenly, however, a reduction in a surrogate for normal tissue irradiation was not observed.

  10. Application of positron emission tomography/computed tomography in radiation treatment planning for head and neck cancers

    Institute of Scientific and Technical Information of China (English)

    Musaddiq; J; Awan; Farzan; Siddiqui; David; Schwartz; Jiankui; Yuan; Mitchell; Machtay; Min; Yao

    2015-01-01

    18-fluorodeoxygluocose positron emission tomography/computed tomography(18FDG-PET/CT) provides significant information in multiple settings in the management of head and neck cancers(HNC). This article seeks to define the additional benefit of PET/CT as related to radiation treatment planning for squamous cell carcinomas(SCCs) of the head and neck through a review of relevant literature. By helping further define both primary and nodal volumes, radiation treatment planning can be improved using PET/CT. Special attention is paid to the independent benefit of PET/CT in targeting mucosal primaries as well as in detecting nodal metastases. The utility of PET/CT is also explored for treatment planning in the setting of SCC of unknown primary as PET/CT may help define a mucosal target volume by guiding biopsies for examination under anesthesia thus changing the treatment paradigm and limiting the extent of therapy. Implications of the use of PET/CT for proper target delineation in patients with artifact from dental procedures are discussed and the impact of dental artifact on CT-based PET attenuation correction is assessed. Finally, comment is made upon the role of PET/CT in the high-risk post-operative setting, particularly in the context of radiation dose escalation. Real case examples are used in these settings to elucidate the practical benefits of PET/CT as related to radiation treatment planning in HNCs.

  11. Can the National Health Service Cancer Plan timeline be applied to colorectal hepatic metastases?

    LENUS (Irish Health Repository)

    Jones, Claire

    2012-02-01

    INTRODUCTION: The National Health Service (NHS) Cancer Plan guidelines recommend a maximum 2-week wait from referral to first appointment, and 2 months from referral to treatment for primary cancers. However, there are currently no guidelines available for metastatic disease. In the UK, nearly half of all colorectal cancer patients develop hepatic metastases. Timely, surgical resection offers the potential for cure. The aim of this study was to audit current practice for colorectal liver metastases in a regional hepatobiliary unit, and compare this to the NHS Cancer Plan standards for primary disease. PATIENTS AND METHODS: A retrospective review of the unit\\'s database was performed for all hepatic metastases referrals from January 2006 to December 2008. The dates of referral, first appointment, investigations and initiation of treatment, along with patient\\'s age and sex, were recorded on Microsoft Excel and analysed. Time was expressed as mean +\\/- SD in days. RESULTS: A total of 102 patients with hepatic metastases were identified. Five were excluded due to incomplete data. The average time from referral to first appointment was 10.6 +\\/- 9.4 days and the average time from referral to treatment was 38.5 +\\/- 28.6 days. Seventy-five (72.7%) had surgical intervention, of whom 37 also had chemotherapy. CONCLUSIONS: The data compare favourably to the NHS Cancer Plan guidelines for primary malignancy, demonstrating that a regional hepatobiliary unit is capable of delivering a service for colorectal liver metastases that adheres to the NHS Cancer Plan. Therefore, the NHS Cancer Plan can be applied to this cohort.

  12. Adaptive Stereotactic Body Radiation Therapy Planning for Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Qin, Yujiao [Medical Physics Graduate Program, Duke University, Durham, North Carolina (United States); Zhang, Fan [Occupational and Environmental Safety Office, Duke University Medical Center, Durham, North Carolina (United States); Yoo, David S.; Kelsey, Chris R. [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Yin, Fang-Fang [Medical Physics Graduate Program, Duke University, Durham, North Carolina (United States); Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Cai, Jing, E-mail: jing.cai@duke.edu [Medical Physics Graduate Program, Duke University, Durham, North Carolina (United States); Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States)

    2013-09-01

    Purpose: To investigate the dosimetric effects of adaptive planning on lung stereotactic body radiation therapy (SBRT). Methods and Materials: Forty of 66 consecutive lung SBRT patients were selected for a retrospective adaptive planning study. CBCT images acquired at each fraction were used for treatment planning. Adaptive plans were created using the same planning parameters as the original CT-based plan, with the goal to achieve comparable comformality index (CI). For each patient, 2 cumulative plans, nonadaptive plan (P{sub NON}) and adaptive plan (P{sub ADP}), were generated and compared for the following organs-at-risks (OARs): cord, esophagus, chest wall, and the lungs. Dosimetric comparison was performed between P{sub NON} and P{sub ADP} for all 40 patients. Correlations were evaluated between changes in dosimetric metrics induced by adaptive planning and potential impacting factors, including tumor-to-OAR distances (d{sub T-OAR}), initial internal target volume (ITV{sub 1}), ITV change (ΔITV), and effective ITV diameter change (Δd{sub ITV}). Results: 34 (85%) patients showed ITV decrease and 6 (15%) patients showed ITV increase throughout the course of lung SBRT. Percentage ITV change ranged from −59.6% to 13.0%, with a mean (±SD) of −21.0% (±21.4%). On average of all patients, P{sub ADP} resulted in significantly (P=0 to .045) lower values for all dosimetric metrics. Δd{sub ITV}/d{sub T-OAR} was found to correlate with changes in dose to 5 cc (ΔD5cc) of esophagus (r=0.61) and dose to 30 cc (ΔD30cc) of chest wall (r=0.81). Stronger correlations between Δd{sub ITV}/d{sub T-OAR} and ΔD30cc of chest wall were discovered for peripheral (r=0.81) and central (r=0.84) tumors, respectively. Conclusions: Dosimetric effects of adaptive lung SBRT planning depend upon target volume changes and tumor-to-OAR distances. Adaptive lung SBRT can potentially reduce dose to adjacent OARs if patients present large tumor volume shrinkage during the treatment.

  13. Wind energy and spatial planning procedures; La programmation spatiale des projects eoliens

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2002-07-01

    Wind turbines projects have been increasing, but some are very conflicted. May be it is a reason why some local authorities have to deal with different point of view, above the only energy question and including local specificity. To give local authorities the possibility to be implicated and to be in control of wind projects in their territory, wind spatial planning should permit to choose suitable areas and to optimize wind power development. In this context this synthesis presents the wind spatial planning in Finistere (France), the french regulation, some international experiences (Danish, Flemish, Walloon region, Dutch) and the different approaches of spatial planning. (A.L.B.)

  14. An operative gamma camera for sentinel lymph node procedure in case of breast cancer

    CERN Document Server

    Salvador, S; Mathelin, C; Guyonne, J; Huss, D

    2007-01-01

    Large field of view gamma cameras are widely used to perform lymphoscintigraphy in the sentinel lymph nodes (SLN) procedure in case of breast cancer. However, they are not specified for this application and their sizes do not enable their use in the operative room to control the excision of the all SLN. We present the results obtained with a prototype of a new mini gamma camera developed especially for the operative lymphoscintigraphy of the axillary area in case of breast cancer. This prototype is composed of 10 mm thick parallel lead collimator, a 2 mm thick GSO:Ce inorganic scintillating crystal from Hitachi and a Hamamatsu H8500 flat panel multianode (64 channels) photomultiplier tube (MAPMT) equipped with a dedicated electronics. Its actual field of view is 50 × 50mm2. The gamma interaction position in the GSO scintillating plate is obtained by calculating the center of gravity of the fired MAPMT channels. The measurements performed with this prototype demonstrate the usefulness of this mini gamma camer...

  15. Maximizing dosimetric benefits of IMRT in the treatment of localized prostate cancer through multicriteria optimization planning

    Energy Technology Data Exchange (ETDEWEB)

    Wala, Jeremiah; Craft, David [Harvard Medical School, Boston, MA (United States); Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); Paly, Jon [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); Zietman, Anthony [Harvard Medical School, Boston, MA (United States); Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); Efstathiou, Jason, E-mail: jefstathiou@partners.org [Harvard Medical School, Boston, MA (United States); Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States)

    2013-10-01

    We examine the quality of plans created using multicriteria optimization (MCO) treatment planning in intensity-modulated radiation therapy (IMRT) in treatment of localized prostate cancer. Nine random cases of patients receiving IMRT to the prostate were selected. Each case was associated with a clinically approved plan created using Corvus. The cases were replanned using MCO-based planning in RayStation. Dose-volume histogram data from both planning systems were presented to 2 radiation oncologists in a blinded evaluation, and were compared at a number of dose-volume points. Both physicians rated all 9 MCO plans as superior to the clinically approved plans (p<10{sup −5}). Target coverage was equivalent (p = 0.81). Maximum doses to the prostate and bladder and the V50 and V70 to the anterior rectum were reduced in all MCO plans (p<0.05). Treatment planning time with MCO took approximately 60 minutes per case. MCO-based planning for prostate IMRT is efficient and produces high-quality plans with good target homogeneity and sparing of the anterior rectum, bladder, and femoral heads, without sacrificing target coverage.

  16. Integrating environment into land-use planning through strategic environmental assessment in China: Towards legal frameworks and operational procedures

    International Nuclear Information System (INIS)

    China currently put forwards 'striving to build an environmentally friendly society' as one of the most important development goals. The land administration authorities are facing the challenge of effectively incorporating environment considerations into their planning system. This paper aims to investigate why and how Strategic Environmental Assessment (SEA) is enacted as an effective tool to integrate the environment into land-use planning during the construction process of an environmentally friendly society in China, and identify factors that influence the integration. It presents characteristics of the land-use planning system, and reviews the progress and current state of SEA in China. Results show that SEA provides many benefits in promoting environmental considerations into the land-use planning process. The legal frameworks and operational procedures, in the context of land-use master planning SEA, are summarized and an assessment made of their effectiveness. Some barriers are highlighted through examination of the latest case studies, and several recommendations are presented to overcome these obstacles

  17. Use of Positron Emission Tomography/Computed Tomography in Radiation Treatment Planning for Lung Cancer

    OpenAIRE

    Kezban Berberoğlu

    2016-01-01

    Radiotherapy (RT) plays an important role in the treatment of lung cancer. Accurate diagnosis and staging are crucial in the delivery of RT with curative intent. Target miss can be prevented by accurate determination of tumor contours during RT planning. Currently, tumor contours are determined manually by computed tomography (CT) during RT planning. This method leads to differences in delineation of tumor volume between users. Given the change in RT tools and methods due to rapidly ...

  18. Functional image-based radiotherapy planning for non-small cell lung cancer: a simulation study

    OpenAIRE

    Bates, E.L.; Bragg, C.M.; Wild, J. M.; Hatton, M.Q.F.; Ireland, R.H.

    2009-01-01

    Background and purpose: To investigate the incorporation of data from single-photon emission computed tomography (SPECT) or hyperpolarized helium-3 magnetic resonance imaging (He-3-MRI) into intensity-modulated radiotherapy (IMRT) planning for non-small cell lung cancer (NSCLC). Material and methods: Seven scenarios were simulated that represent cases of NSCLC with significant functional lung defects. Two independent IMRT plans were produced for each scenario; one to minimise total lung vo...

  19. The impact of preoperative breast MRI on surgical planning in women with incident breast cancer

    OpenAIRE

    Aðalheiður Jónsdóttir 1973

    2011-01-01

    Introduction: Routine breast Magnetic Resonance Imaging (MRI) has recently been introduced in Iceland as a preoperative examination of patients with incident breast cancer. Previous studies report that additional lesions not detected on mammography can be identified with MRI, which may result in revised surgical planning. Objectives: The aim of this study is to determine if additional findings on preoperative breast MRI changed the planned surgical treatment. Methods: This is a descript...

  20. Advantages and limitations of navigation-based multicriteria optimization (MCO) for localized prostate cancer IMRT planning

    Energy Technology Data Exchange (ETDEWEB)

    McGarry, Conor K., E-mail: conor.mcgarry@belfasttrust.hscni.net [Radiotherapy Physics, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, Northern Ireland (United Kingdom); Bokrantz, Rasmus [Optimization and Systems Theory, KTH Royal Institute of Technology, Stockholm (Sweden); RaySearch Laboratories, Stockholm (Sweden); O’Sullivan, Joe M. [Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, Northern Ireland (United Kingdom); Clinical Oncology, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, Northern Ireland (United Kingdom); Hounsell, Alan R. [Radiotherapy Physics, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, Northern Ireland (United Kingdom); Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, Northern Ireland (United Kingdom)

    2014-10-01

    Efficacy of inverse planning is becoming increasingly important for advanced radiotherapy techniques. This study’s aims were to validate multicriteria optimization (MCO) in RayStation (v2.4, RaySearch Laboratories, Sweden) against standard intensity-modulated radiation therapy (IMRT) optimization in Oncentra (v4.1, Nucletron BV, the Netherlands) and characterize dose differences due to conversion of navigated MCO plans into deliverable multileaf collimator apertures. Step-and-shoot IMRT plans were created for 10 patients with localized prostate cancer using both standard optimization and MCO. Acceptable standard IMRT plans with minimal average rectal dose were chosen for comparison with deliverable MCO plans. The trade-off was, for the MCO plans, managed through a user interface that permits continuous navigation between fluence-based plans. Navigated MCO plans were made deliverable at incremental steps along a trajectory between maximal target homogeneity and maximal rectal sparing. Dosimetric differences between navigated and deliverable MCO plans were also quantified. MCO plans, chosen as acceptable under navigated and deliverable conditions resulted in similar rectal sparing compared with standard optimization (33.7 ± 1.8 Gy vs 35.5 ± 4.2 Gy, p = 0.117). The dose differences between navigated and deliverable MCO plans increased as higher priority was placed on rectal avoidance. If the best possible deliverable MCO was chosen, a significant reduction in rectal dose was observed in comparison with standard optimization (30.6 ± 1.4 Gy vs 35.5 ± 4.2 Gy, p = 0.047). Improvements were, however, to some extent, at the expense of less conformal dose distributions, which resulted in significantly higher doses to the bladder for 2 of the 3 tolerance levels. In conclusion, similar IMRT plans can be created for patients with prostate cancer using MCO compared with standard optimization. Limitations exist within MCO regarding conversion of navigated plans to

  1. Optimization in the utility maximization framework for conservation planning: a comparison of solution procedures in a study of multifunctional agriculture

    Science.gov (United States)

    Kreitler, Jason R.; Stoms, David M.; Davis, Frank W.

    2014-01-01

    Quantitative methods of spatial conservation prioritization have traditionally been applied to issues in conservation biology and reserve design, though their use in other types of natural resource management is growing. The utility maximization problem is one form of a covering problem where multiple criteria can represent the expected social benefits of conservation action. This approach allows flexibility with a problem formulation that is more general than typical reserve design problems, though the solution methods are very similar. However, few studies have addressed optimization in utility maximization problems for conservation planning, and the effect of solution procedure is largely unquantified. Therefore, this study mapped five criteria describing elements of multifunctional agriculture to determine a hypothetical conservation resource allocation plan for agricultural land conservation in the Central Valley of CA, USA. We compared solution procedures within the utility maximization framework to determine the difference between an open source integer programming approach and a greedy heuristic, and find gains from optimization of up to 12%. We also model land availability for conservation action as a stochastic process and determine the decline in total utility compared to the globally optimal set using both solution algorithms. Our results are comparable to other studies illustrating the benefits of optimization for different conservation planning problems, and highlight the importance of maximizing the effectiveness of limited funding for conservation and natural resource management.

  2. Automatic bladder segmentation on CBCT for multiple plan ART of bladder cancer using a patient-specific bladder model

    Science.gov (United States)

    Chai, Xiangfei; van Herk, Marcel; Betgen, Anja; Hulshof, Maarten; Bel, Arjan

    2012-06-01

    In multiple plan adaptive radiotherapy (ART) strategies of bladder cancer, a library of plans corresponding to different bladder volumes is created based on images acquired in early treatment sessions. Subsequently, the plan for the smallest PTV safely covering the bladder on cone-beam CT (CBCT) is selected as the plan of the day. The aim of this study is to develop an automatic bladder segmentation approach suitable for CBCT scans and test its ability to select the appropriate plan from the library of plans for such an ART procedure. Twenty-three bladder cancer patients with a planning CT and on average 11.6 CBCT scans were included in our study. For each patient, all CBCT scans were matched to the planning CT on bony anatomy. Bladder contours were manually delineated for each planning CT (for model building) and CBCT (for model building and validation). The automatic segmentation method consisted of two steps. A patient-specific bladder deformation model was built from the training data set of each patient (the planning CT and the first five CBCT scans). Then, the model was applied to automatically segment bladders in the validation data of the same patient (the remaining CBCT scans). Principal component analysis (PCA) was applied to the training data to model patient-specific bladder deformation patterns. The number of PCA modes for each patient was chosen such that the bladder shapes in the training set could be represented by such number of PCA modes with less than 0.1 cm mean residual error. The automatic segmentation started from the bladder shape of a reference CBCT, which was adjusted by changing the weight of each PCA mode. As a result, the segmentation contour was deformed consistently with the training set to fit the bladder in the validation image. A cost function was defined by the absolute difference between the directional gradient field of reference CBCT sampled on the corresponding bladder contour and the directional gradient field of validation

  3. Comparison of CT based-CTV plan and CT based-ICRU38 plan in brachytherapy planning of uterine cervix cancer

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Jung Keun; Han, Tae Jong [Jeonju Univ., Jeonju (Korea, Republic of)

    2007-09-15

    Purpose : In spite of recent remarkable improvement of diagnostic imaging modalities such as CT, MRI, and PET and radiation therapy planing systems, ICR plan of uterine cervix cancer, based on recommendation of ICRU38(2D film-based) such as point A, is still used widely. A 3-dimensional ICR plan based on CT image provides Dose-Volume Histogram(DVH) information of the tumor and normal tissue. In this study, we compared tumor-dose, rectal-dose and bladder-dose through an analysis of DVH between CTV plan and ICRU38 plan based on CT image. Method and Material : We analyzed 11 patients with a cervix cancer who received the ICR of Ir-192 HDR. After 40Gy of external beam radiation therapy, ICR plan was established using PLATO(Nucletron) v.14.2 planning system. CT scan was done to all the patients using CT-simulator(Ultra Z, Philips). We contoured CTV, rectum and bladder on the CT image and established CTV plan which delivers the 100% dose to CTV and ICRU plan which delivers the 100% dose to the point A. Result : The volume(average{+-}SD) of CTV, rectum and bladder in all of 11 patients is 21.8{+-}6.6cm{sup 3}, 60.9{+-}25.0cm{sup 3}, 111.6{+-}40.1cm{sup 3} respectively. The volume covered by 100% isodose curve is 126.7{+-}18.9cm{sup 3} in ICRU plan and 98.2{+-}74.5cm{sup 3} in CTV plan(p=0.0001), respectively. In (On) ICRU planning 22.0cm{sup 3} of CTV volume was not covered by 100% isodose curve in one patient whose residual tumor size is greater than 4cm, while more than 100% dose was irradiated unnecessarily to the normal organ of 62.2{+-}4.8cm{sup 3} other than the tumor in the remaining 10 patients with a residual tumor less than 4cm in size. Bladder dose recommended by ICRU 38 was 90.1{+-}21.3% and 68.7{+-}26.6% in ICRU plan and in CTV plan respectively(p=0.001) while rectal dose recommended by ICRU 38 was 86.4{+-}18.3% and 76.9{+-}15.6% in ICRU plan and in CTV plan, respectively(p=0.08). Bladder and rectum maximum dose was 137.2{+-}50.1%, 101.1{+-}41.8% in ICRU plan

  4. Reduction in the number of sentinel lymph node procedures by preoperative ultrasonography of the axilla in breast cancer.

    NARCIS (Netherlands)

    Deurloo, E.E.; Tanis, P.J.; Gilhuijs, K.G.; Muller, S.H.; Kroger, R.; Peterse, J.L.; Rutgers, E.; Valdes Olmos, R.A.; Schultze Kool, L.J.

    2003-01-01

    Currently, breast cancer patients without clinically suspicious lymph nodes are candidates for sentinel lymph node procedures (SLNPs). The aims of this study were to investigate whether preoperative axillary ultrasonography and fine-needle aspiration cytology (FNA) can reduce the number of the more

  5. Optimized planning target volume margin in helical tomotherapy for prostate cancer: is there a preferred method?

    CERN Document Server

    Cao, Yuan Jie; Chang, Kyung Hwan; Shim, Jang Bo; Kim, Kwang Hyeon; Jang, Min Sun; Yoon, Won Sup; Yang, Dae Sik; Park, Young Je; Kim, Chul Yong

    2015-01-01

    To compare the dosimetrical differences between plans generated by helical tomotherapy using 2D or 3D margining technique in in prostate cancer. Ten prostate cancer patients were included in this study. For 2D plans, planning target volume (PTV) was created by adding 5 mm (lateral/anterior-posterior) to clinical target volume (CTV). For 3D plans, 5 mm margin was added not only in lateral/anterior-posterior, but also in superior-inferior to CTV. Various dosimetrical indices, including the prescription isodose to target volume (PITV) ratio, conformity index (CI), homogeneity index (HI), target coverage index (TCI), modified dose homogeneity index (MHI), conformation number (CN), critical organ scoring index (COSI), and quality factor (QF) were determined to compare the different treatment plans. Differences between 2D and 3D PTV indices were not significant except for CI (p = 0.023). 3D margin plans (11195 MUs) resulted in higher (13.0%) monitor units than 2D margin plans (9728 MUs). There were no significant d...

  6. Preliminary Development of a Workstation for Craniomaxillofacial Surgical Procedures: Introducing a Computer-Assisted Planning and Execution System

    Science.gov (United States)

    Gordon, Chad R.; Murphy, Ryan J.; Coon, Devin; Basafa, Ehsan; Otake, Yoshito; Al Rakan, Mohammed; Rada, Erin; Susarla, Sriniras; Swanson, Edward; Fishman, Elliot; Santiago, Gabriel; Brandacher, Gerald; Liacouras, Peter; Grant, Gerald; Armand, Mehran

    2014-01-01

    Introduction Facial transplantation represents one of the most complicated scenarios in craniofacial surgery because of skeletal, aesthetic, and dental discrepancies between donor and recipient. However, standard off-the-shelf vendor computer-assisted surgery systems may not provide custom features to mitigate the increased complexity of this particular procedure. We propose to develop a computer-assisted surgery solution customized for preoperative planning, intraoperative navigation including cutting guides, and dynamic, instantaneous feedback of cephalometric measurements/angles as needed for facial transplantation. Methods We developed the Computer-Assisted Planning and Execution (CAPE) workstation to assist with planning and execution of facial transplantation. Preoperative maxillofacial computed tomography (CT) scans were obtained on 4 size-mismatched miniature swine encompassing 2 live face-jaw-teeth transplants. The system was tested in a laboratory setting using plastic models of mismatched swine, after which the system was used in 2 live swine transplants. Postoperative CT imaging was obtained and compared with the preoperative plan and intraoperative measures from the CAPE workstation for both transplants. Results Plastic model tests familiarized the team with the CAPE workstation and identified several defects in the workflow. Live swine surgeries demonstrated utility of the CAPE system in the operating room, showing submillimeter registration error of 0.6 ± 0.24 mm and promising qualitative comparisons between intraoperative data and postoperative CT imaging. Conclusions The initial development of the CAPE workstation demonstrated integration of computer planning and intraoperative navigation for facial transplantation are possible with submillimeter accuracy. This approach can potentially improve preoperative planning, allowing ideal donor-recipient matching despite significant size mismatch, and accurate surgical execution. PMID:24406592

  7. 7 CFR 1948.82 - Plan and State Investment Strategy approval procedure.

    Science.gov (United States)

    2010-01-01

    ... hired in coal or uranium development activities in each of the next three years within the approved... Impacted Area Development Assistance Program § 1948.82 Plan and State Investment Strategy approval... production, processing, or transportation in each of the next three calendar years within the area covered...

  8. A Plan to Establish Consistency in Classroom Management Procedures with Preschool Children.

    Science.gov (United States)

    Napoli, Richard A.

    In this practicum, a plan to establish consistency in classroom management was implemented in order to enhance the positive behaviors of preschool and kindergarten children. Participating in the project were 7 classrooms serving 149 preschool and kindergarten children. A total of 14 staff members received inservice training in operant conditioning…

  9. PLAN-TA9-2443(U), Rev. B Remediated Nitrate Salt (RNS) Surrogate Formulation and Testing Standard Procedure

    Energy Technology Data Exchange (ETDEWEB)

    Brown, Geoffrey Wayne [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2016-03-16

    This document identifies scope and some general procedural steps for performing Remediated Nitrate Salt (RNS) Surrogate Formulation and Testing. This Test Plan describes the requirements, responsibilities, and process for preparing and testing a range of chemical surrogates intended to mimic the energetic response of waste created during processing of legacy nitrate salts. The surrogates developed are expected to bound1 the thermal and mechanical sensitivity of such waste, allowing for the development of process parameters required to minimize the risk to worker and public when processing this waste. Such parameters will be based on the worst-case kinetic parameters as derived from APTAC measurements as well as the development of controls to mitigate sensitivities that may exist due to friction, impact, and spark. This Test Plan will define the scope and technical approach for activities that implement Quality Assurance requirements relevant to formulation and testing.

  10. Development of a novel approach for breast cancer prediction and early detection using minimally invasive procedures and molecular analysis: how cytomorphology became a breast cancer risk predictor.

    Science.gov (United States)

    Masood, Shahla

    2015-01-01

    With enhanced public awareness, advances in breast imaging, and emphasis on early breast cancer detection and prevention, more women are seeking consultation to assess the status of their breast health. Risk assessment has become an integral part of established multi-disciplinary breast care, and breast cancer risk reduction interventions have received a great deal of attention. Similarly, interest in identification of high-risk individuals has increased significantly. Atypical proliferative changes in breast epithelial cells are ranked high among various known breast cancer risk factors and, in recent years, have been the subject of several investigations. Breast tissue and fluid in the ductal system provide a rich source of cells and biomarkers that have the potential to aid in the assessment of short-term risk of breast cancer development, and assess responses to interventional prevention efforts. There are three minimally invasive procedures currently being utilized to sample breast tissue in asymptomatic high-risk individuals. These procedures are: fine-needle aspiration biopsy, nipple aspiration fluid, and ductal lavage. In this review article, the merits and limitations of each procedure are presented, and the contribution of cytomorphology and molecular analysis in breast cancer prediction is highlighted. In addition, the role of Masood Cytology Index as a surrogate endpoint biomarker in chemopreventative trials is discussed. PMID:25556774

  11. Magnetic resonance imaging for planning intracavitary brachytherapy for the treatment of locally advanced cervical cancer.

    Science.gov (United States)

    Oñate Miranda, M; Pinho, D F; Wardak, Z; Albuquerque, K; Pedrosa, I

    2016-01-01

    Cervical cancer is the third most common gynecological cancer. Its treatment depends on tumor staging at the time of diagnosis, and a combination of chemotherapy and radiotherapy is the treatment of choice in locally advanced cervical cancers. The combined use of external beam radiotherapy and brachytherapy increases survival in these patients. Brachytherapy enables a larger dose of radiation to be delivered to the tumor with less toxicity for neighboring tissues with less toxicity for neighboring tissues compared to the use of external beam radiotherapy alone. For years, brachytherapy was planned exclusively using computed tomography (CT). The recent incorporation of magnetic resonance imaging (MRI) provides essential information about the tumor and neighboring structures making possible to better define the target volumes. Nevertheless, MRI has limitations, some of which can be compensated for by fusing CT and MRI. Fusing the images from the two techniques ensures optimal planning by combining the advantages of each technique.

  12. Breast cancer therapy planning - a novel support concept for a sequential decision making problem.

    Science.gov (United States)

    Scherrer, Alexander; Schwidde, Ilka; Dinges, Andreas; Rüdiger, Patrick; Kümmel, Sherko; Küfer, Karl-Heinz

    2015-09-01

    Breast cancer is the most common carcinosis with the largest number of mortalities in women. Its therapy comprises a wide spectrum of different treatment modalities a breast oncologist decides about for the individual patient case. These decisions happen according to medical guide lines, current scientific publications and experiences acquired in former cases. Clinical decision making therefore involves the time-consuming search for possible therapy options and their thorough testing for applicability to the current patient case.This research work addresses breast cancer therapy planning as a multi-criteria sequential decision making problem. The approach is based on a data model for patient cases with therapy descriptions and a mathematical notion for therapeutic relevance of medical information. This formulation allows for a novel decision support concept, which targets at eliminating observed weaknesses in clinical routine of breast cancer therapy planning.

  13. SU-E-T-460: Comparison of Proton and IMRT Planning for Head and Neck Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Fontenla, S; Zhou, Y; Kowalski, A [Memorial Sloan Kettering Cancer Center, NY, NY (United States); Mah, D [Procure Treatment Center, Somerset, NJ (United States); Leven, T [Procure Proton Therapy Cneter, Somerset, New Jersey (United States); Cahlon, O [ProCure Proton Therapy, Somerset, New Jersey (United States); Lee, N [Memorial Sloan Kettering cancer center, NY, NY (United States); Hunt, M [Mem Sloan-Kettering Cancer Ctr, NY, NY (United States); Mechalakos, J [Memorial Sloan-Kettering Cancer Center, NY, NY (United States)

    2014-06-01

    Purpose: A retrospective study comparing proton and intensity-modulated radiation therapy (IMRT) for head and neck cancer Methods: This study consists of six H and N cancer patients that underwent proton as well as IMRT planning. Patients analyzed had unilateral target volumes, one had prior RT. 3D-conformal proton therapy (3D-CPT) plans with multiple field uniform scanning were generated for delivery on the inclined beam line. IMRT was planned using fixed field sliding window. Final plan evaluations were performed by a radiation oncologist and a physicist. Metrics for comparison included tumor coverage, organ sparing with respect to spinal cord, brainstem, parotids, submandibulars, oral cavity, larynx, brachial plexus, cochleas, normal brain tissue, and skin using relevant indices for these structures. Dose volume histograms were generated as well as a qualitative comparison of isodose distributions between the two modalities. Planning and treatment delivery times were compared. Results: Results showed that IMRT plans offered better conformality in the high dose region as demonstrated by the conformality index for each plan. Ipsilateral cochlea, submandibular gland, and skin doses were lower with IMRT than proton therapy. There was significant sparing of larynx, oral cavity, and brainstem with proton therapy compared to IMRT. This translated into direct patient benefit with no evidence of hoarseness, mucositis, or nausea. Contralateral parotid and submandibular glands were equally spared. IMRT had shorter planning/parts fabrication and treatment times which needs to be taken into account when deciding modality. Conclusion: Sparing of clinically significant normal tissue structures such as oral cavity and larynx for unilateral H and N cancers was seen with 3D-CPT versus IMRT. However, this is at the expense of less conformality at the high dose region and higher skin dose. Future studies are needed with full gantry systems and pencil beam scanning as these

  14. [Definition of accurate planning target volume margins for esophageal cancer radiotherapy].

    Science.gov (United States)

    Lesueur, P; Servagi-Vernat, S

    2016-10-01

    More than 4000 cases of esophagus neoplasms are diagnosed every year in France. Radiotherapy, which can be delivered in preoperative or exclusive with a concomitant chemotherapy, plays a central role in treatment of esophagus cancer. Even if efficacy of radiotherapy no longer has to be proved, the prognosis of esophagus cancer remains unfortunately poor with a high recurrence rate. Toxicity of esophageal radiotherapy is correlated with the irradiation volume, and limits dose escalation and local control. Esophagus is a deep thoracic organ, which undergoes cardiac and respiratory motion, making the radiotherapy delivery more difficult and increasing the planning target volume margins. Definition of accurate planning target volume margins, taking into account the esophagus' intrafraction motion and set up margins is very important to be sure to cover the clinical target volume and restrains acute and late radiotoxicity. In this article, based on a review of the literature, we propose planning target volume margins adapted to esophageal radiotherapy.

  15. Yield of claims data and surveys for determining colon cancer screening among health plan members.

    Science.gov (United States)

    Pignone, Michael; Scott, Tracy L; Schild, Laura A; Lewis, Carmen; Vázquez, Raquel; Glanz, Karen

    2009-03-01

    Screening can reduce incidence and mortality from colorectal cancer but has been underutilized. Efforts to increase screening depend on accurate data about screening status. We sought to evaluate the independent and combined yield of claims and direct survey for identifying colorectal cancer screening among average-risk health plan beneficiaries. Participants were Aetna members ages between 52 and 80 years from 32 primary care practices in Florida and Georgia participating in the Communicating Health Options through Information and Cancer Education study. Main outcomes were the proportion of average-risk patients who were up-to-date with colorectal cancer screening based on claims data and the estimated additional yield of survey data for patients with no evidence of screening in their claims history. Of 4,020 average-risk members identified, claims data indicated that 1,066 (27%) had recent colorectal cancer screening. Among the 1,269 average-risk members with no evidence of screening by claims data who returned surveys, 498 (39%) reported being up-to-date with screening. Combining claims data and survey data and accounting for survey nonresponse, we estimate that 47% to 59% of member patients were actually up-to-date with screening, an additional yield of 20 to 32 percentage points. We conclude that, among health plan members, the combination of claims data and survey information had substantially higher yield than claims data alone for identifying colorectal cancer screening. PMID:19273480

  16. Refractory Metal Heat Pipe Life Test - Test Plan and Standard Operating Procedures

    Science.gov (United States)

    Martin, J. J.; Reid, R. S.

    2010-01-01

    Refractory metal heat pipes developed during this project shall be subjected to various operating conditions to evaluate life-limiting corrosion factors. To accomplish this objective, various parameters shall be investigated, including the effect of temperature and mass fluence on long-term corrosion rate. The test series will begin with a performance test of one module to evaluate its performance and to establish the temperature and power settings for the remaining modules. The performance test will be followed by round-the-clock testing of 16 heat pipes. All heat pipes shall be nondestructively inspected at 6-month intervals. At longer intervals, specific modules will be destructively evaluated. Both the nondestructive and destructive evaluations shall be coordinated with Los Alamos National Laboratory. During the processing, setup, and testing of the heat pipes, standard operating procedures shall be developed. Initial procedures are listed here and, as hardware is developed, will be updated, incorporating findings and lessons learned.

  17. MODELING OF A STRUCTURED PLAN OF ACCOUNTS IN PROCEDURES OF INSOLVENCY AND BANKRUPTCY

    Directory of Open Access Journals (Sweden)

    Chalenko R. V.

    2014-02-01

    Full Text Available The article details the problems of constructing a structured plan of accounts in bankruptcy and insolvency proceedings. The proposed model is based on two principal positions, first structured chart of accounts has its own dimension, and secondly, it is built on the principles of architectonics. Architectonics constructing structured chart of accounts allows you to integrate managerial, strategic, transactional accounting and making accounting transparent and efficient

  18. Local Elites and Italian Town Planning Procedures in Early Colonial Tripoli (1911-1912)

    OpenAIRE

    Bocquet, Denis; Lafi, Nora

    2002-01-01

    International audience The object of this paper is an analysis of the issue of town planning during the first years of the Italian occupation of Libya. Based upon the archives of the presidency of the council of ministers in Rome and on local archives in Tripoli, the authors trace the rivalries between army engineers, civil engineers and the former ottoman municipality in the drawing of the first colonial masterplan of Tripoli. Cet article est consacré à une lecture des enjeux instituti...

  19. Utility of Preoperative CA125 Assay in the Management Planning of Women Diagnosed with Uterine Cancer

    Directory of Open Access Journals (Sweden)

    N. Povolotskaya

    2014-01-01

    grade did not (P=0.5. Overall, at five-year follow-up, while there were no deaths among the women with preoperative serum CA125 less than 12 U/mL, eleven of the twenty-three deaths (47.82% in the study occurred in women with a preoperative CA125 more than 28 U/mL. Conclusions. A preoperative CA125 assay for women with uterine cancer is a relatively inexpensive, reproducible, and objective test which provides valuable information regarding the risk of metastatic disease and overall likelihood of long term survival. Patients with a low likelihood of metastatic/nodal disease (favourable tissue type and CA125 level < 28 U/mL and significant comorbidities may benefit from avoiding an extended complete staging procedure. Alternatively, a high level of CA125 may prompt further imaging and multidisciplinary discussions to plan for individualised management and consideration for recruitment to clinical trials.

  20. A 4D treatment planning tool for the evaluation of motion effects on lung cancer treatments

    International Nuclear Information System (INIS)

    In this study, a 4D treatment planning tool using an analytical model accounting for breathing motion is investigated to evaluate the motion effect on delivered dose for lung cancer treatments with three-dimensional conformal radiotherapy (3DCRT). The Monte Carlo EGS4/MCDOSE user code is used in the treatment planning dose calculation, and the patient CT data are converted into respective patient geometry files for Monte Carlo dose calculation. The model interpolates CT images at different phases of the breathing cycle from patient CT scans taken at end inspiration and end expiration phases and the chest wall position. Correlation between the voxels in a reference CT dataset and the voxels in the interpolated CT datasets at any breathing phases is established so that the dose to a voxel can be accumulated through the entire breathing cycle. Simulated lung tumors at different locations are used to demonstrate our model in 3DCRT for lung cancer treatments. We demonstrated the use of a 4D treatment planning tool in evaluating the breathing motion effect on delivered dose for different planning margins. Further studies are being conducted to use this tool to study the lung motion effect through large-scale analysis and to implement this useful tool for treatment planning dose calculation and plan evaluation for 4D radiotherapy

  1. Strategic planning by the palliative care steering committee of the Middle East Cancer Consortium.

    Science.gov (United States)

    Moore, Shannon Y; Pirrello, Rosene D; Christianson, Sonya K; Ferris, Frank D

    2011-04-01

    High quality comprehensive palliative care is a critical need for millions of patients and families, but remains only a dream in many parts of the world. The failure to do a strategic planning process is one obstacle to advancing education and pain prevention and relief. The Middle Eastern Cancer Consortium Steering Committee attendees completed an initial strategic planning process and identified "developmental steps" to advance palliative care. Underscoring the multi-disciplinary nature of comprehensive palliative care, discipline-specific planning was done (adult and pediatric cancer and medicine, pharmacy, nursing) in a separate process from country-specific planning. Delineating the layers of intersection and differences between disciplines and countries was very powerful. Finding the common strengths and weaknesses in the status quo creates the potential for a more powerful regional response to the palliative care needs. Implementing and refining these preliminary strategic plans will augment and align the efforts to advance palliative care education and pain management in the Middle East. The dream to prevent and relieve suffering for millions of patients with advanced disease will become reality with a powerful strategic planning process well implemented.

  2. The effect of photon energy on intensity-modulated radiation therapy (IMRT) plans for prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Sung, Won Mo; Park, Jong Min; Choi, Chang Heon; Ha, Sung Whan; Ye, Sung Joon [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2012-03-15

    To evaluate the effect of common three photon energies (6-MV, 10-MV, and 15-MV) on intensity-modulated radiation therapy (IMRT) plans to treat prostate cancer patients. Twenty patients with prostate cancer treated locally to 81.0 Gy were retrospectively studied. 6-MV, 10-MV, and 15-MV IMRT plans for each patient were generated using suitable planning objectives, dose constraints, and 8-field setting. The plans were analyzed in terms of dose-volume histogram for the target coverage, dose conformity, organs at risk (OAR) sparing, and normal tissue integral dose. Regardless of the energies chosen at the plans, the target coverage, conformity, and homogeneity of the plans were similar. However, there was a significant dose increase in rectal wall and femoral heads for 6-MV compared to those for 10-MV and 15-MV. The V20 Gy of rectal wall with 6-MV, 10-MV, and 15-MV were 95.6%, 88.4%, and 89.4% while the mean dose to femoral heads were 31.7, 25.9, and 26.3 Gy, respectively. Integral doses to the normal tissues in higher energy (10-MV and 15-MV) plans were reduced by about 7%. Overall, integral doses in mid and low dose regions in 6-MV plans were increased by up to 13%. In this study, 10-MV prostate IMRT plans showed better OAR sparing and less integral doses than the 6-MV. The biological and clinical significance of this finding remains to be determined afterward, considering neutron dose contribution.

  3. SU-E-T-170: Evaluation of Rotational Errors in Proton Therapy Planning of Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Rana, S; Zhao, L; Ramirez, E; Singh, H; Zheng, Y [Procure Proton Therapy Center, Oklahoma City, OK (United States)

    2014-06-01

    Purpose: To investigate the impact of rotational (roll, yaw, and pitch) errors in proton therapy planning of lung cancer. Methods: A lung cancer case treated at our center was used in this retrospective study. The original plan was generated using two proton fields (posterior-anterior and left-lateral) with XiO treatment planning system (TPS) and delivered using uniform scanning proton therapy system. First, the computed tomography (CT) set of original lung treatment plan was re-sampled for rotational (roll, yaw, and pitch) angles ranged from −5° to +5°, with an increment of 2.5°. Second, 12 new proton plans were generated in XiO using the 12 re-sampled CT datasets. The same beam conditions, isocenter, and devices were used in new treatment plans as in the original plan. All 12 new proton plans were compared with original plan for planning target volume (PTV) coverage and maximum dose to spinal cord (cord Dmax). Results: PTV coverage was reduced in all 12 new proton plans when compared to that of original plan. Specifically, PTV coverage was reduced by 0.03% to 1.22% for roll, by 0.05% to 1.14% for yaw, and by 0.10% to 3.22% for pitch errors. In comparison to original plan, the cord Dmax in new proton plans was reduced by 8.21% to 25.81% for +2.5° to +5° pitch, by 5.28% to 20.71% for +2.5° to +5° yaw, and by 5.28% to 14.47% for −2.5° to −5° roll. In contrast, cord Dmax was increased by 3.80% to 3.86% for −2.5° to −5° pitch, by 0.63% to 3.25% for −2.5° to −5° yaw, and by 3.75% to 4.54% for +2.5° to +5° roll. Conclusion: PTV coverage was reduced by up to 3.22% for rotational error of 5°. The cord Dmax could increase or decrease depending on the direction of rotational error, beam angles, and the location of lung tumor.

  4. Development of an Estimating Procedure for the Annual PLAN Process - with Special Emphasis on the Estimating Group

    International Nuclear Information System (INIS)

    This research study deals with the PLAN 2000 procedure. This complex annual estimating procedure is based on the Swedish law on financing, 1992:1537. It requires the Swedish Nuclear Power inspectorate, SKI, to submit to the Government a fully supported annual proposal for the following year's unit fee for nuclear generated electricity to be paid by the owners of the Swedish nuclear power plants. The function of this Fund, KAF, is to finance the future Swedish decommissioning programme. The underlying reason for the study is current criticism of the existing procedure, not least of the composition and working conditions of the analysis group. The purpose of the study is to improve the procedure. The aim is (1) to maximise the realism and neutrality of the necessary estimates in order to allow the KAF Fund to grow steadily at the current rate to the desired target size, allowing it to pay all relevant costs associated with this large decommissioning programme; (2) to do this with a controlled degree of safety; (3) to improve the transparency of the whole procedure in order to avoid any distrust of the procedure and its results. The scope covers all technical and statistical issues; and to some degree also the directly related organisational aspects, notably in respect of the present law and its administration. However, some details are dealt with which seem contrary to the aim of the law. Since 1996, SKI has delegated to the Swedish Nuclear Fuel and Waste Management Co., SKB, the task of performing the basic part of the necessary annual estimating procedure. SKI has then evaluated and supplemented the base estimate before the drafting of the final proposals for the Government and the Board of the Fund, KAFS. Some basic requirements are crucial to the quality of the result of the study: (1) full identification of all potential sources of major uncertainty and the subsequent correct handling of these, (2) balanced and unbiased quantitative evaluation of uncertain

  5. Current concepts in F18 FDG PET/CT-based Radiation Therapy planning for Lung Cancer

    Directory of Open Access Journals (Sweden)

    Percy eLee

    2012-07-01

    Full Text Available Radiation therapy is an important component of cancer therapy for early stage as well as locally advanced lung cancer. The use of F18 FDG PET/CT has come to the forefront of lung cancer staging and overall treatment decision-making. FDG PET/CT parameters such as standard uptake value and metabolic tumor volume provide important prognostic and predictive information in lung cancer. Importantly, FDG PET/CT for radiation planning has added biological information in defining the gross tumor volume as well as involved nodal disease. For example, accurate target delineation between tumor and atelectasis is facilitated by utilizing PET and CT imaging. Furthermore, there has been meaningful progress in incorporating metabolic information from FDG PET/CT imaging in radiation treatment planning strategies such as radiation dose escalation based on standard uptake value thresholds as well as using respiratory gated PET and CT planning for improved target delineation of moving targets. In addition, PET/CT based follow-up after radiation therapy has provided the possibility of early detection of local as well as distant recurrences after treatment. More research is needed to incorporate other biomarkers such as proliferative and hypoxia biomarkers in PET as well as integrating metabolic information in adaptive, patient-centered, tailored radiation therapy.

  6. Use of Positron Emission Tomography/Computed Tomography in Radiation Treatment Planning for Lung Cancer

    Directory of Open Access Journals (Sweden)

    Kezban Berberoğlu

    2016-06-01

    Full Text Available Radiotherapy (RT plays an important role in the treatment of lung cancer. Accurate diagnosis and staging are crucial in the delivery of RT with curative intent. Target miss can be prevented by accurate determination of tumor contours during RT planning. Currently, tumor contours are determined manually by computed tomography (CT during RT planning. This method leads to differences in delineation of tumor volume between users. Given the change in RT tools and methods due to rapidly developing technology, it is now more significant to accurately delineate the tumor tissue. F18 fluorodeoxyglucose positron emission tomography/CT (F18 FDG PET/CT has been established as an accurate method in correctly staging and detecting tumor dissemination in lung cancer. Since it provides both anatomic and biologic information, F18 FDG PET decreases interuser variability in tumor delineation. For instance, tumor volumes may be decreased as atelectasis and malignant tissue can be more accurately differentiated, as well as better evaluation of benign and malignant lymph nodes given the difference in FDG uptake. Using F18 FDG PET/CT, the radiation dose can be escalated without serious adverse effects in lung cancer. In this study, we evaluated the contribution of F18 FDG PET/CT for RT planning in lung cancer.

  7. Advanced Monitoring Is Associated with Fewer Alarm Events During Planned Moderate Procedure-Related Sedation: A 2-Part Pilot Trial

    Science.gov (United States)

    Lenart, John; Malkin, Mathew; Meineke, Minhthy N.; Qoshlli, Silvana; Neumann, Monica; Jacobson, J. Paul; Kruger, Alison; Ching, Jeffrey; Hassanian, Mohammad; Um, Michael

    2016-01-01

    BACKGROUND: Diagnostic and interventional procedures are often facilitated by moderate procedure-related sedation. Many studies support the overall safety of this sedation; however, adverse cardiovascular and respiratory events are reported in up to 70% of these procedures, more frequently in very young, very old, or sicker patients. Monitoring with pulse oximetry may underreport hypoventilation during sedation, particularly if supplemental oxygen is provided. Capnometry may result in false alarms during sedation when patients mouth breathe or displace sampling devices. Advanced monitor use during sedation may allow event detection before complications develop. This 2-part pilot study used advanced monitors during planned moderate sedation to (1) determine incidences of desaturation, low respiratory rate, and deeper than intended sedation alarm events; and (2) determine whether advanced monitor use is associated with fewer alarm events. METHODS: Adult patients undergoing scheduled gastroenterology or interventional radiology procedures with planned moderate sedation given by dedicated sedation nurses under the direction of procedural physicians (procedural sedation team) were monitored per standard protocols (electrocardiography blood pressure, pulse oximetry, and capnometry) and advanced monitors (acoustic respiratory monitoring and processed electroencephalograpy). Data were collected to computers for analysis. Advanced monitor parameters were not visible to teams in part 1 (standard) but were visible to teams in part 2 (advanced). Alarm events were defined as desaturation—Spo2 ≤92%; respiratory depression, acoustic respiratory rate ≤8 breaths per minute, and deeper than intended sedation, indicated by processed electroencephalograpy. The number of alarm events was compared. RESULTS: Of 100 patients enrolled, 10 were excluded for data collection computer malfunction or consent withdrawal. Data were analyzed from 90 patients (44 standard and 46 advanced

  8. [Clinical to planning target volume margins in prostate cancer radiotherapy].

    Science.gov (United States)

    Ramiandrisoa, F; Duvergé, L; Castelli, J; Nguyen, T D; Servagi-Vernat, S; de Crevoisier, R

    2016-10-01

    The knowledge of inter- and intrafraction motion and deformations of the intrapelvic target volumes (prostate, seminal vesicles, prostatectomy bed and lymph nodes) as well as the main organs at risk (bladder and rectum) allow to define rational clinical to planning target volume margins, depending on the different radiotherapy techniques and their uncertainties. In case of image-guided radiotherapy, prostate margins and seminal vesicles margins can be between 5 and 10mm. The margins around the prostatectomy bed vary from 10 to 15mm and those around the lymph node clinical target volume between 7 and 10mm. Stereotactic body radiotherapy allows lower margins, which are 3 to 5mm around the prostate. Image-guided and stereotactic body radiotherapy with adequate margins allow finally moderate or extreme hypofractionation. PMID:27614515

  9. Planning evaluation of radiotherapy for complex lung cancer cases using helical tomotherapy

    Science.gov (United States)

    Kron, Tomas; Grigorov, Grigor; Yu, Edward; Yartsev, Slav; Chen, Jeff Z.; Wong, Eugene; Rodrigues, George; Trenka, Kris; Coad, Terry; Bauman, Glenn; Van Dyk, Jake

    2004-08-01

    Lung cancer treatment is one of the most challenging fields in radiotherapy. The aim of the present study was to investigate what role helical tomotherapy (HT), a novel approach to the delivery of highly conformal dose distributions using intensity-modulated radiation fan beams, can play in difficult cases with large target volumes typical for many of these patients. Tomotherapy plans were developed for 15 patients with stage III inoperable non-small-cell lung cancer. While not necessarily clinically indicated, elective nodal irradiation was included for all cases to create the most challenging scenarios with large target volumes. A 2 cm margin was used around the gross tumour volume (GTV) to generate primary planning target volume (PTV2) and 1 cm margin around elective nodes for secondary planning target volume (PTV1) resulting in PTV1 volumes larger than 1000 cm3 in 13 of the 15 patients. Tomotherapy plans were created using an inverse treatment planning system (TomoTherapy Inc.) based on superposition/convolution dose calculation for a fan beam thickness of 25 mm and a pitch factor between 0.3 and 0.8. For comparison, plans were created using an intensity-modulated radiation therapy (IMRT) approach planned on a commercial treatment planning system (TheraplanPlus, Nucletron). Tomotherapy delivery times for the large target volumes were estimated to be between 4 and 19 min. Using a prescribed dose of 60 Gy to PTV2 and 46 Gy to PTV1, the mean lung dose was 23.8 ± 4.6 Gy. A 'dose quality factor' was introduced to correlate the plan outcome with patient specific parameters. A good correlation was found between the quality of the HT plans and the IMRT plans with HT being slightly better in most cases. The overlap between lung and PTV was found to be a good indicator of plan quality for HT. The mean lung dose was found to increase by approximately 0.9 Gy per percent overlap volume. Helical tomotherapy planning resulted in highly conformal dose distributions. It

  10. Evaluating efficiency of split VMAT plan for prostate cancer radiotherapy involving pelvic lymph nodes

    Energy Technology Data Exchange (ETDEWEB)

    Mun, Jun Ki; Son, Sang Jun; Kim, Dae Ho; Seo, Seok Jin [Dept. of Radiation Oncology, Seoul National University Hospital, Seoul (Korea, Republic of)

    2015-12-15

    The purpose of this study is to evaluate the efficiency of Split VMAT planning(Contouring rectum divided into an upper and a lower for reduce rectum dose) compare to Conventional VMAT planning(Contouring whole rectum) for prostate cancer radiotherapy involving pelvic lymph nodes. A total of 9 cases were enrolled. Each case received radiotherapy with Split VMAT planning to the prostate involving pelvic lymph nodes. Treatment was delivered using TrueBeam STX(Varian Medical Systems, USA) and planned on Eclipse(Ver. 10.0.42, Varian, USA), PRO3(Progressive Resolution Optimizer 10.0.28), AAA(Anisotropic Analytic Algorithm Ver. 10.0.28). Lower rectum contour was defined as starting 1 cm superior and ending 1 cm inferior to the prostate PTV, upper rectum is a part, except lower rectum from the whole rectum. Split VMAT plan parameters consisted of 10 MV coplanar 360° arcs. Each arc had 30° and 30° collimator angle, respectively. An SIB(Simultaneous Integrated Boost) treatment prescription was employed delivering 50.4 Gy to pelvic lymph nodes and 63- 70 Gy to the prostate in 28 fractions. D{sub mean} of whole rectum on Split VMAT plan was applied for DVC(Dose Volume Constraint) of the whole rectum for Conventional VMAT plan. In addition, all parameters were set to be the same of existing treatment plans. To minimize the dose difference that shows up randomly on optimizing, all plans were optimized and calculated twice respectively using a 0.2 cm grid. All plans were normalized to the prostate PTV{sub 100%} = 90% or 95%. A comparison of D{sub mean} of whole rectum, upperr ectum, lower rectum, and bladder, V{sub 50%} of upper rectum, total MU and H.I.(Homogeneity Index) and C.I.(Conformity Index) of the PTV was used for technique evaluation. All Split VMAT plans were verified by gamma test with portal dosimetry using EPID. Using DVH analysis, a difference between the Conventional and the Split VMAT plans was demonstrated. The Split VMAT plan demonstrated better in the D

  11. Road-corridor planning in the EIA procedure in Spain. A review of case studies

    Energy Technology Data Exchange (ETDEWEB)

    Loro, Manuel, E-mail: manuel.loro@upm.es [Department of Urban and Regional Planning and Environment, Civil Engineering School, Universidad Politécnica de Madrid, Prof. Aranguren s/n, 28040 Madrid (Spain); Transport Research Centre (TRANSyT-UPM) Universidad Politécnica de Madrid, ETSI Caminos, Canales y Puertos, Prof. Aranguren s/n, 28040 Madrid (Spain); Centro de investigación del transporte, TRANSyT-UPM, ETSI Caminos, Canales y Puertos, Universidad Politécnica de Madrid, Prof. Aranguren s/n, 28040 Madrid (Spain); Arce, Rosa M., E-mail: rosa.arce.ruiz@upm.es [Department of Urban and Regional Planning and Environment, Civil Engineering School, Universidad Politécnica de Madrid, Prof. Aranguren s/n, 28040 Madrid (Spain); Transport Research Centre (TRANSyT-UPM) Universidad Politécnica de Madrid, ETSI Caminos, Canales y Puertos, Prof. Aranguren s/n, 28040 Madrid (Spain); Centro de investigación del transporte, TRANSyT-UPM, ETSI Caminos, Canales y Puertos, Universidad Politécnica de Madrid, Prof. Aranguren s/n, 28040 Madrid (Spain); Ortega, Emilio, E-mail: e.ortega@upm.es [Transport Research Centre (TRANSyT-UPM) Universidad Politécnica de Madrid, ETSI Caminos, Canales y Puertos, Prof. Aranguren s/n, 28040 Madrid (Spain); Centro de investigación del transporte, TRANSyT-UPM, ETSI Caminos, Canales y Puertos, Universidad Politécnica de Madrid, Prof. Aranguren s/n, 28040 Madrid (Spain); Department of Construction and Rural Roads, Forestry Engineering School, Universidad Politécnica de Madrid, Ciudad Universitaria s/n, 28040 Madrid (Spain); and others

    2014-01-15

    The assessment of different alternatives in road-corridor planning must be based on a number of well-defined territorial variables that serve as decision making criteria, and this requires a high-quality preliminary environmental assessment study. In Spain the formal specifications for the technical requirements stipulate the constraints that must be considered in the early stages of defining road corridors, but not how they should be analyzed and ranked. As part of the feasibility study of a new road definition, the most common methodology is to establish different levels of Territorial Carrying Capacity (TCC) in the study area in order to summarize the territorial variables on thematic maps and to ease the tracing process of road-corridor layout alternatives. This paper explores the variables used in 22 road-construction projects conducted by the Ministry of Public Works that were subject to the Spanish EIA regulation and published between 2006 and 2008. The aim was to evaluate the quality of the methods applied and the homogeneity and suitability of the variables used for defining the TCC. The variables were clustered into physical, environmental, land-use and cultural constraints for the purpose of comparing the TCC values assigned in the studies reviewed. We found the average quality of the studies to be generally acceptable in terms of the justification of the methodology, the weighting and classification of the variables, and the creation of a synthesis map. Nevertheless, the methods for assessing the TCC are not sufficiently standardized; there is a lack of uniformity in the cartographic information sources and methodologies for the TCC valuation. -- Highlights: • We explore 22 road-corridor planning studies subjected to the Spanish EIA regulation. • We analyze the variables selected for defining territorial carrying capacity. • The quality of the studies is acceptable (methodology, variable weighting, mapping). • There is heterogeneity in the

  12. Safety evaluation by living probabilistic safety assessment. Procedures and applications for planning of operational activities and analysis of operating experience

    International Nuclear Information System (INIS)

    Living Probabilistic Safety Assessment (PSA) is a daily safety management system and it is based on a plant-specific PSA and supporting information systems. In the living use of PSA, plant status knowledge is used to represent actual plant safety status in monitoring or follow-up perspective. The PSA model must be able to express the risk at a given time and plant configuration. The process, to update the PSA model to represent the current or planned configuration and to use the model to evaluate and direct the changes in the configuration, is called living PSA programme. The main purposes to develop and increase the usefulness of living PSA are: Long term safety planning: To continue the risk assessment process started with the basic PSA by extending and improving the basic models and data to provide a general risk evaluation tool for analyzing the safety effects of changes in plant design and procedures. Risk planning of operational activities: To support the operational management by providing means for searching optimal operational maintenance and testing strategies from the safety point of view. The results provide support for risk decision making in the short term or in a planning mode. The operational limits and conditions given by technical specifications can be analyzed by evaluating the risk effects of alternative requirements in order to balance the requirements with respect to operational flexibility and plant economy. Risk analysis of operating experience: To provide a general risk evaluation tool for analyzing the safety effects of incidents and plant status changes. The analyses are used to: identify possible high risk situations, rank the occurred events from safety point of view, and get feedback from operational events for the identification of risk contributors. This report describes the methods, models and applications required to continue the process towards a living use of PSA. 19 tabs, 20 figs

  13. Lung cancer patients' decisions about clinical trials and the theory of planned behavior.

    Science.gov (United States)

    Quinn, Gwendolyn P; Pratt, Christie L; Bryant-George, Kathy; Caraway, Vicki D; Paternoster, Bonnie; Roldan, Tere; Shaffer, Andrea; Shimizu, Cynthia O; Vaughn, Elizabeth J; Williams, Charles; Bepler, Gerold

    2011-12-01

    The theory of planned behavior explores the relationship between behavior, beliefs, attitudes, and intentions presupposing that behavioral intention is influenced by a person's attitude about the behavior and beliefs about whether individuals, who are important to them, approve or disapprove of the behavior (subjective norm). An added dimension to the theory is the idea of perceived behavioral control, or the belief that one has control over performing the behavior. The theory of planned behavior suggests that people may make greater efforts to perform a behavior if they feel they have a high level of control over it. In this examination of data, we explored the application of the theory of planned behavior to patient's decisions about participating in a clinic trial. Twelve respondents in this study had previously participated in a clinical trial for lung cancer and nine respondents had declined a clinical trial for lung cancer. The data were analyzed with regard to the four constructs associated with the theory of planned behavior: behavioral intention, attitude, subjective norm, and perceived behavioral control. Results indicate that the theory of planned behavior may be a useful tool to examine psychosocial needs in relation to behavioral intention of clinical trial participation.

  14. Surgical outcome of pancreatic cancer using radical antegrade modular pancreatosplenectomy procedure

    Institute of Scientific and Technical Information of China (English)

    Ye Rim Chang; Sung-Sik Han; Sang-Jae Park; Seung Duk Lee; Tae Suk Yoo; Young-Kyu Kim; Tae Hyun Kim

    2012-01-01

    To evaluate the surgical outcomes following radical antegrade modular pancreatosplenectomy (RAMPS)for pancreatic cancer.METHODS:Twenty-four patients underwent RAMPS with curative intent between January 2005 and June 2009 at the National Cancer Center,South Korea.Clinicopathologic data,including age,sex,operative findings,pathologic results,adjuvant therapy,postoperative clinical course and follow-up data were retrospectively collected and analyzed for this study.RESULTS:Twenty-one patients (87.5%) underwent distal pancreatectomy and 3 patients (12.5%) underwent total pancreatectomy using RAMPS.Nine patients (37.5%) underwent combined vessel resection,including 8 superior mesenteric-portal vein resections and 1 celiac axis resection.Two patients (8.3%) underwent combined resection of other organs,including the colon,stomach or duodenum.Negative tangential margins were achieved in 22 patients (91.7%).The mean tumor diameter for all patients was 4.09 ± 2.15 cm.The 2 patients with positive margins had a mean diameter of 7.25 cm.The mean number of retrieved lymph nodes was 20.92 ± 11.24 and the node positivity rate was 70.8%.The median survival of the 24 patients was 18.23 ± 6.02 mo.Patients with negative margins had a median survival of 21.80 ± 5.30 mo and those with positive margins had a median survival of 6.47 mo (P =0.021).Nine patients (37.5%) had postoperative complications,but there were no postoperative mortalities.Pancreatic fistula occurred in 4 patients (16.7%):2 patients had a grade A fistula and 2 had a grade B fistula.On univariate analysis,histologic grade,positive tangential margin,pancreatic fistula and adjuvant therapy were significant prognostic factors for survival.CONCLUSION:RAMPS is a feasible procedure for achieving negative tangential margins in patients with carcinoma of the body and tail of the pancreas.

  15. Determination of doses and cancer risk to paediatric and young adult patients undergoing plain radiographic and fluoroscopic guided surgical procedures

    International Nuclear Information System (INIS)

    Fifty paediatric and young adult patients who underwent plain radiographic and fluoroscopic procedures in the operating theatres of a selected orthopaedic hospital were investigated. Radiation Dose was measured using single chip TLD (LiF) held at the skin surface at the beam entrance site for scoliotic, kyphotic and kyphoscoliotic patients undergoing Posterior Spinal Fusion (single stage), Posterior Spinal Fusion (two stage), Growing Rod and Revision Posterior Spinal Fusion as well as patients undergoing Intramedullary Nailing of the Femur and Osteotomy of the lower Extremity. The radiographic equipment were working at self-consistencies. The readings from the TLD, with patient data and other relevant information from the equipment console were used in Monte Carlo program software (PCMXC 2.0) to estimate organ and effective doses as well as assess cancer risk. Mean effective dose from Posterior Spinal Fusion (single stage), Posterior Spinal Fusion (two stage), Growing Rod, Revision Posterior Spinal Fusion, Nailing of the Femur and Osteotomy of the lower Extremity were found to be 7.62 ± 0.84 mSv, 7.48 ± 1.0, 6.82 ± 0.99 mSv, 2.50 ± 0.27 mSv, 0.18 ± 0.09 mSv and 0.001 ± 0.6E4 mSv respectively. The ribs recorded the highest bony organ tissue whiles the breast recorded the highest soft tissue organ dose with Posterior Spinal Fusion (single stage) recording the highest of 25.55±2.81 mGy and 11.49±1.22 mGy. Comparison of paediatric and young adult effective dose showed a higher effective dose in paediatric. Risk of radiation exposure induced cancer death from any cancer were considered for all the procedures and growing rod recorded the highest with 0.0954 % for females and 0.0500% for males. Risk of lung cancer was prevalent in all surgical procedures considered for the study followed by other cancers. However risk of breast cancer was high in females and risk of colon cancer for males. Paediatric and young adult patients exposure records were recommended to be

  16. Plan and procedures for rapid inventory taking at the Research Institute for Atomic Reactors

    Energy Technology Data Exchange (ETDEWEB)

    Kalygin, V.; Gorobets, A.; Karlov, S. [Research Inst. for Atomic Reactors, Dimitrovgrad (Russian Federation); Suda, S.C.; Bonner, M.F. [Brookhaven National Lab., Upton, NY (United States); Satkowiak, L. [Oak Ridge National Lab., TN (United States)

    1997-12-31

    A major element of a system for nuclear material protection, control, and accounting (MPC and A) is to take the physical inventory of the nuclear material periodically. Physical inventory taking (PIT) includes ensuring that all nuclear material on inventory is included in the facility records and that the measured content of items or containers corresponds to the recorded values. A preliminary step to the conduct of the PIT is application of rapid inventory procedures that serve to provide the benchmark for the inventory, e.g., by identifying if any items are missing and also, if any unrecorded items are present. The Rapid Inventory approach is being implemented by the Research Institute for Atomic Reactors (RIAR) in Dimitrovgrad, Russia, as one of the first steps in the program to enhance nuclear materials safeguards at the site. This effort is being conducted under the US-Russian Cooperative Program on Nuclear Materials Protection. Control And Accounting (MPC and A), with assistance provided by specialists from US Department of Energy National Laboratories. This paper summarizes the features of the existing physical inventory system at RIAR, discusses the upgrades being introduced, and provides some observations on the technology transfer process with regard to the safeguards program.

  17. Planning of External Beam Radiotherapy for Prostate Cancer Guided by PET/CT.

    Science.gov (United States)

    von Eyben, Finn Edler; Kairemo, Kalevi; Kiljunen, Timo; Joensuu, Timo

    2015-01-01

    In this paper, we give an overview of articles on non-choline tracers for PET/CT for patients with prostate cancer and planning of radiotherapy guided by PET/CT. Nineteen articles described (11)C-Acetate PET/CT. Of 629 patients 483 (77%, 95% CI 74% - 80%) had positive (11)C-Acetate PET/CT scans. Five articles described (18)F-FACBC PET/CT. Of 174 patients, 127 (73%, 95% CI 68% - 78%) had positive scans. Both tracers detected local lesions, lesions in regional lymph nodes, and distant organs. Ten articles described (18)F-NaF PET/CT and found that 1289 of 3918 patients (33%) had positive reactive lesions in bones. PET/CT scan can guide external beam radiotherapy (EBRT) planning for patients with loco-regional prostate cancer. In six studies with 178 patients with localized prostate cancer, PET/CT pointed out dominant intraprostatic lesions (DIL). Oncologists gave EBRT to the whole prostate and a simultaneously integrated boost to the DIL. Four studies with 254 patients described planning of EBRT for patients with PETpositive lymph nodes. After the EBRT, 15 of 29 node-positive patients remained in remission for median 28 months (range 14 to 50 months). Most articles describe (11)C- and (18)F-Choline PET/CT. However, (11)C-Acetate and (18)F-FACBC may also be useful tracers for PET/CT. Planning of radiotherapy guided by MRI or PET/CT is an investigational method for localized prostate cancer. Current clinical controlled trials evaluate whether the method improves overall survival.

  18. A three-stage short-term electric power planning procedure for a generation company in a liberalized market

    Energy Technology Data Exchange (ETDEWEB)

    Nabona, Narcis; Pages, Adela [Department of Statistics and Operations Research, Universitat Politecnica de Catalunya, 08034 Barcelona (Spain)

    2007-06-15

    In liberalized electricity markets, generation companies bid their hourly generation in order to maximize their profit. The optimization of the generation bids over a short-term weekly period must take into account the action of the competing generation companies and the market-price formation rules and must be coordinated with long-term planning results. This paper presents a three stage optimization process with a data analysis and parameter calculation, a linearized unit commitment, and a nonlinear generation scheduling refinement. Although the procedure has been developed from the experience with the Spanish power market, with minor adaptations it is also applicable to any generation company participating in a competitive market system. (author)

  19. A three-stage short-term electric power planning procedure for a generation company in a liberalized market

    International Nuclear Information System (INIS)

    In liberalized electricity markets, generation companies bid their hourly generation in order to maximize their profit. The optimization of the generation bids over a short-term weekly period must take into account the action of the competing generation companies and the market-price formation rules and must be coordinated with long-term planning results. This paper presents a three stage optimization process with a data analysis and parameter calculation, a linearized unit commitment, and a nonlinear generation scheduling refinement. Although the procedure has been developed from the experience with the Spanish power market, with minor adaptations it is also applicable to any generation company participating in a competitive market system. (author)

  20. TSUNAMI RISK MITIGATION THROUGH STRATEGIC LAND-USE PLANNING AND EVACUATION PROCEDURES FOR COASTAL COMMUNITIES IN SRI LANKA

    Directory of Open Access Journals (Sweden)

    Woharika Kaumudi Weerasinghe

    2011-01-01

    Full Text Available Safety measures against the future disaster risk are considered as the main aspect of post disaster reconstructions. The majority of post-disaster villages/settlements and due projects on Sri Lankan coastline are apparently lacking behind the proper safety measures and adequate evacuation procedures. Therefore the immediate necessities of proper safety measures have to be emphasized in order to mitigate future tsunami risks. This paper introduces a number of post disaster coastal villages/settlements, which are in future coastline hazard risk, mainly in a future tsunami event. These include their location risk, land uses and housing designs defects and shortcomings of other safety measures. Furthermore few tsunami risk mitigation measures through land use planning strategies, which could be applied more easily in community level, are introduced. In addition to those the strategic development methods of functional networks of evacuation routes and shelters in different topographies are examined.

  1. Understanding Cancer Prognosis

    Medline Plus

    Full Text Available ... Talking about Advanced Cancer Coping with Your Feelings Planning for Advanced Cancer Advanced Cancer and Caregivers Questions ... Talking About Advanced Cancer Coping With Your Feelings Planning for Advanced Cancer Advanced Cancer & Caregivers Managing Cancer ...

  2. A treatment planning approach to spatially fractionated megavoltage grid therapy for bulky lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Costlow, Heather N. [Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN (United States); Zhang, Hualin, E-mail: hzhang@nmh.org [Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN (United States); Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Northwestern University, Northwestern Memorial Hospital, Chicago, IL (United States); Das, Indra J. [Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN (United States)

    2014-10-01

    The purpose of this study was to explore the treatment planning methods of spatially fractionated megavoltage grid therapy for treating bulky lung tumors using multileaf collimator (MLC). A total of 5 patients with lung cancer who had gross tumor volumes ranging from 277 to 635 cm{sup 3} were retrospectively chosen for this study. The tumors were from 6.5 to 9.6 cm at shortest dimension. Several techniques using either electronic compensation or intensity-modulated radiation therapy (IMRT) were used to create a variety of grid therapy plans on the Eclipse treatment planning system. The dose prescription point was calculated to the volume, and a dose of 20 Gy with 6-MV/15-MV beams was used in each plan. The dose-volume histogram (DVH) curves were obtained to evaluate dosimetric characteristics. In addition, DVH curves from a commercially available cerrobend grid collimator were also used for comparison. The linear-quadratic radiobiological response model was used to assess therapeutic ratios (TRs) and equivalent uniform doses (EUD) for all generated plans. A total of 6 different grid therapy plans were created for each patient. Overall, 4 plans had different electronic compensation techniques: Ecomps-Tubes, Ecomps-Circles, Ecomps-Squares, and Ecomps-Weave; the other 2 plans used IMRT and IMRT-Weave techniques. The DVH curves and TRs demonstrated that these MLC-based grid therapy plans can achieve dosimetric properties very similar to those of the cerrobend grid collimator. However, the MLC-based plans have larger EUDs than those with the cerrobend grid collimator. In addition, the field shaping can be performed for targets of any shape in MLC-based plans. Thus, they can deliver a more conformal dose to the targets and spare normal structures better than the cerrobend grid collimator can. The plans generated by the MLC technique demonstrated the advantage over the standard cerrobend grid collimator on accommodating targets and sparing normal structures. Overall, 6

  3. The role of PET/CT in radiation treatment planning for cancer patient treatment

    International Nuclear Information System (INIS)

    Positron emission tomography (PET) and, more recently, integrated positron emission tomography/X ray computed tomography (PET/CT) have appeared as significant diagnostic imaging systems in clinical medicine. Accurate recognition of cancers in patients by means of PET scanning with Fluorine-18-fluorodeoxyglucose (18F-FDG) has illustrated a need to determine a mode of therapy to achieve better prognoses. The clinical management of cancer patients has improved dramatically with the introduction of clinical PET. For treatment of cancer patients, on the other hand, radiation therapy (RT) plays an important role as a non-invasive therapy. It is crucial that cancers are encompassed by high dose irradiation, particularly in cases of curative RT. Irradiation should precisely target the entire tumour and aim to minimise the size of microscopic extensions of the cancer, as well as minimize radiation damage to normal tissues. A new imaging technique has therefore been sought to allow precise delineation of the cancer target to be irradiated. Clinical PET, combined with utilization of 18F-FDG, may have an important role in radiation treatment planning (RTP) in lung cancer. In addition to determining if RT is appropriate and whether therapy will be given with curative or palliative intent, 18F-FDG-PET is useful for determining therapy ports. It can be used both to limit ports to spare normal tissue and to include additional involved regions. Several studies have shown that PET has an impact on RTP in an important proportion of patients. It is to be hoped that treatment plans that include all the 18F-FDG-avid lesions or the 18F-FDG-avid portions of a complex mass will result in more effective local control with less unnecessary tissue being treated. The IAEA has placed emphasis on the issue of application of clinical PET for radiation treatment planning in various cancer patients. Two consultants meetings were held in 2006 and their results are summarized into this IAEA

  4. The value of peri-interventional procedure serum bile acid (TBA) detection in patients with primary liver cancer

    International Nuclear Information System (INIS)

    Objective: To investigate the clinical value of peri-interventional procedure serum bile acid (TBA) detection in patients with primary liver cancer. Methods: The serum TBA was examined peri-operatively in 160 patients with primary liver cancer for testing the correlations between TBA, liver function, the degree of hepatocirrhosis, interventional therapy method and hepatic failure. Results: The preoperative mean value of serum TBA increased significantly in comparing with that of the control group (P<0.01). The preoperative value of serum TBA in different Child grading patients with primary liver cancer were different significantly (P<0.01), Child A< Child B< Child C, the increased degree of serum TBA corresponded with Child grading of the liver function and the cirrhotic degree of liver. In patients with liver function of Child B and C, the postoperative mean values of serum TBA in different interventional therapy methods were different significantly (P<0.01). Comparing with that of the patients without hepatic failure, the postoperative value of serum TBA in the patients with hepatic failure increased significantly (P<0.01). Conclusions: The value of serum TBA can sensitively and accurately reflect liver reserve ability and damage degree of peri-interventional procedure liver function. Hepatic failure can be detected in time and the prognosis of the patients with primary liver cancer can be predicted by testing the value of serum TBA continually. (authors)

  5. Radiation therapy planning with photons and protons for early and advanced breast cancer: an overview

    Directory of Open Access Journals (Sweden)

    Lomax Antony J

    2006-07-01

    Full Text Available Abstract Postoperative radiation therapy substantially decreases local relapse and moderately reduces breast cancer mortality, but can be associated with increased late mortality due to cardiovascular morbidity and secondary malignancies. Sophistication of breast irradiation techniques, including conformal radiotherapy and intensity modulated radiation therapy, has been shown to markedly reduce cardiac and lung irradiation. The delivery of more conformal treatment can also be achieved with particle beam therapy using protons. Protons have superior dose distributional qualities compared to photons, as dose deposition occurs in a modulated narrow zone, called the Bragg peak. As a result, further dose optimization in breast cancer treatment can be reasonably expected with protons. In this review, we outline the potential indications and benefits of breast cancer radiotherapy with protons. Comparative planning studies and preliminary clinical data are detailed and future developments are considered.

  6. Dosimetric comparison of intensity modulated radiotherapy isocentric field plans and field in field (FIF) forward plans in the treatment of breast cancer

    OpenAIRE

    Al-Rahbi, Zakiya Salem; Al Mandhari, Zahid; Ravichandran, Ramamoorthy; Al-Kindi, Fatma; Davis, Cheriyathmanjiyil Anthony; Bhasi, Saju; Satyapal, Namrata; Rajan, Balakrishnan

    2013-01-01

    The present study is aimed at comparing the planning and delivery efficiency between three-dimensional conformal radiotherapy (3D-CRT), field-in-field, forward planned, intensity modulated radiotherapy (FIF-FP-IMRT), and inverse planned intensity modulated radiotherapy (IP-IMRT). Treatment plans of 20 patients with left-sided breast cancer, 10 post-mastectomy treated to a prescribed dose of 45 Gy to the chest wall in 20 fractions, and 10 post-breast-conserving surgery to a prescribed dose of ...

  7. Survivorship care planning in a comprehensive cancer center using an implementation framework.

    Science.gov (United States)

    Garcia, Sofia F; Kircher, Sheetal M; Oden, Megan; Veneruso, Aubri; McKoy, June M; Pearman, Timothy; Penedo, Frank J

    2016-05-01

    Cancer survivorship care plans (SCPs) have been recommended to improve clinical care and patient outcomes. Research is needed to establish their efficacy and identify best practices. Starting in 2015, centers accredited by the American College of Surgeons Commission on Cancer must deliver SCPs to patients completing primary cancer treatment with curative intent. We describe how we established routine SCP delivery at the Robert H Lurie Comprehensive Cancer Center in Chicago, Illinois, using the Quality Implementation Framework. We evaluated local practices, gathered clinician and patient stakeholder input, developed customized SCP templates within the electronic health record (EHR), and implemented 2 complementary delivery models. Clinician interviews (n = 41) and survey responses (n = 12), along with input from patients (n = 68) and a patient advisory board (n = 15), indicated support for SCPs and survivorship services. To promote feasible implementation and leverage existing workflows, we harmonized 2 SCP delivery models: integrated care within clinics where patients received treatment, and referral to a centralized survivorship clinic. We are implementing SCP delivery with prominent disease sites and will extend services to survivors of other cancers in the future. We developed four electronic disease-specific SCP templates for breast, colorectal, lung, and prostate cancers and a fifth, generic template that can be used for other malignancies. The templates reduced free-text clinician entry by auto-populating 20% of the fields from existing EHR data, and using drop-down menus for another 65%. Mean SCP completion time is 12 minutes (range, 10-15; n = 64). We designed our framework to facilitate ongoing evaluation of implementation and quality improvement. Funding/sponsorship Robert H Lurie Comprehensive Cancer Center, the Coleman Foundation, and the Lynn Sage Cancer Research Foundation. PMID:27258051

  8. Dose planning objectives in anal canal cancer IMRT: the TROG ANROTAT experience

    Energy Technology Data Exchange (ETDEWEB)

    Brown, Elizabeth, E-mail: elizabeth@mebrown.net [Princess Alexandra Hospital, Brisbane, Queensland (Australia); Cray, Alison [Peter MacCallum Cancer Cancer Centre, Box Hill, Victoria (Australia); Haworth, Annette [Peter MacCallum Cancer Cancer Centre, Box Hill, Victoria (Australia); University of Melbourne, Melbourne, Victoria (Australia); Chander, Sarat [Peter MacCallum Cancer Cancer Centre, Box Hill, Victoria (Australia); Lin, Robert [Medica Oncology, Hurstville, New South Wales (Australia); Subramanian, Brindha; Ng, Michael [Radiation Oncology Victoria, Melbourne, Victoria (Australia); Princess Alexandra Hospital, Brisbane, Queensland (Australia)

    2015-06-15

    Intensity modulated radiotherapy (IMRT) is ideal for anal canal cancer (ACC), delivering high doses to irregular tumour volumes whilst minimising dose to surrounding normal tissues. Establishing achievable dose objectives is a challenge. The purpose of this paper was to utilise data collected in the Assessment of New Radiation Oncology Treatments and Technologies (ANROTAT) project to evaluate the feasibility of ACC IMRT dose planning objectives employed in the Australian situation. Ten Australian centres were randomly allocated three data sets from 15 non-identifiable computed tomography data sets representing a range of disease stages and gender. Each data set was planned by two different centres, producing 30 plans. All tumour and organ at risk (OAR) contours, prescription and dose constraint details were provided. Dose–volume histograms (DVHs) for each plan were analysed to evaluate the feasibility of dose planning objectives provided. All dose planning objectives for the bone marrow (BM) and femoral heads were achieved. Median planned doses exceeded one or more objectives for bowel, external genitalia and bladder. This reached statistical significance for bowel V30 (P = 0.04), V45 (P < 0.001), V50 (P < 0.001), external genitalia V20 (P < 0.001) and bladder V35 (P < 0.001), V40 (P = 0.01). Gender was found to be the only significant factor in the likelihood of achieving the bowel V50 (P = 0.03) and BM V30 constraints (P = 0.04). The dose planning objectives used in the ANROTAT project provide a good starting point for ACC IMRT planning. To facilitate clinical implementation, it is important to prioritise OAR objectives and recognise factors that affect the achievability of these objectives.

  9. Dose planning objectives in anal canal cancer IMRT: the TROG ANROTAT experience

    International Nuclear Information System (INIS)

    Intensity modulated radiotherapy (IMRT) is ideal for anal canal cancer (ACC), delivering high doses to irregular tumour volumes whilst minimising dose to surrounding normal tissues. Establishing achievable dose objectives is a challenge. The purpose of this paper was to utilise data collected in the Assessment of New Radiation Oncology Treatments and Technologies (ANROTAT) project to evaluate the feasibility of ACC IMRT dose planning objectives employed in the Australian situation. Ten Australian centres were randomly allocated three data sets from 15 non-identifiable computed tomography data sets representing a range of disease stages and gender. Each data set was planned by two different centres, producing 30 plans. All tumour and organ at risk (OAR) contours, prescription and dose constraint details were provided. Dose–volume histograms (DVHs) for each plan were analysed to evaluate the feasibility of dose planning objectives provided. All dose planning objectives for the bone marrow (BM) and femoral heads were achieved. Median planned doses exceeded one or more objectives for bowel, external genitalia and bladder. This reached statistical significance for bowel V30 (P = 0.04), V45 (P < 0.001), V50 (P < 0.001), external genitalia V20 (P < 0.001) and bladder V35 (P < 0.001), V40 (P = 0.01). Gender was found to be the only significant factor in the likelihood of achieving the bowel V50 (P = 0.03) and BM V30 constraints (P = 0.04). The dose planning objectives used in the ANROTAT project provide a good starting point for ACC IMRT planning. To facilitate clinical implementation, it is important to prioritise OAR objectives and recognise factors that affect the achievability of these objectives

  10. Influence of radioactive sources discretization in the Monte Carlo computational simulations of brachytherapy procedures: a case study on the procedures for treatment of prostate cancer

    International Nuclear Information System (INIS)

    Radiotherapy computational simulation procedures using Monte Carlo (MC) methods have shown to be increasingly important to the improvement of cancer fighting strategies. One of the biases in this practice is the discretization of the radioactive source in brachytherapy simulations, which often do not match with a real situation. This study had the aim to identify and to measure the influence of radioactive sources discretization in brachytherapy MC simulations when compared to those that do not present discretization, using prostate brachytherapy with Iodine-125 radionuclide as model. Simulations were carried out with 108 events with both types of sources to compare them using EGSnrc code associated to MASH phantom in orthostatic and supine positions with some anatomic adaptations. Significant alterations were found, especially regarding bladder, rectum and the prostate itself. It can be concluded that there is a need to discretized sources in brachytherapy simulations to ensure its representativeness. (author)

  11. Evaluating Higher Education Policy in Turkey: Assessment of the Admission Procedure to Architecture, Planning and Engineering Schools

    Directory of Open Access Journals (Sweden)

    Kemal Mert Cubukcu

    2009-04-01

    Full Text Available The admission procedure to higher education institutions in Turkey is based on the student’s high school grades and Central University Entrance Examination (CUEE score, with a much greater weight on the latter. However, whether the CUEE is an appropriate measure in the admission process to universities is still a much-debated question. This study assesses the validity of the CUEE as a selection tool for design-based departments by examining the relationship between CUEE scores and success in university education in two design-based departments, architecture and city planning. The analysis is then extended to test the relationship in three engineering departments, computer engineering, civil engineering, and mechanical engineering. Based on the bivariate correlation and one sample t-test result, we report that CUEE scores and graduation grades have no relationship at all. We conclude that the current admission procedure to design-based schools based on solely a central examination score is not preferable.

  12. The effectiveness of drama therapy on preparation for diagnostic and therapeutic procedures in children suffering from cancer

    Directory of Open Access Journals (Sweden)

    Ľubica Ilievová

    2015-10-01

    Full Text Available Introduction: The integral part of the treatment of pediatric oncological patients is a range of diagnostic and therapeutic procedures. These procedures are often associated with the fear and anxiety of the suffering child. We investigated whether a psychological preparation through drama therapy and the therapeutic puppet may reduce the anxiety related to diagnostic and therapeutic procedures in the preschool or early school children suffering from cancer.Methods: Twenty consecutive pediatric patients of preschool and early school age, with the diagnosis of lymphoblastic leukemia, were included in the study. The patients were alternatingly assigned to experimental or control group, and subjected or not subjected to drama therapy, respectively. We measured the changes in heart rate, blood pressure and respiratory rate as indicators of anxiety and fear, before and after the diagnostic or therapeutic procedures.Results: Heart rate, blood pressure, and respiratory rate in pediatric oncological patients before and after the diagnostic or therapeutic procedure were significantly lower in the experimental group of patients.Conclusion: Our results show that psychological preparation using drama therapy and therapeutic puppet reduced the fear and anxiety related to diagnostic or therapeutic procedures in pediatric oncological patients.Key words: drama therapy; therapeutic puppet; children; oncology; psychology 

  13. Volumetric-modulated arc therapy planning using multicriteria optimization for localized prostate cancer.

    Science.gov (United States)

    Ghandour, Sarah; Matzinger, Oscar; Pachoud, Marc

    2015-01-01

    The purpose of this work is to evaluate the volumetric-modulated arc therapy (VMAT) multicriteria optimization (MCO) algorithm clinically available in the RayStation treatment planning system (TPS) and its ability to reduce treatment planning time while providing high dosimetric plan quality. Nine patients with localized prostate cancer who were previously treated with 78 Gy in 39 fractions using VMAT plans and rayArc system based on the direct machine parameter optimization (DMPO) algorithm were selected and replanned using the VMAT-MCO system. First, the dosimetric quality of the plans was evaluated using multiple conformity metrics that account for target coverage and sparing of healthy tissue, used in our departmental clinical protocols. The conformity and homogeneity index, number of monitor units, and treatment planning time for both modalities were assessed. Next, the effects of the technical plan parameters, such as constraint leaf motion CLM (cm/°) and maximum arc delivery time T (s), on the accuracy of delivered dose were evaluated using quality assurance passing rates (QAs) measured using the Delta4 phantom from ScandiDos. For the dosimetric plan's quality analysis, the results show that the VMAT-MCO system provides plans comparable to the rayArc system with no statistical difference for V95% (p < 0.01), D1% (p < 0.01), CI (p < 0.01), and HI (p < 0.01) of the PTV, bladder (p < 0.01), and rectum (p < 0.01) constraints, except for the femoral heads and healthy tissues, for which a dose reduction was observed using MCO compared with rayArc (p < 0.01). The technical parameter study showed that a combination of CLM equal to 0.5 cm/degree and a maximum delivery time of 72 s allowed the accurate delivery of the VMAT-MCO plan on the Elekta Versa HD linear accelerator. Planning evaluation and dosimetric measurements showed that VMAT-MCO can be used clinically with the advantage of enhanced planning process efficiency by reducing the treatment planning time

  14. Cancer care. Cancer plan--progress report: must try even harder.

    Science.gov (United States)

    Coombes, Rebecca

    2004-11-25

    Despite progress in some areas, major obstacle achieving a uniformly good service for cancer patients remain. PCTs' lack of expertise is holding back progress ending delays in diagnosis and treatment. SHAs need to be clearer with PCTs about the importance of meeting national targets. PMID:15597927

  15. Clinical validation of FDG-PET/CT in the radiation treatment planning for patients with oesophageal cancer

    NARCIS (Netherlands)

    Muijs, Christina T.; Beukema, Jannet C.; Woutersen, Dankert; Mul, Veronique E.; Berveling, Maaike J.; Pruim, Jan; van der Jagt, Eric J.; Hospers, Geke A. P.; Groen, Henk; Plukker, John Th.; Langendijk, Johannes A.

    2014-01-01

    Background: The aim of this prospective study was to determine the proportion of locoregional recurrences (LRRs) that could have been prevented if radiotherapy treatment planning for oesophageal cancer was based on PET/CT instead of CT. Materials and methods: Ninety oesophageal cancer patients, elig

  16. Survivorship Care Planning in Improving Quality of Life in Survivors of Ovarian Cancer

    Science.gov (United States)

    2016-08-19

    Cancer Survivor; Stage IA Ovarian Epithelial Cancer; Stage IB Ovarian Epithelial Cancer; Stage IC Ovarian Epithelial Cancer; Stage IIA Ovarian Epithelial Cancer; Stage IIB Ovarian Epithelial Cancer; Stage IIC Ovarian Epithelial Cancer; Stage IIIA Ovarian Epithelial Cancer; Stage IIIB Ovarian Epithelial Cancer; Stage IIIC Ovarian Epithelial Cancer

  17. Investigating dosimetric effect of rotational setup errors in IMPT planning of synchronous bilateral lung cancer

    Directory of Open Access Journals (Sweden)

    Suresh Rana

    2015-12-01

    Full Text Available Purpose: The purpose of this study is to evaluate the dosimetric effect of rotational setup errors on the synchronous bi-lateral lung cancer plans generated by the intensity modulated proton therapy (IMPT technique.Methods: The original IMPT plans were generated in for the left planning target volume (PTV and right PTV of the left lung and right lung, respectively. Each plan was generated using two beams (lateral and posterior-anterior with an isocenter placed at the center of the corresponding PTV. The IMPT plans were optimized for a total dose of 74 Gy[RBE] prescribed to each PTV with 2 Gy(RBE per fraction. Original plans were recalculated by introducing simulated rotational errors. For each PTV, 18 rotational plans (±1⁰, ±2⁰, and ±3⁰ for each of the yaw, roll, and pitch rotations were generated. Results: Rotational errors caused the reduction in the clinical target volume (CTV and PTV coverage in new rotational IMPT plans when compared to the original IMPT lung plans. The CTV D99 was reduced by up to 13.3%, 9.1%, and 5.9% for the yaw (+3⁰, roll (-3⁰, and pitch (+3⁰, respectively. The PTV D95 was reduced by up to 8.7%, 7.3%, and 4.6% for the yaw (+3⁰, roll (-3⁰, and pitch (+3⁰, respectively. The PTV V100 showed the highest deviation with a reduction of dose coverage by up to 40.1%, 31.8%, and 33.9% for the yaw (-3⁰, roll (-3⁰, and pitch (+3⁰ respectively. Conclusion: The rotational setup errors with magnitude of ≥2⁰ can produce a significant loss of dose coverage to the target volume in the IMPT of a synchronous bi-lateral lung cancer. The yaw had the most severe impact on the dosimetric results when compared to other two rotational errors (roll and pitch.

  18. Evaluation of a Knowledge-Based Planning Solution for Head and Neck Cancer

    International Nuclear Information System (INIS)

    Purpose: Automated and knowledge-based planning techniques aim to reduce variations in plan quality. RapidPlan uses a library consisting of different patient plans to make a model that can predict achievable dose-volume histograms (DVHs) for new patients and uses those models for setting optimization objectives. We benchmarked RapidPlan versus clinical plans for 2 patient groups, using 3 different libraries. Methods and Materials: Volumetric modulated arc therapy plans of 60 recent head and neck cancer patients that included sparing of the salivary glands, swallowing muscles, and oral cavity were evenly divided between 2 models, Model30A and Model30B, and were combined in a third model, Model60. Knowledge-based plans were created for 2 evaluation groups: evaluation group 1 (EG1), consisting of 15 recent patients, and evaluation group 2 (EG2), consisting of 15 older patients in whom only the salivary glands were spared. RapidPlan results were compared with clinical plans (CP) for boost and/or elective planning target volume homogeneity index, using HIB/HIE = 100 × (D2% − D98%)/D50%, and mean dose to composite salivary glands, swallowing muscles, and oral cavity (Dsal, Dswal, and Doc, respectively). Results: For EG1, RapidPlan improved HIB and HIE values compared with CP by 1.0% to 1.3% and 1.0% to 0.6%, respectively. Comparable Dsal and Dswal values were seen in Model30A, Model30B, and Model60, decreasing by an average of 0.1, 1.0, and 0.8 Gy and 4.8, 3.7, and 4.4 Gy, respectively. However, differences were noted between individual organs at risk (OARs), with Model30B increasing Doc by 0.1, 3.2, and 2.8 Gy compared with CP, Model30A, and Model60. Plan quality was less consistent when the patient was flagged as an outlier. For EG2, RapidPlan decreased Dsal by 4.1 to 4.9 Gy on average, whereas HIB and HIE decreased by 1.1% to 1.5% and 2.3% to 1.9%, respectively. Conclusions: RapidPlan knowledge-based treatment plans were comparable to CP if the patient

  19. Evaluation of a Knowledge-Based Planning Solution for Head and Neck Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Tol, Jim P., E-mail: j.tol@vumc.nl; Delaney, Alexander R.; Dahele, Max; Slotman, Ben J.; Verbakel, Wilko F.A.R.

    2015-03-01

    Purpose: Automated and knowledge-based planning techniques aim to reduce variations in plan quality. RapidPlan uses a library consisting of different patient plans to make a model that can predict achievable dose-volume histograms (DVHs) for new patients and uses those models for setting optimization objectives. We benchmarked RapidPlan versus clinical plans for 2 patient groups, using 3 different libraries. Methods and Materials: Volumetric modulated arc therapy plans of 60 recent head and neck cancer patients that included sparing of the salivary glands, swallowing muscles, and oral cavity were evenly divided between 2 models, Model{sub 30A} and Model{sub 30B}, and were combined in a third model, Model{sub 60}. Knowledge-based plans were created for 2 evaluation groups: evaluation group 1 (EG1), consisting of 15 recent patients, and evaluation group 2 (EG2), consisting of 15 older patients in whom only the salivary glands were spared. RapidPlan results were compared with clinical plans (CP) for boost and/or elective planning target volume homogeneity index, using HI{sub B}/HI{sub E} = 100 × (D2% − D98%)/D50%, and mean dose to composite salivary glands, swallowing muscles, and oral cavity (D{sub sal}, D{sub swal}, and D{sub oc}, respectively). Results: For EG1, RapidPlan improved HI{sub B} and HI{sub E} values compared with CP by 1.0% to 1.3% and 1.0% to 0.6%, respectively. Comparable D{sub sal} and D{sub swal} values were seen in Model{sub 30A}, Model{sub 30B}, and Model{sub 60}, decreasing by an average of 0.1, 1.0, and 0.8 Gy and 4.8, 3.7, and 4.4 Gy, respectively. However, differences were noted between individual organs at risk (OARs), with Model{sub 30B} increasing D{sub oc} by 0.1, 3.2, and 2.8 Gy compared with CP, Model{sub 30A}, and Model{sub 60}. Plan quality was less consistent when the patient was flagged as an outlier. For EG2, RapidPlan decreased D{sub sal} by 4.1 to 4.9 Gy on average, whereas HI{sub B} and HI{sub E} decreased by 1.1% to

  20. Semiautomatic bladder segmentation on CBCT using a population-based model for multiple-plan ART of bladder cancer

    Science.gov (United States)

    Chai, Xiangfei; van Herk, Marcel; Betgen, Anja; Hulshof, Maarten; Bel, Arjan

    2012-12-01

    The aim of this study is to develop a novel semiautomatic bladder segmentation approach for selecting the appropriate plan from the library of plans for a multiple-plan adaptive radiotherapy (ART) procedure. A population-based statistical bladder model was first built from a training data set (95 bladder contours from 8 patients). This model was then used as constraint to segment the bladder in an independent validation data set (233 CBCT scans from the remaining 22 patients). All 3D bladder contours were converted into parametric surface representations using spherical harmonic expansion. Principal component analysis (PCA) was applied in the spherical harmonic-based shape parameter space to calculate the major variation of bladder shapes. The number of dominating PCA modes was chosen such that 95% of the total shape variation of the training data set was described. The automatic segmentation started from the bladder contour of the planning CT of each patient, which was modified by changing the weight of each PCA mode. As a result, the segmentation contour was deformed consistently with the training set to best fit the bladder boundary in the localization CBCT image. A cost function was defined to measure the goodness of fit of the segmentation on the localization CBCT image. The segmentation was obtained by minimizing this cost function using a simplex optimizer. After automatic segmentation, a fast manual correction method was provided to correct those bladders (parts) that were poorly segmented. Volume- and distance-based metrics and the accuracy of plan selection from multiple plans were evaluated to quantify the performance of the automatic and semiautomatic segmentation methods. For the training data set, only seven PCA modes were needed to represent 95% of the bladder shape variation. The mean CI overlap and residual error (SD) of automatic bladder segmentation over all of the validation data were 70.5% and 0.39 cm, respectively. The agreement of plan

  1. Feasibility of the partial-single arc technique in RapidArc planning for prostate cancer treatment

    Institute of Scientific and Technical Information of China (English)

    Suresh Rana; ChihYao Cheng

    2013-01-01

    The volumetric modulated arc therapy (VMAT) technique, in the form of RapidArc, is widely used to treat prostate cancer. The full-single arc (f-SA) technique in RapidArc planning for prostate cancer treatment provides efficient treatment, but it also delivers a higher radiation dose to the rectum. This study aimed to compare the dosimetric results from the new partial-single arc (p-SA) technique with those from the f-SA technique in RapidArc planning for prostate cancer treatment. In this study, 10 patients with low-risk prostate cancer were selected. For each patient, two sets of RapidArc plans (f-SA and p-SA) were created in the Eclipse treatment planning system. The f-SA plan was created using one ful arc, and the p-SA plan was created using planning parameters identical to those of the f-SA plan but with anterior and posterior avoidance sectors. Various dosimetric parameters of the f-SA and p-SA plans were evaluated and compared for the same target coverage and identical plan optimization parameters. The f-SA and p-SA plans showed an average difference of ±1% for the doses to the planning target volume (PTV), and there were no clear differences in dose homogeneity or plan conformity. In comparison to the f-SA technique, the p-SA technique reduced the doses to the rectum by approximately 6.1% to 21.2%, to the bladder by approximately 10.3%to 29.5%, and to the penile bulb by approximately 2.2%. In contrast, the dose to the femoral heads, the integral dose, and the number of monitor units were higher in the p-SA plans by approximately 34.4%, 7.7%, and 9.2%, respectively. In conclusion, it is feasible to use the p-SA technique for RapidArc planning for prostate cancer treatment. For the same PTV coverage and identical plan optimization parameters, the p-SA technique is better in sparing the rectum and bladder without compromising plan conformity or target homogeneity when compared to the f-SA technique.

  2. End of Life Planning and its Relevance for Patients and Oncologists’ Decisions in Choosing Cancer Therapy

    Science.gov (United States)

    Saraiya, Biren; Bodnar-Deren, Susan; Leventhal, Elaine; Leventhal, Howard

    2008-01-01

    The goal of end of life (EoL) planning is to provide individuals with tools to control their financial and health care decisions when they are incapacitated. When an elderly patient is diagnosed with advanced cancer, the possible treatment options are: palliative care with curative intent or prolongation of life or palliative care only. Treatment of cancer in elderly patients creates a significant array of monetary and symptom burdens. The question is whether advance care planning (ACP), part of EoL planning, allows patients families and communities to control and reduce these burdens. Although the number of patients completing advance directives has increased in recent years, there are multiple barriers to the implementation of patients’ wishes such as limited knowledge of patient wishes by proxy and physician and inadequate communication regarding prognosis. We propose that improvements in patient decision making and clinical practice can reduce the burden of symptoms for patients if clinicians better understood patients’ models and expectations respecting the longer term consequences of diagnosis and treatment. This understanding can arise from improved information exchange and constant updating of the information as the disease and treatment evolves. Clinicians also need better prognostication tools and better training in effective communication skills to elicit patient goals and make appropriate recommendations. PMID:19058149

  3. A case study of radiotherapy planning for a bilateral metal hip prosthesis prostate cancer patient

    International Nuclear Information System (INIS)

    The purpose of this report is to communicate the observed advantage of intensity-modulated radiotherapy (IMRT) in a patient with bilateral metallic hip prostheses. In this patient with early-stage low-risk disease, a dose of 74 Gy was planned in two phases-an initial 50 Gy to the prostate and seminal vesicles and an additional 24 Gy to the prostate alone. Each coplanar beam avoided the prosthesis in the beam's eye view. Using the same target expansions for each phase, IMRT and 3D-conformal radiotherapy (CRT) plans were compared for target coverage and inhomogeneity as well as dose to the bladder and rectum. The results of the analysis demonstrated that IMRT provided superior target coverage with reduced dose to normal tissues for both individual phases of the treatment plan as well as for the composite treatment plan. The dose to the rectum was significantly reduced with the IMRT technique, with a composite V80 of 35% for the IMRT plan versus 70% for 3D-CRT plan. Similarly, the dose to the bladder was significantly reduced with a V80 of 9% versus 20%. Overall, various dosimetric parameters revealed the corresponding 3D-CRT plan would not have been acceptable. The results indicate significant success with IMRT in a clinical scenario where there were no curative alternatives for local treatment other than external beam radiotherapy. Therefore, definitive external beam radiation of prostate cancer patients with bilateral prosthesis is made feasible with IMRT. The work described herein may also have applicability to other groups of patients, such as those with gynecological or other pelvic malignancies

  4. High procedure volume is strongly associated with improved survival after lung cancer surgery

    DEFF Research Database (Denmark)

    Lüchtenborg, Margreet; Riaz, Sharma P; Coupland, Victoria H;

    2013-01-01

    Studies have reported an association between hospital volume and survival for non-small-cell lung cancer (NSCLC). We explored this association in England, accounting for case mix and propensity to resect.......Studies have reported an association between hospital volume and survival for non-small-cell lung cancer (NSCLC). We explored this association in England, accounting for case mix and propensity to resect....

  5. Intravenous Mistletoe Treatment in Integrative Cancer Care: A Qualitative Study Exploring the Procedures, Concepts, and Observations of Expert Doctors

    Directory of Open Access Journals (Sweden)

    Gunver S. Kienle

    2016-01-01

    Full Text Available Background. Mistletoe therapy (MT is widely used in patient-centered integrative cancer care. The objective of this study was to explore the concepts, procedures, and observations of expert doctors, with a focus on intravenous MT. Method. A qualitative interview study was conducted with 35 highly experienced doctors specialized in integrative and anthroposophic medicine. Structured qualitative content analysis was applied. For triangulation, the results were compared with external evidence that was systematically collected, reviewed, and presented. Results. Doctors perform individualized patient assessments that lead to multimodal treatment approaches. The underlying goal is to help patients to live with and overcome disease. Mistletoe infusions are a means of accomplishing this goal. They are applied to stabilize disease, achieve responsiveness, induce fever, improve quality of life, and improve the tolerability of conventional cancer treatments. The doctors reported long-term disease stability and improvements in patients’ general condition, vitality, strength, thermal comfort, appetite, sleep, pain from bone metastases, dyspnea in pulmonary lymphangitis carcinomatosa, fatigue, and cachexia; chemotherapy was better tolerated. Also patients’ emotional and mental condition was reported to have improved. Conclusion. Individualized integrative cancer treatment including MT aims to help cancer patients to live well with their disease. Further research should investigate the reported observations.

  6. Flight Planning and Procedures

    Science.gov (United States)

    Rich, Allison C.

    2016-01-01

    The National Aeronautics and Space Administration (NASA) was founded in 1958 by President Eisenhower as a civilian lead United States federal agency designed to advance the science of space. Over the years, NASA has grown with a vision to "reach for new heights and reveal the unknown for the benefit of humankind" (About NASA). Mercury, Gemini, Apollo, Skylab, and Space Shuttle are just a few of the programs that NASA has led to advance our understanding of the universe. Each of the eleven main NASA space centers located across the United States plays a unique role in accomplishing that vision. Since 1961, Johnson Space Center (JSC) has led the effort for manned spaceflight missions. JSC has a mission to "provide and apply the preeminent capabilities to develop, operate, and integrate human exploration missions spanning commercial, academic, international, and US government partners" (Co-op Orientation). To do that, JSC is currently focused on two main programs, Orion and the International Space Station (ISS). Orion is the exploration vehicle that will take astronauts to Mars; a vessel comparable to the Apollo capsule. The International Space Station (ISS) is a space research facility designed to expand our knowledge of science in microgravity. The first piece of the ISS was launched in November of 1998 and has been in a continuous low earth orbit ever since. Recently, two sub-programs have been developed to resupply the ISS. The Commercial Cargo program is currently flying cargo and payloads to the ISS; the Commercial Crew program will begin flying astronauts to the ISS in a few years.

  7. Space capsule recovery—Evaluation of risk factors, safety plans and procedures and design of experiments for systems qualification

    Science.gov (United States)

    Narasaiah, N.; Varaprasad, R.; Seshagiri Rao, V.; Krishnamurty, V.; Sanyal, M. K.

    2009-11-01

    The Indian Space capsule (SRE-1) launched aboard PSLV-C7 rocket, was recovered successfully in the Bay of Bengal on January 22, 2007 after its orbital sojourn of 12 days. Apart from serving as a platform for micro-gravity experiments, SRE-1 demonstrated ISRO's capability in the field of orbital reentry and recovery technologies. Satish Dhawan Space Centre (SDSC SHAR), the Spaceport of India was given the prime responsibility of assessment of mission risk, formulation and execution of safety plans and procedures, design and conduct of trials for validating the mission-critical sub-systems as well as the physical recovery of the capsule. To achieve these objectives, a number of drop tests were designed and conducted by SDSC SHAR involving real time computer network, ground-based tracking and telemetry stations, communication systems, safety and material handling systems, target identification and recovery systems. Dissemination of relevant information and coordination with multiple external organizations such as Indian Coast Guard, Indian Air Force and Indian Navy is an important aspect of these experiments. This paper delineates the methodologies designed and implemented at SDSC SHAR for validating those critical systems whose functionality finally culminated in the success of the mission, enabling India to join the elite group of nations with reentry module recovery capability.

  8. On the scope of the Federal Government to issue orders in plan approval procedures under para. 9b of the Atomic Energy Act as provided by article 85 section 3 of the Basic Law

    International Nuclear Information System (INIS)

    Under Paragraph 9b of the Atomic Energy Act the Lower Saxonian Minister of the Environment has the competence for the plan approval procedure concerning the final disposal site Konrad. The plan approval procedure under atomic energy law is a unitary administrative procedure which makes further administrative procedures and administrative decisions superfluous on the strength of its unitary character and without impingement on constitutional law. In conducting the plan approval procedure the Lower Saxonican Minister of the Environment is acting within the framework of Laender administration on behalf of the Federation. To this extent he is subject to the orders of the Federal Minister of the Enviroment under Article 85 Section 3 of The Basic Law with respect to the formation of the procedure and procedural decisions as well as decisions on the merits pending. The concentrating effect of the plan approval procedure under atomic energy law also extends to permits under water law. (orig./HSCH)

  9. A randomized trial of hypnosis for relief of pain and anxiety in adult cancer patients undergoing bone marrow procedures.

    Science.gov (United States)

    Snow, Alison; Dorfman, David; Warbet, Rachel; Cammarata, Meredith; Eisenman, Stephanie; Zilberfein, Felice; Isola, Luis; Navada, Shyamala

    2012-01-01

    Pain and anxiety are closely associated with bone marrow aspirates and biopsies. To determine whether hypnosis administered concurrently with the procedure can ameliorate these morbidities, the authors randomly assigned 80 cancer patients undergoing bone marrow aspirates and biopsies to either hypnosis or standard of care. The hypnosis intervention reduced the anxiety associated with procedure, but the difference in pain scores between the two groups was not statistically significant. The authors conclude that brief hypnosis concurrently administered reduces patient anxiety during bone marrow aspirates and biopsies but may not adequately control pain. The authors explain this latter finding as indicating that the sensory component of a patient's pain experience may be of lesser importance than the affective component. The authors describe future studies to clarify their results and address the limitations of this study. PMID:22571244

  10. Coefficients calculations of conversion of cancer risk for occupational exposure using Monte Carlo simulations in cardiac procedures of interventionist radiology

    International Nuclear Information System (INIS)

    Cardiac procedures are among the most common procedures in interventional radiology (IR), and can lead to high medical and occupational exposures, as in most cases are procedures complex and long lasting. In this work, conversion coefficients (CC) for the risk of cancer, normalized by kerma area product (KAP) to the patient, cardiologist and nurse were calculated using Monte Carlo simulation. The patient and the cardiologist were represented by anthropomorphic simulators MESH, and the nurse by anthropomorphic phantom FASH. Simulators were incorporated into the code of Monte Carlo MCNPX. Two scenarios were created: in the first (1), lead curtain and protective equipment suspended were not included, and in the second (2) these devices were inserted. The radiographic parameters employed in Monte Carlo simulations were: tube voltage of 60 kVp and 120 kVp; filtration of the beam and 3,5 mmAl beam area of 10 x 10 cm2. The average values of CCs to eight projections (in 10-4 / Gy.cm2 were 1,2 for the patient, 2,6E-03 (scenario 1) and 4,9E-04 (scenario 2) for cardiologist and 5,2E-04 (scenario 1) and 4,0E-04 (Scenario 2) to the nurse. The results show a significant reduction in CCs for professionals, when the lead curtain and protective equipment suspended are employed. The evaluation method used in this work can provide important information on the risk of cancer patient and professional, and thus improve the protection of workers in cardiac procedures of RI

  11. Prospective study evaluating the use of IV contrast on IMRT treatment planning for lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Li, Hua, E-mail: huli@radonc.wustl.edu; Bottani, Beth; DeWees, Todd; Michalski, Jeff M.; Mutic, Sasa; Bradley, Jeffrey D.; Robinson, Clifford G. [Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri 63110 (United States); Low, Daniel A. [Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California 90095 (United States)

    2014-03-15

    Purpose: To investigate the impact of exclusively using intravenous (IV) contrast x-ray computed tomography (CT) scans on lung cancer intensity-modulated radiation therapy (IMRT) treatment planning. Methods: Eight patients with lung cancer (one small cell, seven nonsmall cell) scheduled to receive IMRT consented to acquisition of simulation CT scans with and without IV contrast. Clinical treatment plans optimized on the noncontrast scans were recomputed on contrast scans and dose coverage was compared, along with the γ passing rates. Results: IV contrast enhanced scans provided better target and critical structure conspicuity than the noncontrast scans. Using noncontrast scan as a reference, the median absolute/relative differences in mean, maximum, and minimum doses to the planning target volume (PTV) were −4.5 cGy/−0.09%, 41.1 cGy/0.62%, and −19.7 cGy/−0.50%, respectively. Regarding organs-at-risk (OARs), the median absolute/relative differences of maximum dose to heart was −13.3 cGy/−0.32%, to esophagus was −63.4 cGy/−0.89%, and to spinal cord was −16.3 cGy/−0.46%. The median heart region of interest CT Hounsfield Unit (HU) number difference between noncontrast and contrast scans was 136.4 HU (range, 94.2–161.8 HU). Subjectively, the regions with absolute dose differences greater than 3% of the prescription dose were small and typically located at the patient periphery and/or at the beam edges. The median γ passing rate was 0.9981 (range, 0.9654–0.9999) using 3% absolute dose difference/3 mm distance-to-agreement criteria. Overall, all evaluated cases were found to be clinically equivalent. Conclusions: PTV and OARs dose differences between noncontrast and contrast scans appear to be minimal for lung cancer patients undergoing IMRT. Using IV contrast scans as the primary simulation dataset could increase treatment planning efficiency and accuracy by avoiding unnecessary scans, manually region overriding, and planning errors caused by

  12. Prospective study evaluating the use of IV contrast on IMRT treatment planning for lung cancer

    International Nuclear Information System (INIS)

    Purpose: To investigate the impact of exclusively using intravenous (IV) contrast x-ray computed tomography (CT) scans on lung cancer intensity-modulated radiation therapy (IMRT) treatment planning. Methods: Eight patients with lung cancer (one small cell, seven nonsmall cell) scheduled to receive IMRT consented to acquisition of simulation CT scans with and without IV contrast. Clinical treatment plans optimized on the noncontrast scans were recomputed on contrast scans and dose coverage was compared, along with the γ passing rates. Results: IV contrast enhanced scans provided better target and critical structure conspicuity than the noncontrast scans. Using noncontrast scan as a reference, the median absolute/relative differences in mean, maximum, and minimum doses to the planning target volume (PTV) were −4.5 cGy/−0.09%, 41.1 cGy/0.62%, and −19.7 cGy/−0.50%, respectively. Regarding organs-at-risk (OARs), the median absolute/relative differences of maximum dose to heart was −13.3 cGy/−0.32%, to esophagus was −63.4 cGy/−0.89%, and to spinal cord was −16.3 cGy/−0.46%. The median heart region of interest CT Hounsfield Unit (HU) number difference between noncontrast and contrast scans was 136.4 HU (range, 94.2–161.8 HU). Subjectively, the regions with absolute dose differences greater than 3% of the prescription dose were small and typically located at the patient periphery and/or at the beam edges. The median γ passing rate was 0.9981 (range, 0.9654–0.9999) using 3% absolute dose difference/3 mm distance-to-agreement criteria. Overall, all evaluated cases were found to be clinically equivalent. Conclusions: PTV and OARs dose differences between noncontrast and contrast scans appear to be minimal for lung cancer patients undergoing IMRT. Using IV contrast scans as the primary simulation dataset could increase treatment planning efficiency and accuracy by avoiding unnecessary scans, manually region overriding, and planning errors caused by

  13. Retrospective Estimation of the Quality of Intensity-Modulated Radiotherapy Plans for Lung Cancer

    CERN Document Server

    Koo, Jihye; Chung, Weon Kuu; Kim, Dong Wook

    2015-01-01

    This study estimated the planning quality of intensity-modulated radiotherapy in 42 lung cancer cases to provide preliminary data for the development of a planning quality assurance algorithm. Organs in or near the thoracic cavity (ipsilateral lung, contralateral lung, heart, liver, esophagus, spinal cord, and bronchus) were selected as organs at risk (OARs). Radiotherapy plans were compared using the conformity index (CI), coverage index (CVI), and homogeneity index (HI) of the planning target volume (PTV), OAR-PTV distance and OAR-PTV overlap volume, and the V10Gy, V20Gy, and equivalent uniform dose (EUD) of the OARs. The CI, CVI, and HI of the PTV were 0.54 - 0.89 , 0.90 - 1.00 , and 0.11 - 0.41, respectively. The mean EUDs (V10Gy, V20Gy) of the ipsilateral lung, contralateral lung, esophagus, cord, liver, heart, and bronchus were 8.07 Gy (28.06, 13.17), 2.59 Gy (6.53, 1.18), 7.02 Gy (26.17, 12.32), 3.56 Gy (13.56, 4.48), 0.72 Gy (2.15, 0.91), 5.14 Gy (19.68, 8.62), and 10.56 Gy (36.08, 19.79), respectivel...

  14. Magnetic resonance spectroscopic imaging for improved treatment planning of prostate cancer

    Science.gov (United States)

    Venugopal, Niranjan

    Prostate cancer is the most common malignancy afflicting Canadian men in 2011. Physicians use digital rectal exams (DRE), blood tests for prostate specific antigen (PSA) and transrectal ultrasound (TRUS)-guided biopsies for the initial diagnosis of prostate cancer. None of these tests detail the spatial extent of prostate cancer - information critical for using new therapies that can target cancerous prostate. With an MRI technique called proton magnetic resonance spectroscopic imaging (1H-MRSI), biochemical analysis of the entire prostate can be done without the need for biopsy, providing detailed information beyond the non-specific changes in hardness felt by an experienced urologist in a DRE, the presence of PSA in blood, or the "blind-guidance" of TRUS-guided biopsy. A hindrance to acquiring high quality 1H-MRSI data comes from signal originating from fatty tissue surrounding prostate that tends to mask or distort signal from within the prostate, thus reducing the overall clinical usefulness of 1H-MRSI data. This thesis has three major areas of focus: 1) The development of an optimized 1H-MRSI technique, called conformal voxel magnetic resonance spectroscopy (CV-MRS), to deal the with removal of unwanted lipid contaminating artifacts at short and long echo times. 2) An in vivo human study to test the CV-MRS technique, including healthy volunteers and cancer patients scheduled for radical prostatectomy or radiation therapy. 3) A study to determine the efficacy of using the 1H-MRSI data for optimized radiation treatment planning using modern delivery techniques like intensity modulated radiation treatment. Data collected from the study using the optimized CV-MRS method show significantly reduced lipid contamination resulting in high quality spectra throughout the prostate. Combining the CV-MRS technique with spectral-spatial excitation further reduced lipid contamination and opened up the possibility of detecting metabolites with short T2 relaxation times

  15. Patient-centered cancer treatment planning: improving the quality of oncology care. Summary of an Institute of Medicine workshop.

    Science.gov (United States)

    Balogh, Erin P; Ganz, Patricia A; Murphy, Sharon B; Nass, Sharyl J; Ferrell, Betty R; Stovall, Ellen

    2011-01-01

    The Institute of Medicine's National Cancer Policy Forum recently convened a workshop on patient-centered cancer treatment planning, with the aim of raising awareness about this important but often overlooked aspect of cancer treatment. A primary goal of patient-centered treatment planning is to engage patients and their families in meaningful, thorough interactions with their health care providers to develop an accurate, well-conceived treatment plan, using all available medical information appropriately while also considering the medical, social, and cultural needs and desires of the patient and family. A cancer treatment plan can be shared among the patient, family, and care team in order to facilitate care coordination and provide a roadmap to help patients navigate the path of cancer treatment. There are numerous obstacles to achieving patient-centered cancer treatment planning in practice. Some of these challenges stem from the patient and include patients' lack of assertiveness, health literacy, and numeracy, and their emotional state and concurrent illnesses. Others are a result of physician limitations, such as a lack of time to explain complex information and a lack of tools to facilitate treatment planning, as well as insensitivity to patients' informational, cultural, and emotional needs. Potential solutions to address these obstacles include better training of health care providers and patients in optimal communication and shared decision making, and greater use of support services and tools such as patient navigation and electronic health records. Other options include greater use of quality metrics and reimbursement for the time it takes to develop, discuss, and document a treatment plan. PMID:22128118

  16. Clinical dosimetric impact of Acuros XB and analytical anisotropic algorithm (AAA on real lung cancer treatment plans : review

    Directory of Open Access Journals (Sweden)

    Suresh Rana

    2014-02-01

    Full Text Available Photon dose calculation algorithms in treatment planning system could affect the accuracy of dose delivery when tissue heterogeneity is involved along the beam path. Treatment planning for lung cancer is challenging, especially in the case of treatment plan involving small fields. The combination of low-density (air medium and small fields cause charge particle disequilibrium nears the air/tissue interface. Beam modeling within the dose calculation algorithms must also employ an accurate method of accounting tissue heterogeneity corrections in order to avoid dose overestimation or underestimation. Analytical anisotropic algorithm (AAA is one of the widely tested and validated dose calculation algorithms in external beam photon radiation therapy. Recently, Acuros XB (AXB was made available for photon dose calculations, and several studies have demonstrated better dose prediction accuracy of the AXB over AAA. This article reviews the results from the treatment planning studies, which have investigated the clinical dosimetric impact of the AXB and AAA on real lung cancer treatment plans.--------------------------------------Cite this article as: Rana S. Clinical dosimetric impact of Acuros XB and analytical anisotropic algorithm (AAA on real lung cancer treatment plans: review. Int J Cancer Ther Oncol 2014; 2(1:02019.DOI: http://dx.doi.org/10.14319/ijcto.0201.9

  17. Commissioning of radiotherapy treatment planning systems: Testing for typical external beam treatment techniques. Report of the Coordinated Research Project (CRP) on Development of Procedures for Quality Assurance of Dosimetry Calculations in Radiotherapy

    International Nuclear Information System (INIS)

    Quality Assurance (QA) in the radiation therapy treatment planning process is essential to ensure accurate dose delivery to the patient and to minimize the possibility of accidental exposure. Computerized radiotherapy treatment planning systems (RTPSs) are now widely available in both industrialised and developing countries so, it is of special importance to support hospitals in the IAEA Member States in developing procedures for acceptance testing, commissioning and ongoing QA of their RTPSs. Responding to these needs, a group of experts developed a comprehensive report, the IAEA Technical Reports Series No 430 'Commissioning and quality assurance of computerized planning systems for radiation treatment of cancer', that provides the general framework and describes a large number of tests and procedures to be considered by the RTPS users. To provide practical guidance for implementation of IAEA Technical Reports Series No. 430 in radiotherapy hospitals and particularly in those with limited resources, a coordinated research project (CRP E2.40.13) 'Development of procedures for dosimetry calculation in radiotherapy' was established. The main goal of the project was to create a set of practical acceptance and commissioning tests for dosimetry calculations in radiotherapy, defined in a dedicated protocol. Two specific guidance publications that were developed in the framework of the Coordinated Research Project E2.40.13 are based on guidelines described in the IAEA Technical Report Series No. 430 and provide a step-by-step description for users at hospitals or cancer centres how to implement acceptance and commissioning procedures for their RTPSs. The first publication, 'Specification and acceptance testing of radiotherapy treatment planning systems' IAEA-TECDOC-1540 uses the International Electrotechnical Commission (IEC) standard IEC 62083 as its basis and addresses the procedures for specification and acceptance testing of RTPSs to be used by both manufacturers and

  18. Commissioning of Radiotherapy Treatment Planning Systems: Testing for Typical External Beam Treatment Techniques. Report of the Coordinated Research Project (CRP) on Development of Procedures for Quality Assurance of Dosimetry Calculations in Radiotherapy

    International Nuclear Information System (INIS)

    Quality Assurance (QA) in the radiation therapy treatment planning process is essential to ensure accurate dose delivery to the patient and to minimize the possibility of accidental exposure. Computerized radiotherapy treatment planning systems (RTPSs) are now widely available in both industrialised and developing countries so, it is of special importance to support hospitals in the IAEA Member States in developing procedures for acceptance testing, commissioning and ongoing QA of their RTPSs. Responding to these needs, a group of experts developed a comprehensive report, the IAEA Technical Reports Series No 430 'Commissioning and quality assurance of computerized planning systems for radiation treatment of cancer', that provides the general framework and describes a large number of tests and procedures to be considered by the RTPS users. To provide practical guidance for implementation of IAEA Technical Reports Series No. 430 in radiotherapy hospitals and particularly in those with limited resources, a coordinated research project (CRP E2.40.13) 'Development of procedures for dosimetry calculation in radiotherapy' was established. The main goal of the project was to create a set of practical acceptance and commissioning tests for dosimetry calculations in radiotherapy, defined in a dedicated protocol. Two specific guidance publications that were developed in the framework of the Coordinated Research Project E2.40.13 are based on guidelines described in the IAEA Technical Report Series No. 430 and provide a step-by-step description for users at hospitals or cancer centres how to implement acceptance and commissioning procedures for their RTPSs. The first publication, 'Specification and acceptance testing of radiotherapy treatment planning systems' IAEA-TECDOC-1540 uses the International Electrotechnical Commission (IEC) standard IEC 62083 as its basis and addresses the procedures for specification and acceptance testing of RTPSs to be

  19. Development and validation of a treatment planning model for magnetic nanoparticle hyperthermia cancer therapy

    Science.gov (United States)

    Stigliano, Robert Vincent

    The use of magnetic nanoparticles (mNPs) to induce local hyperthermia has been emerging in recent years as a promising cancer therapy, in both a stand-alone and combination treatment setting, including surgery radiation and chemotherapy. The mNP solution can be injected either directly into the tumor, or administered intravenously. Studies have shown that some cancer cells associate with, internalize, and aggregate mNPs more preferentially than normal cells, with and without antibody targeting. Once the mNPs are delivered inside the cells, a low frequency (30-300kHz) alternating electromagnetic field is used to activate the mNPs. The nanoparticles absorb the applied field and provide localized heat generation at nano-micron scales. Treatment planning models have been shown to improve treatment efficacy in radiation therapy by limiting normal tissue damage while maximizing dose to the tumor. To date, there does not exist a clinical treatment planning model for magnetic nanoparticle hyperthermia which is robust, validated, and commercially available. The focus of this research is on the development and experimental validation of a treatment planning model, consisting of a coupled electromagnetic and thermal model that predicts dynamic thermal distributions during treatment. When allowed to incubate, the mNPs are often sequestered by cancer cells and packed into endosomes. The proximity of the mNPs has a strong influence on their ability to heat due to interparticle magnetic interaction effects. A model of mNP heating which takes into account the effects of magnetic interaction was developed, and validated against experimental data. An animal study in mice was conducted to determine the effects of mNP solution injection duration and PEGylation on macroscale mNP distribution within the tumor, in order to further inform the treatment planning model and future experimental technique. In clinical applications, a critical limiting factor for the maximum applied field is

  20. Depression and medication adherence among breast cancer survivors: bridging the gap with the theory of planned behaviour.

    Science.gov (United States)

    Manning, Mark; Bettencourt, B Ann

    2011-09-01

    Evidence suggests that more depressed breast cancer patients will less likely adhere to treatment plans. This study presents evidence that the theory of planned behaviour mediates the relation between depression and intentions to adhere to treatment plans and between depression and lack of adherence to medication regime. Two hundred and thirteen women undergoing breast cancer treatment participated in this study. Measures of depressive symptoms and planned behaviour variables were collected at the first time point; measures of medication adherence were collected at the second time point. Structural equation models were utilised to fit the data to the proposed models. Depressive symptoms were significantly correlated to both intentions and medication adherence. In support of hypotheses, the relation between depressive symptoms and treatment intention was mediated by attitudes towards health maintenance plans. The relation between depressive symptoms and medication adherence was fully mediated by the planned behaviour process. Conditions under which treatment intentions and perceptions of control in adhering to treatment were most related to medication adherence were elucidated. The results point to avenues for interventions to increase medication adherence among breast cancer patients. Manipulating attitudes and perceptions of control towards treatment plans will potentially serve to increase medication adherence. PMID:21929477

  1. Locally advanced rectal cancer: a cooperative surgical approach to a complex surgical procedure.

    LENUS (Irish Health Repository)

    Owens, P

    2015-01-01

    Single stage en bloc abdominoperineal resection and sacrectomy, with a myocutaneous flap closure is a relatively uncommon procedure. Our case study of a 77 year old man with a locally invasive rectal adenocarcinoma highlights the complex intraoperative management of such a patient.

  2. Multifactor Screener in the 2000 National Health Interview Survey Cancer Control Supplement: Scoring Procedures

    Science.gov (United States)

    Scoring procedures were developed to convert a respondent's screener responses to estimates of individual dietary intake for percentage energy from fat, grams of fiber, and servings of fruits and vegetables, using USDA's 1994-96 Continuing Survey of Food Intakes of Individuals (CSFII 94-96) dietary recall data.

  3. Increased rate change over time of a sphincter-saving procedure for lower rectal cancer

    Institute of Scientific and Technical Information of China (English)

    WU Xiao-jian; WANG Jian-ping; WANG Lei; HE Xiao-sheng; ZOU Yi-feng; LIAN Lei; ZHANG Long-juan; LAN Ping

    2008-01-01

    Background Total mesorectal excision(TME)has increased the rate of sphincter-preservation(SP)for more patients with low-lying rectal cancer.Here,we analyze the change of sphincter preserving rates in lower rectal cancer and their related factors.Methods We reviewed retrospectively the medical records of 316 patients with lower rectal cancers,1 to 5 cm from the anorectal line,who had surgical resections from August 1994 to November 2005.The 12-year span was divided into 2 periods:period Ⅰ(August 1994-December 1998)and period Ⅱ(January 1999-November 2005),based on the date (January 1999)when standard total mesorectal excision(TME)was introduced.The patients were divided jnto two groups based on the operation:abdominoperineal resection(APR)or SP surgery.SP rates,leakage and other clinicopathological characteristics were compared between the two time periods and between the two different groups.Results The SP rate increased significantly over the 12 years,from 44.9% in period Ⅰ to 76.2% in period Ⅱ(P=0.000).The factors significantly influencing SP included the distance of the tumor from the anorectal line,gender,time period,circumference of intramural spread and histological differentiation (P<0.05).Significant differences were detected between the two time periods in gender,blood transfusion volume and Dukes'stage(P<0.05).The leakage rate was 2.7% in period Ⅰ and 1.3% in period Ⅱ (P>0.05).Conclusions Over the 12-year period of the study the SP rate in rectal cancers 1-5 cm from the anorectal line has increased significantly while the blood transfusion volume has decreased due to the introduction of TME.However,TME had no effect on operating time and leakage rates.

  4. Challenges in integrating 18FDG PET-CT into radiotherapy planning of head and neck cancer.

    Science.gov (United States)

    Dandekar, P; Partridge, M; Kazi, R; Nutting, C; Harrington, K; Newbold, K

    2010-01-01

    Radiotherapy forms one of the major treatment modalities for head and neck cancers (HNC), and precision radiotherapy techniques, such as intensity-modulated radiotherapy require accurate target delineation to ensure success of the treatment. Conventionally used imaging modalities, such as X-ray computed tomography (CT) and magnetic resonance imaging are used to delineate the tumor. Imaging, such as positron emission tomography (PET)-CT, which combines the functional and anatomic modalities, is increasingly being used in the management of HNC. Currently, 18-fluorodeoxyglucose is the most commonly used radioisotope, which is accumulated in areas of high glucose uptake, such as the tumor tissue. Because most disease recurrences are within the high-dose radiotherapy volume, defining a biological target volume for radiotherapy boost is an attractive approach to improve the results. There are many challenges in employing the PET-CT for radiotherapy planning, such as patient positioning, target edge definition, and use of new PET tracers, which represent various functional properties, such as hypoxia, protein synthesis, and proliferation. The role of PET-CT for radiotherapy planning is ever expanding and more clinical data underlining the advantages and challenges in this approach are emerging. In this article, we review the current clinical evidence for the application of functional imaging to radiotherapy planning and discuss some of the current challenges and possible solutions that have been suggested to date.

  5. Magnetic resonance tomography-guided interventional procedure for diagnosis of prostate cancer

    International Nuclear Information System (INIS)

    In recent years magnetic resonance imaging (MRI) has been increasingly established in the diagnosis of prostate cancer in addition to transrectal ultrasonography (TRUS). The use of T2-weighted imaging allows an exact delineation of the zonal anatomy of the prostate and its surrounding structures. Other MR imaging tools, such as dynamic contrast-enhanced T1-weighted imaging or diffusion-weighted imaging allow an inference of the biochemical characteristics (multiparametric MRI). Prostate cancer, which could only be diagnosed using MR imaging or lesions suspected as being prostate cancer, which are localized in the anterior aspect of the prostate and were missed with repetitive TRUS biopsy, need to undergo MR guided biopsy. Recent studies have shown a good correlation between MR imaging and histopathology of specimens collected by MR-guided biopsy. Improved lesion targeting is therefore possible with MR-guided biopsy. So far data suggest that MR-guided biopsy of the prostate is a promising alternative diagnostic tool to TRUS-guided biopsy. (orig.)

  6. Is the planning dosimetry accurate to estimate the Normal Tissue Complication Probability (NTCP) in case of prostate cancer radiotherapy (RT)?

    International Nuclear Information System (INIS)

    The prediction of toxicity is crucial to manage prostate cancer radiotherapy. This prediction is classically based on the dose volume histogram (DVH) calculated at the planning time and using the mathematical Lyman NTCP (Normal Tissue Complication Probability) model. However, anatomical deformations occur during the 8 weeks of radiotherapy and consequently the planned dose does not correspond to the actual delivered dose, leading to uncertainties in NTCP calculation. The objective of this study was to compare the planned DVH-based rectal NTCP with a cumulative DVH-based rectal NTCP, in one case of prostate cancer radiotherapy. The average difference between planning DVH-based NTCP and cumulative-based DVH NTCP was 14% and the standard deviation 10.7%. We showed the impact of organ deformation on NTCP calculation, which leads to significant uncertainties in toxicity prediction. Cumulative DVH, being more representative of the actual received dose, should lead to a more reliable NTCP model

  7. An Assessment to Inform Pediatric Cancer Provider Development and Delivery of Survivor Care Plans.

    Science.gov (United States)

    Warner, Echo L; Wu, Yelena P; Hacking, Claire C; Wright, Jennifer; Spraker-Perlman, Holly L; Gardner, Emmie; Kirchhoff, Anne C

    2015-12-01

    Current guidelines recommend all pediatric cancer survivors receive a survivor care plan (SCP) for optimal health management, yet clinical delivery of SCPs varies. We evaluated oncology providers' familiarity with and preferences for delivering SCPs to inform the implementation of a future SCP program at our institution. From November 2013 to April 2014, oncology providers from the Primary Children's Hospital in Salt Lake City, UT, completed a survey (n=41) and a 45-min focus group (n=18). Participants reported their familiarity with and training in SCP guidelines, opinions on SCPs, and barriers to delivering SCPs. As a secondary analysis, we examined differences in survey responses between physicians and nurses with Fisher's exact tests. Focus group transcripts and open-ended survey responses were content analyzed. Participants reported high familiarity with late effects of cancer treatment (87.8%) and follow-up care that cancer survivors should receive (82.5%). Few providers had delivered an SCP (oncologists 35.3% and nurses 5.0%; p=0.03). Barriers to providing SCPs included lack of knowledge (66.7%), SCP delivery is not expected in their clinic (53.9%), and no champion (48.7%). In qualitative comments, providers expressed that patient age variation complicated SCP delivery. Participants supported testing an SCP intervention program (95.1%) and felt this should be a team-based approach. Strategies for optimal delivery of SCPs are needed. Participants supported testing an SCP program to improve the quality of patient care. Team-based approaches, including nurses and physicians, that incorporate provider training on and support for SCP delivery are needed to improve pediatric cancer care.

  8. An Assessment to Inform Pediatric Cancer Provider Development and Delivery of Survivor Care Plans.

    Science.gov (United States)

    Warner, Echo L; Wu, Yelena P; Hacking, Claire C; Wright, Jennifer; Spraker-Perlman, Holly L; Gardner, Emmie; Kirchhoff, Anne C

    2015-12-01

    Current guidelines recommend all pediatric cancer survivors receive a survivor care plan (SCP) for optimal health management, yet clinical delivery of SCPs varies. We evaluated oncology providers' familiarity with and preferences for delivering SCPs to inform the implementation of a future SCP program at our institution. From November 2013 to April 2014, oncology providers from the Primary Children's Hospital in Salt Lake City, UT, completed a survey (n=41) and a 45-min focus group (n=18). Participants reported their familiarity with and training in SCP guidelines, opinions on SCPs, and barriers to delivering SCPs. As a secondary analysis, we examined differences in survey responses between physicians and nurses with Fisher's exact tests. Focus group transcripts and open-ended survey responses were content analyzed. Participants reported high familiarity with late effects of cancer treatment (87.8%) and follow-up care that cancer survivors should receive (82.5%). Few providers had delivered an SCP (oncologists 35.3% and nurses 5.0%; p=0.03). Barriers to providing SCPs included lack of knowledge (66.7%), SCP delivery is not expected in their clinic (53.9%), and no champion (48.7%). In qualitative comments, providers expressed that patient age variation complicated SCP delivery. Participants supported testing an SCP intervention program (95.1%) and felt this should be a team-based approach. Strategies for optimal delivery of SCPs are needed. Participants supported testing an SCP program to improve the quality of patient care. Team-based approaches, including nurses and physicians, that incorporate provider training on and support for SCP delivery are needed to improve pediatric cancer care. PMID:25893925

  9. Questionnaire for the contents of cancer professional training plan by Ministry of Education, Culture, Sports, Science, and Technology Japan

    International Nuclear Information System (INIS)

    Questionnaire for the contents of cancer professional training plan by Ministry of Education, Culture, Sports, Science, and Technology Japan were widely assessed and introduced in the 4th Japanese Society for Therapeutic Radiology and Oncology (JASTRO) Future Planning Seminar held on March 8, 2008 in Tokyo, Japan. From the assessment, small number of instructors for medical physicists was elucidated as the most important problem for the future of fields of radiation oncology in Japan. (author)

  10. Changes produced in the urothelium by traditional and newer therapeutic procedures for bladder cancer

    OpenAIRE

    Lopez-Beltran, A.; Luque, R J; Mazzucchelli, R; Scarpelli, M; Montironi, R

    2002-01-01

    A handful of traditional and newer therapeutic procedures, such as chemotherapy, immunotherapy, radiotherapy, photodynamic and laser treatment, and gene therapy, are used to treat epithelial malignancies of bladder origin. These treatment modalities, used either intravesically or systemically, produce morphological changes in the urothelial mucosa that can be mistaken for carcinoma. The pathologist must be able to separate toxic and drug related alterations from tumour related changes. The cl...

  11. Estimation of breast dose and cancer risk in chest and abdomen CT procedures

    International Nuclear Information System (INIS)

    The use of CT in medical diagnosis delivers radiation doses to patents that are higher than those from other radiological procedures. Lack of optimized protocols be an additional source of increased dose in developing countries. The aims of this study are first, to measure patient doses during CT chest and abdomen procedures, second, to estimate the radiation dose to the breast, and third to quantify the radiation risks during the procedures. Patient doses from two common CT examinations were obtained from four hospitals in Khartoum.The patient doses were estimated using measurement of CT dose indexes (CTDI), exposure-related parameters, and the IMPACT spreadsheet based on NRPB conversion factors. A large variation of mean organ doses among hospitals was observed for similar CT examinations. These variations largely originated from different CT scanning protocols used in different hospitals and scanner type. The largest range was found for CT of the chest, for which the dose varied from 2.3 to 47 (average 24.7) mSv and for abdomen CT, it was 1.6 to 18.8 (average 10.2) mSv. Radiation dose to the breast ranged from 1.6 to 32.9 mSv for the chest and 1.1 to 13.2 mSv for the abdomen. The radiation risk per procedure was high. The obtained values were mostly higher than the values of organ doses reported from the other studies. It was concluded that current clinical chest and abdomen protocols result in variable radiation doses to the breast. The magnitude of exposure may have implications for imaging strategies.(Author)

  12. Daily CT planning during boost irradiation of prostate cancer. Feasibility and time requirements

    Energy Technology Data Exchange (ETDEWEB)

    Geinitz, H.; Zimmermann, F.B.; Kuzmany, A.; Kneschaurek, P. [Technische Univ. Muenchen (Germany). Inst. und Poliklinik fuer Strahlentherapie und Radiologische Onkologie

    2000-09-01

    Background: In the irradiation of prostate cancer internal organ movement leads to uncertainties in the daily localization of the clinical target volume. Therefore more or less large safety margins are added when designing the treatment portals. With daily CT planning internal organ movement can be compensated to some extent, safety margins can be reduced and irradiated normal tissue can be spared. The feasibility of daily CT-based 3D treatment planning is studied in a patient with localized prostate carcinoma using a new patient positioning system. Methods: Daily CT planning was applied during boost irradiation of a patient with prostate cancer: After patient immobilization the pelvis was scanned in 3 mm CT slices. Planning was done with the BrainSCAN planning system for stereotactic body irradiation. The prostate was contoured in all slices and the safety margins of the micromultileafs were automatically set to the distance chosen by the physician (0.8 cm). Patient positioning was done with the BrainLAB ExacTrac positioning system on the basis of skin attached stereotactic body markers. Before each treatment verification images of the isocenter were taken. Results: The total time requirement for planning and irradiation was about 1 hour 15 minutes. Patient positioning on the treatment couch took about 10 minutes. The accuracy of the positioning system was good (75% of the deviations were smaller than 3 mm). The shift of the single markers from CT scan to CT scan was more extensive than those of the center of all 7 markers combined (47% of the deviations were smaller than 3 mm). The location of the markers seems to influence the magnitude of their dislocation. Conclusion: Daily CT planning is feasible but time consuming. The new patient positioning system ExacTrac is an interesting tool especially for daily CT planning since conventional simulation can be omitted. (orig.) [German] Hintergrund: Bei der Bestrahlung der Prostata kommt es aufgrund der Organbewegung zu

  13. Inverse Planned High-Dose-Rate Brachytherapy for Locoregionally Advanced Cervical Cancer: 4-Year Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Tinkle, Christopher L.; Weinberg, Vivian [Department of Radiation Oncology, University of California, San Francisco, California (United States); Chen, Lee-May [Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California (United States); Littell, Ramey [Gynecologic Oncology, The Permanente Medical Group, San Francisco, California (United States); Cunha, J. Adam M.; Sethi, Rajni A. [Department of Radiation Oncology, University of California, San Francisco, California (United States); Chan, John K. [Gynecologic Oncology, California Pacific Medical Center, San Francisco, California (United States); Hsu, I-Chow, E-mail: ichow.hsu@ucsf.edu [Department of Radiation Oncology, University of California, San Francisco, California (United States)

    2015-08-01

    Purpose: Evaluate the efficacy and toxicity of image guided brachytherapy using inverse planning simulated annealing (IPSA) high-dose-rate brachytherapy (HDRB) boost for locoregionally advanced cervical cancer. Methods and Materials: From December 2003 through September 2009, 111 patients with primary cervical cancer were treated definitively with IPSA-planned HDRB boost (28 Gy in 4 fractions) after external radiation at our institution. We performed a retrospective review of our experience using image guided brachytherapy. Of the patients, 70% had a tumor size >4 cm, 38% had regional nodal disease, and 15% had clinically evident distant metastasis, including nonregional nodal disease, at the time of diagnosis. Surgical staging involving pelvic lymph node dissection was performed in 15% of patients, and 93% received concurrent cisplatin-based chemotherapy. Toxicities are reported according to the Common Terminology Criteria for Adverse Events version 4.0 guidelines. Results: With a median follow-up time of 42 months (range, 3-84 months), no acute or late toxicities of grade 4 or higher were observed, and grade 3 toxicities (both acute and late) developed in 8 patients (1 constitutional, 1 hematologic, 2 genitourinary, 4 gastrointestinal). The 4-year Kaplan-Meier estimate of late grade 3 toxicity was 8%. Local recurrence developed in 5 patients (4 to 9 months after HDRB), regional recurrence in 3 (6, 16, and 72 months after HDRB), and locoregional recurrence in 1 (4 months after HDR boost). The 4-year estimates of local, locoregional, and distant control of disease were 94.0%, 91.9%, and 69.1%, respectively. The overall and disease-free survival rates at 4 years were 64.3% (95% confidence interval [CI] of 54%-73%) and 61.0% (95% CI, 51%-70%), respectively. Conclusions: Definitive radiation by use of inverse planned HDRB boost for locoregionally advanced cervical cancer is well tolerated and achieves excellent local control of disease. However, overall

  14. Forward versus inverse planning in oropharyngeal cancer: A comparative study using physical and biological indices

    Directory of Open Access Journals (Sweden)

    T Sundaram

    2013-01-01

    Full Text Available Context: Possible benefits of inverse planning. Aims: To analyze possible benefits of inverse planning intensity modulated radiation therapy (IMRT over field-in-field 3D conformal radiation therapy (FIF-3DCRT and to evaluate the differences if any, between low (6 Million Volts and high energy (15 Million Volts IMRT plans. Materials and Methods: Ten patients with squamous cell carcinoma of oropharynx, previously treated with 6 MV step and shoot IMRT were studied. V 100 , V 33 , V 66 , mean dose and normal tissue complication probabilities (NTCP were evaluated for parotid glands. Maximum dose and NTCP were the parameters for spinal cord. Statistical Analysis Used: A two-tailed t-test was applied to analyze statistical significance between the different techniques. Results: For combined parotid gland, a reduction of 4.374 Gy, 9.343 Gy and 7.883 Gy were achieved for D 100 , D 66 and D 33 , respectively in 6 MV-IMRT when compared with FIF-3DCRT. Spinal cord sparing was better in 6 MV-IMRT (40.963 ± 2.650, with an average reduction of maximum spinal cord dose by 7.355 Gy from that using the FIF-3DCRT technique. The uncomplicated tumor control probabilities values were higher in IMRT plans thus leading to a possibility of dose escalation. Conclusions: Though low-energy IMRT is the preferred choice for treatment of oropharyngeal cancers, FIF-3DCRT must be given due consideration as a second choice for its well established advantages over traditional conventioan technique.

  15. Node-positive left-sided breast cancer. Does VMAT improve treatment plan quality with respect to IMRT?

    Energy Technology Data Exchange (ETDEWEB)

    Pasler, M.; Bartelt, S.; Lutterbach, J. [Lake Constance Radiation Oncology Center Singen, Friedrichshafen (Germany); Georg, D. [Medical University Vienna/AKH Wien, Vienna (Austria). Dept. of Radiooncology; Medical University Vienna (Austria). Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology

    2013-05-15

    Purpose: The aim of the present work was to explore plan quality and dosimetric accuracy of intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) for lymph node-positive left-sided breast cancer. Methods: VMAT and IMRT plans were generated with the Pinnacle{sup 3} V9.0 treatment planning system for 10 lymph node-positive left-sided breast cancer patients. VMAT plans were created using a single arc and IMRT was performed with 4 beams using 6, 10, and 15 MV photon energy, respectively. Plans were evaluated both manually and automatically using ArtiView trademark. Dosimetric plan verification was performed with a 2D ionization chamber array placed in a full scatter phantom. Results: Photon energy had no significant influence on plan quality for both VMAT and IMRT. Large variability in low doses to the heart was found due to patient anatomy (range V{sub 5} {sub Gy} 26.5-95 %). Slightly more normal tissue dose was found for VMAT (e.g., V{sub Tissue30%} = 22 %) than in IMRT (V{sub Tissue30%} = 18 %). The manual and ArtiView trademark plan evaluation coincided very accurately for most dose metrics (difference < 1 %). In VMAT, 96.7 % of detector points passed the 3 %/3 mm gamma criterion; marginally better accuracy was found in IMRT (98.3 %). Conclusion: VMAT for node-positive left-sided breast cancer retains target homogeneity and coverage when compared to IMRT and allows maximum doses to organs at risk to be reduced. ArtiView trademark enables fast and accurate plan evaluation. (orig.)

  16. Recommendations for dose calculations of lung cancer treatment plans treated with stereotactic ablative body radiotherapy (SABR)

    Science.gov (United States)

    Devpura, S.; Siddiqui, M. S.; Chen, D.; Liu, D.; Li, H.; Kumar, S.; Gordon, J.; Ajlouni, M.; Movsas, B.; Chetty, I. J.

    2014-03-01

    The purpose of this study was to systematically evaluate dose distributions computed with 5 different dose algorithms for patients with lung cancers treated using stereotactic ablative body radiotherapy (SABR). Treatment plans for 133 lung cancer patients, initially computed with a 1D-pencil beam (equivalent-path-length, EPL-1D) algorithm, were recalculated with 4 other algorithms commissioned for treatment planning, including 3-D pencil-beam (EPL-3D), anisotropic analytical algorithm (AAA), collapsed cone convolution superposition (CCC), and Monte Carlo (MC). The plan prescription dose was 48 Gy in 4 fractions normalized to the 95% isodose line. Tumors were classified according to location: peripheral tumors surrounded by lung (lung-island, N=39), peripheral tumors attached to the rib-cage or chest wall (lung-wall, N=44), and centrally-located tumors (lung-central, N=50). Relative to the EPL-1D algorithm, PTV D95 and mean dose values computed with the other 4 algorithms were lowest for "lung-island" tumors with smallest field sizes (3-5 cm). On the other hand, the smallest differences were noted for lung-central tumors treated with largest field widths (7-10 cm). Amongst all locations, dose distribution differences were most strongly correlated with tumor size for lung-island tumors. For most cases, convolution/superposition and MC algorithms were in good agreement. Mean lung dose (MLD) values computed with the EPL-1D algorithm were highly correlated with that of the other algorithms (correlation coefficient =0.99). The MLD values were found to be ~10% lower for small lung-island tumors with the model-based (conv/superposition and MC) vs. the correction-based (pencil-beam) algorithms with the model-based algorithms predicting greater low dose spread within the lungs. This study suggests that pencil beam algorithms should be avoided for lung SABR planning. For the most challenging cases, small tumors surrounded entirely by lung tissue (lung-island type), a Monte

  17. Informal work and formal plans: articulating the active role of patients in cancer trajectories

    DEFF Research Database (Denmark)

    Dalsted, Rikke Juul; Hølge-Hazelton, Bibi; Brostrøm Kousgaard, Marius;

    2012-01-01

    Introduction: Formal pathway models outline that patients should receive information in order to experience a coherent journey but do not describe an active role for patients or their relatives. The aim of this is paper is to articulate and discuss the active role of patients during their cancer...... trajectories. Methods and theory: An in-depth case study of patient trajectories at a Danish hospital and surrounding municipality using individual interviews with patients. Theory about trajectory and work by Strauss was included. Results: Patients continuously took initiatives to organize their treatment....... The patients’ requests were not sufficiently supported in the professional organisation of work or formal planning. Patients’ insertion and use of information in their trajectories challenged professional views and working processes. And the design of the formal pathway models limits the patients´ active...

  18. Informal work and formal plans: Articulating the active role of patients in cancer trajectories

    DEFF Research Database (Denmark)

    Dalsted, R.; Hølge-Hazelton, Bibi; Kousgaard, MB;

    2013-01-01

    Formal pathways models outline that patients should receive information in order to experience a coherent journey but do not describe an active role for patients or their relatives. The aim of this is paper is to articulate and discuss the active role of patients during their cancer trajectories....... METHODS AND THEORY: An in-depth case study of patient trajectories at a Danish hospital and surrounding municipality using individual interviews with patients. Theory about trajectory and work by Strauss was included. RESULTS: Patients continuously took initiatives to organize their treatment and care......' requests were not sufficiently supported in the professional organisation of work or formal planning. Patients' insertion and use of information in their trajectories challenged professional views and working processes. And the design of the formal pathway models limits the patients' active participation...

  19. Understanding Cancer Prognosis

    Medline Plus

    Full Text Available ... Types Recurrent Cancer Common Cancer Types Bladder Cancer Breast Cancer Colorectal Cancer Kidney (Renal Cell) Cancer Leukemia Lung ... Advisory Board Meetings Cancer Currents Blog Research Findings Drug Approvals Precision Medicine Leadership Views 2017 Annual Plan & ...

  20. A treatment planning study of the potential of geometrical tracking for intensity modulated proton therapy of lung cancer

    DEFF Research Database (Denmark)

    Munck af Rosenschöld, Per; Aznar, Marianne; Nygaard, Ditte Eklund;

    2010-01-01

    Proton therapy of lung cancer holds the potential for a reduction of the volume of irradiated normal lung tissue. In this work we investigate the robustness of intensity modulated proton therapy (IMPT) plans to motion, and evaluate a geometrical tumour tracking method to compensate for tumour mot...

  1. MRI-assisted cervix cancer brachytherapy pre-planning, based on application in paracervical anaesthesia: final report

    Directory of Open Access Journals (Sweden)

    Petric Primoz

    2014-09-01

    Full Text Available Background. Optimal applicator insertion is a precondition for the success of cervix cancer brachytherapy (BT. We aimed to assess feasibility and efficacy of MRI-assisted pre-planning, based on applicator insertion in para-cervical anaesthesia (PCA.

  2. A treatment planning study of the potential of geometrical tracking for intensity modulated proton therapy of lung cancer

    DEFF Research Database (Denmark)

    af Rosenschöld, Per Munck; Aznar, Marianne C; Nygaard, Ditte E;

    2010-01-01

    Proton therapy of lung cancer holds the potential for a reduction of the volume of irradiated normal lung tissue. In this work we investigate the robustness of intensity modulated proton therapy (IMPT) plans to motion, and evaluate a geometrical tumour tracking method to compensate for tumour...

  3. Robot-assisted surgery for kidney cancer increased access to a procedure that can reduce mortality and renal failure.

    Science.gov (United States)

    Chandra, Amitabh; Snider, Julia Thornton; Wu, Yanyu; Jena, Anupam; Goldman, Dana P

    2015-02-01

    Surgeons increasingly use robot-assisted minimally invasive surgery for a variety of medical conditions. For hospitals, the acquisition and maintenance of a robot requires a significant investment, but financial returns are not linked to any improvement in long-term patient outcomes in the current reimbursement environment. Kidney cancer provides a useful case study for evaluating the long-term value that this innovation can provide. Kidney cancer is generally treated through partial or radical nephrectomy, with evidence favoring the former procedure for appropriate patients. We found that robot-assisted surgery increased access to partial nephrectomy and that partial nephrectomy reduced mortality and renal failure. The value of the benefits of robot-assisted minimally invasive surgery to patients, in terms of quality-adjusted life-years gained, outweighed the health care and surgical costs to patients and payers by a ratio of five to one. In addition, we found no evidence that the availability of robot-assisted minimally invasive surgery increased the likelihood that inappropriate patients received partial nephrectomy. PMID:25646101

  4. Personalized treatment planning with a model of radiation therapy outcomes for use in multiobjective optimization of IMRT plans for prostate cancer

    International Nuclear Information System (INIS)

    To build a new treatment planning approach that extends beyond radiation transport and IMRT optimization by modeling the radiation therapy process and prognostic indicators for more outcome-focused decision making. An in-house treatment planning system was modified to include multiobjective inverse planning, a probabilistic outcome model, and a multi-attribute decision aid. A genetic algorithm generated a set of plans embodying trade-offs between the separate objectives. An influence diagram network modeled the radiation therapy process of prostate cancer using expert opinion, results of clinical trials, and published research. A Markov model calculated a quality adjusted life expectancy (QALE), which was the endpoint for ranking plans. The Multiobjective Evolutionary Algorithm (MOEA) was designed to produce an approximation of the Pareto Front representing optimal tradeoffs for IMRT plans. Prognostic information from the dosimetrics of the plans, and from patient-specific clinical variables were combined by the influence diagram. QALEs were calculated for each plan for each set of patient characteristics. Sensitivity analyses were conducted to explore changes in outcomes for variations in patient characteristics and dosimetric variables. The model calculated life expectancies that were in agreement with an independent clinical study. The radiation therapy model proposed has integrated a number of different physical, biological and clinical models into a more comprehensive model. It illustrates a number of the critical aspects of treatment planning that can be improved and represents a more detailed description of the therapy process. A Markov model was implemented to provide a stronger connection between dosimetric variables and clinical outcomes and could provide a practical, quantitative method for making difficult clinical decisions

  5. Evaluation of plan quality assurance models for prostate cancer patients based on fully automatically generated Pareto-optimal treatment plans

    Science.gov (United States)

    Wang, Yibing; Breedveld, Sebastiaan; Heijmen, Ben; Petit, Steven F.

    2016-06-01

    IMRT planning with commercial Treatment Planning Systems (TPSs) is a trial-and-error process. Consequently, the quality of treatment plans may not be consistent among patients, planners and institutions. Recently, different plan quality assurance (QA) models have been proposed, that could flag and guide improvement of suboptimal treatment plans. However, the performance of these models was validated using plans that were created using the conventional trail-and-error treatment planning process. Consequently, it is challenging to assess and compare quantitatively the accuracy of different treatment planning QA models. Therefore, we created a golden standard dataset of consistently planned Pareto-optimal IMRT plans for 115 prostate patients. Next, the dataset was used to assess the performance of a treatment planning QA model that uses the overlap volume histogram (OVH). 115 prostate IMRT plans were fully automatically planned using our in-house developed TPS Erasmus-iCycle. An existing OVH model was trained on the plans of 58 of the patients. Next it was applied to predict DVHs of the rectum, bladder and anus of the remaining 57 patients. The predictions were compared with the achieved values of the golden standard plans for the rectum D mean, V 65, and V 75, and D mean of the anus and the bladder. For the rectum, the prediction errors (predicted-achieved) were only  -0.2  ±  0.9 Gy (mean  ±  1 SD) for D mean,-1.0  ±  1.6% for V 65, and  -0.4  ±  1.1% for V 75. For D mean of the anus and the bladder, the prediction error was 0.1  ±  1.6 Gy and 4.8  ±  4.1 Gy, respectively. Increasing the training cohort to 114 patients only led to minor improvements. A dataset of consistently planned Pareto-optimal prostate IMRT plans was generated. This dataset can be used to train new, and validate and compare existing treatment planning QA models, and has been made publicly available. The OVH model was highly accurate

  6. Evaluation of plan quality assurance models for prostate cancer patients based on fully automatically generated Pareto-optimal treatment plans

    Science.gov (United States)

    Wang, Yibing; Breedveld, Sebastiaan; Heijmen, Ben; Petit, Steven F.

    2016-06-01

    IMRT planning with commercial Treatment Planning Systems (TPSs) is a trial-and-error process. Consequently, the quality of treatment plans may not be consistent among patients, planners and institutions. Recently, different plan quality assurance (QA) models have been proposed, that could flag and guide improvement of suboptimal treatment plans. However, the performance of these models was validated using plans that were created using the conventional trail-and-error treatment planning process. Consequently, it is challenging to assess and compare quantitatively the accuracy of different treatment planning QA models. Therefore, we created a golden standard dataset of consistently planned Pareto-optimal IMRT plans for 115 prostate patients. Next, the dataset was used to assess the performance of a treatment planning QA model that uses the overlap volume histogram (OVH). 115 prostate IMRT plans were fully automatically planned using our in-house developed TPS Erasmus-iCycle. An existing OVH model was trained on the plans of 58 of the patients. Next it was applied to predict DVHs of the rectum, bladder and anus of the remaining 57 patients. The predictions were compared with the achieved values of the golden standard plans for the rectum D mean, V 65, and V 75, and D mean of the anus and the bladder. For the rectum, the prediction errors (predicted–achieved) were only  ‑0.2  ±  0.9 Gy (mean  ±  1 SD) for D mean,‑1.0  ±  1.6% for V 65, and  ‑0.4  ±  1.1% for V 75. For D mean of the anus and the bladder, the prediction error was 0.1  ±  1.6 Gy and 4.8  ±  4.1 Gy, respectively. Increasing the training cohort to 114 patients only led to minor improvements. A dataset of consistently planned Pareto-optimal prostate IMRT plans was generated. This dataset can be used to train new, and validate and compare existing treatment planning QA models, and has been made publicly available. The OVH model was highly

  7. Quality of life in Chinese women treated surgically for breast cancer with one of three different procedures

    Institute of Scientific and Technical Information of China (English)

    任敏

    2015-01-01

    Objective To determine the quality of life of patients treated with one of three different types of surgery for breast cancer.Methods This was a cross-sectional study using a questionnaire survey completed by Chinese patients without active disease after at least 2 years of follow-up after breast cancer surgery.Results This study totally included 139 breast cancer patients:44 ( 31.6%) had undergone modified radical mastectomy with reconstruction, 41(29.5%)had a quadrantectomy with axillary lymph node dissection, and 54(38.9%)had a modified radical mastectomy without reconstruction.The EORTC QLQ-C30 and EORTC QLQ-BR23 question-naires were used;their reliability was>0.82.Global health status(94.30 ±12.04, P=0.028)and role functio-ning(85.16 ±17.23, P=0.138)were highest in the quadrantectomy group.Pain score was highest in the modi-fied radical mastectomy with reconstruction group(26.13 ±30.15, P =0.042).The breast symptom score (22.56 ±22.30, P=0.009)and body image perception(85.56 ±19.72, P=0.025)were highest in the conser-vative treatment group.The overall health of patients given modified radical mastectomy without reconstruction was lower(72.61 ±20.89, P=0.014) in women older than 50 years compared with younger women.Conclu-sions The quadrantectomy with axillary lymph node dissection procedure had better acceptance, but the overall health status did not differ between groups.Overall health status is lower in women older than 50 years receiving a modified radical mastectomy without reconstruction.

  8. Survival outcomes in patients with cervical cancer after inclusion of PET/CT in staging procedures

    International Nuclear Information System (INIS)

    In cancer of the uterine cervix, lymph node metastases are associated with a poor prognosis. Even so, the International Federation of Gynecology and Obstetrics (FIGO) does not take into account diagnostic results of methods such as PET/CT, since these are not readily available everywhere. As undetected lymph node metastases can lead to undertreatment, any difference in the underlying prevalence of false-negative scans between CT and PET/CT may be reflected in treatment outcomes. This study investigated survival outcomes in node-negative patients before and after the introduction of PET/CT. This was a single-institution retrospective analysis of 301 patients with a histopathological diagnosis of cervical cancer. The patients were receiving chemoradiotherapy with curative intent according to the standard protocol of the department for patients without lymph node metastases as assessed by pretreatment CT or PET/CT. Patients were stratified into two groups: PET/CT and non-PET/CT. Patient characteristics and treatment outcomes were acquired from the treatment database. Significant differences of 23 % (95 % CI 17 - 29 %), 19 % (95 % CI 13 - 25 %) and 12 % (95 % CI 6 - 18 %) in 5-year overall, disease-free and disease-specific survival, respectively, were observed between the two patient groups. The difference remained significant in univariate and multivariate analyses of overall survival (hazard ratio 0.61, 95 % CI 0.42 - 0.89; p = 0.010), including age, FIGO stage, performance status, BMI, and histopathology. Inclusion of PET/CT in the preradiotherapy diagnostic protocol may lead to nodal stage migration not reflected in the FIGO stage. It was found to be a significant covariate, and could lead to selection bias that needs to be taken into account when designing and reporting on clinical trials. (orig.)

  9. Survival outcomes in patients with cervical cancer after inclusion of PET/CT in staging procedures

    Energy Technology Data Exchange (ETDEWEB)

    Hansen, Henrik Villibald [University of Copenhagen, Department of Radiation Oncology, Rigshospitalet, Copenhagen (Denmark); Section for Radiotherapy, Rigshospitalet, Department of Oncology, Copenhagen (Denmark); Loft, Annika [University of Copenhagen, Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen (Denmark); Berthelsen, Anne Kiil [University of Copenhagen, Department of Radiation Oncology, Rigshospitalet, Copenhagen (Denmark); University of Copenhagen, Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen (Denmark); Christensen, Ib Jarle [University of Copenhagen, The Finsen Laboratory, Rigshospitalet, Copenhagen (Denmark); University of Copenhagen, Biotech Research and Innovation Centre (BRIC), Copenhagen (Denmark); Hoegdall, Claus [University of Copenhagen, Department of Gynecology, Rigshospitalet, Copenhagen (Denmark); Engelholm, Svend Aage [University of Copenhagen, Department of Radiation Oncology, Rigshospitalet, Copenhagen (Denmark)

    2015-11-15

    In cancer of the uterine cervix, lymph node metastases are associated with a poor prognosis. Even so, the International Federation of Gynecology and Obstetrics (FIGO) does not take into account diagnostic results of methods such as PET/CT, since these are not readily available everywhere. As undetected lymph node metastases can lead to undertreatment, any difference in the underlying prevalence of false-negative scans between CT and PET/CT may be reflected in treatment outcomes. This study investigated survival outcomes in node-negative patients before and after the introduction of PET/CT. This was a single-institution retrospective analysis of 301 patients with a histopathological diagnosis of cervical cancer. The patients were receiving chemoradiotherapy with curative intent according to the standard protocol of the department for patients without lymph node metastases as assessed by pretreatment CT or PET/CT. Patients were stratified into two groups: PET/CT and non-PET/CT. Patient characteristics and treatment outcomes were acquired from the treatment database. Significant differences of 23 % (95 % CI 17 - 29 %), 19 % (95 % CI 13 - 25 %) and 12 % (95 % CI 6 - 18 %) in 5-year overall, disease-free and disease-specific survival, respectively, were observed between the two patient groups. The difference remained significant in univariate and multivariate analyses of overall survival (hazard ratio 0.61, 95 % CI 0.42 - 0.89; p = 0.010), including age, FIGO stage, performance status, BMI, and histopathology. Inclusion of PET/CT in the preradiotherapy diagnostic protocol may lead to nodal stage migration not reflected in the FIGO stage. It was found to be a significant covariate, and could lead to selection bias that needs to be taken into account when designing and reporting on clinical trials. (orig.)

  10. Whole-pelvic radiotherapy with spot-scanning proton beams for uterine cervical cancer: a planning study

    Science.gov (United States)

    Hashimoto, Shingo; Shibamoto, Yuta; Iwata, Hiromitsu; Ogino, Hiroyuki; Shibata, Hiroki; Toshito, Toshiyuki; Sugie, Chikao; Mizoe, Jun-etsu

    2016-01-01

    The aim of this study was to compare the dosimetric parameters of whole-pelvic radiotherapy (WPRT) for cervical cancer among plans involving 3D conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT), or spot-scanning proton therapy (SSPT). The dose distributions of 3D-CRT-, IMRT-, and SSPT-based WPRT plans were compared in 10 patients with cervical cancer. All of the patients were treated with a prescribed dose of 50.4 Gy in 1.8-Gy daily fractions, and all of the plans involved the same planning target volume (PTV) constrictions. A 3D-CRT plan involving a four-field box, an IMRT plan involving seven coplanar fields, and an SSPT plan involving four fields were created. The median PTV D95% did not differ between the 3D-CRT, IMRT and SSPT plans. The median conformity index 95% and homogeneity index of the IMRT and SSPT were better than those of the 3D-CRT. The homogeneity index of the SSPT was better than that of the IMRT. SSPT resulted in lower median V20 values for the bladder wall, small intestine, colon, bilateral femoral heads, skin, and pelvic bone than IMRT. Comparing the Dmean values, SSPT spared the small intestine, colon, bilateral femoral heads, skin and pelvic bone to a greater extent than the other modalities. SSPT can reduce the irradiated volume of the organs at risk compared with 3D-CRT and IMRT, while maintaining excellent PTV coverage. Further investigations of SSPT are warranted to assess its role in the treatment of cervical cancer. PMID:27380800

  11. Quantitative MR imaging in planning and assessing novel cancer treatments Radiotherapy

    CERN Document Server

    Baustert, I C

    2001-01-01

    Novel treatments in cancer, like conformal radiotherapy and anticancer drugs, require new MRI techniques to assess their benefits and potential. In conformal radiotherapy, MRI can be used to measure the shape and dose of the conformed radiation field in dose sensitive gel test-objects thus validating the predicted dose computed by complex programs. In antiangiogenic drug treatment, the vascular dysfunction of the tumour can be assessed by MRI prior to treatment. Response to treatment may also be monitored by measuring the changes in vascular function. In this thesis, MRI of polyacrylamide gels is investigated as a 3D dosimeter for conformal radiotherapy treatment planning. Quantitative MRI sequences capable of measuring the wide range of T2 values typically expected in gel dosimetry, are identified. Different T2 measurement methods are compared in terms of accuracy, signal to noise ratio and acquisition time. Examples of a complex dose distribution in 2D and 3D are presented and compared to the planned dose p...

  12. The Addition of SPECT/CT Lymphoscintigraphy to Breast Cancer Radiation Planning Spares Lymph Nodes Critical for Arm Drainage

    Energy Technology Data Exchange (ETDEWEB)

    Cheville, Andrea L., E-mail: Cheville.andrea@mayo.edu [Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota (United States); Brinkmann, Debra H.; Ward, Shelly B. [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Durski, Jolanta [Department of Radiology, Nuclear Medicine Program, Mayo Clinic, Rochester, Minnesota (United States); Laack, Nadia N.; Yan, Elizabeth; Schomberg, Paula J.; Garces, Yolanda I. [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Suman, Vera J. [Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota (United States); Petersen, Ivy A. [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States)

    2013-03-15

    Background: This prospective cohort study was designed to determine whether the amount of radiation delivered to the nonpathological lymph nodes (LNs) that drain the arm can be significantly reduced by integrating single-photon emission computed tomography (SPECT)/computed tomography (CT) scans into radiation treatment planning. Methods: SPECT-CT scans were acquired for the 28 patients with stage I or II breast cancer and fused with the routinely obtained radiation oncology planning CT scans. Arm-draining LNs were contoured with 0.5-cm margins automatically using a threshold of 50% maximum intensity. Two treatment plans were generated: 1 per routine clinical practice (standard; STD) and the second (modified; MOD) with treatment fields modified to minimize dose to the arm-draining LNs visible on SPECT/CT images without interfering with the dosage delivered to target tissues. Participants were treated per the MOD plans. Arm volumes were measured prior to radiation and thereafter at least three subsequent 6-month intervals. Results: Sixty-eight level I-III arm-draining LNs were identified, 57% of which were inside the STD plan fields but could be blocked in the MOD plan fields. Sixty-five percent of arm-draining LNs in the STD versus 16% in the MOD plans received a mean of ≥10 Gy, and 26% in the STD versus 4% in the MOD plans received a mean of ≥40 Gy. Mean LN radiation exposure was 23.6 Gy (standard deviation 18.2) with the STD and 7.7 Gy (standard deviation 11.3) with the MOD plans (P<.001). No participant developed lymphedema. Conclusions: The integration of SPECT/CT scans into breast cancer radiation treatment planning reduces unnecessary arm-draining LN radiation exposure and may lessen the risk of lymphedema.

  13. The Addition of SPECT/CT Lymphoscintigraphy to Breast Cancer Radiation Planning Spares Lymph Nodes Critical for Arm Drainage

    International Nuclear Information System (INIS)

    Background: This prospective cohort study was designed to determine whether the amount of radiation delivered to the nonpathological lymph nodes (LNs) that drain the arm can be significantly reduced by integrating single-photon emission computed tomography (SPECT)/computed tomography (CT) scans into radiation treatment planning. Methods: SPECT-CT scans were acquired for the 28 patients with stage I or II breast cancer and fused with the routinely obtained radiation oncology planning CT scans. Arm-draining LNs were contoured with 0.5-cm margins automatically using a threshold of 50% maximum intensity. Two treatment plans were generated: 1 per routine clinical practice (standard; STD) and the second (modified; MOD) with treatment fields modified to minimize dose to the arm-draining LNs visible on SPECT/CT images without interfering with the dosage delivered to target tissues. Participants were treated per the MOD plans. Arm volumes were measured prior to radiation and thereafter at least three subsequent 6-month intervals. Results: Sixty-eight level I-III arm-draining LNs were identified, 57% of which were inside the STD plan fields but could be blocked in the MOD plan fields. Sixty-five percent of arm-draining LNs in the STD versus 16% in the MOD plans received a mean of ≥10 Gy, and 26% in the STD versus 4% in the MOD plans received a mean of ≥40 Gy. Mean LN radiation exposure was 23.6 Gy (standard deviation 18.2) with the STD and 7.7 Gy (standard deviation 11.3) with the MOD plans (P<.001). No participant developed lymphedema. Conclusions: The integration of SPECT/CT scans into breast cancer radiation treatment planning reduces unnecessary arm-draining LN radiation exposure and may lessen the risk of lymphedema

  14. Dosimetric effects of endorectal balloons on intensity-modulated radiation therapy plans for prostate cancer

    Science.gov (United States)

    Kim, Jae-Sung; Chung, Jin-Beom; Kim, In-Ah; Eom, Keun-Yong

    2013-10-01

    We used an endorectal balloon (ERB) for prostate immobilization during intensity-modulated radiotherapy (IMRT) for prostate cancer treatment. To investigate the dosimetric effects of ERB-filling materials, we changed the ERB Hounsfield unit (HU) from 0 to 1000 HU in 200-HU intervals to simulate the various ERB fillings; 0 HU simulated a water-filled ERB, and 1000 HU simulated the densest material-filled ERB. Dosimetric data (coverage, homogeneity, conformity, maximal dose, and typical volume dose) for the tumor and the organs at risk (OARs) were evaluated in prostate IMRT treatment plans with 6-MV and 15-MV beams. The tumor coverage appeared to differ by approximately 1%, except for the clinical target volume (CTV) V100% and the planning target volume (PTV) V100%. The largest difference for the various ERB fillings was observed in the PTV V100%. In spite of increasing HU, the prostate IMRT plans at both energies had relatively low dosimetric effects on the PTV and the CTV. However, the maximal and the typical volume doses (D25%, D30%, and D50%) to the rectal wall and the bladder increased with increasing HU. For an air-filled ERB, the maximal doses to the rectal wall and the monitor units were lower than the corresponding values for the water-filled and the densest material-filled ERBs. An air-filled ERB spared the rectal wall because of its dosimetric effect. Thus, we conclude that the use of an air-filled ERB provides a dosimetric benefit to the rectal wall without a loss of target coverage and is an effective option for prostate IMRT treatment.

  15. PET/CT fusion in radiotherapy planning for lung cancer - case reports

    Directory of Open Access Journals (Sweden)

    Erak Marko Đ.

    2016-01-01

    Full Text Available Introduction. Application of imaging methods, namely computed tomography (CT, magnetic resonance imaging (MRI and in recent years positron emission tomography-computed tomography (PET/CT, and the progress of computer technology have allowed the construction of effective computerized systems for treatment planning (TPS and introducing the concept of virtual simulation in 3D conformal radiotherapy planning. Case report. We hereby presented two patients with the diagnosis of non-small cell lung cancer who did PET/CT examination. Both patients had surgery earlier and local recidives are diagnosed with PET/CT. PET/CT of the first patient described the focus of intense fluorodeoxyglucose (FDG accumulation 2.99 × 2.9 × 2.1cm in diameter in the projection of soft-tissue volume in the left corner, at operating clips height, corresponding to metabolically active recurrence of the tumor. Mediastinum and right lung parenchyma were without focal accumulation of FDG. Control PET/CT after 3 months was without detectable focus of intense pathological FDG accumulation - good therapeutic response, (metabolic disease remission. On the other hand, in the second case PET/CT showed a focus of intense FDG accumulation screening in the scar tissue of the apical part of the right lung, 20 × 16 mm, corresponding to metabolically active tumor recurrence. In the lung parenchyma on the left and in the mediastinum no visible focus of intense FDG accumulation was descrbed. Radiography included using 3D conformal radiotherapy with fusion PET/CT scan and CT simulations. Conclusion. PET/CT provides important information for planning conformal radiotherapy, especially in dose escalation, sparing of organ at risk and better locoregional control of the disease.

  16. Protection of lung function by introducing single photon emission computed tomography lung perfusion image into radiotherapy plan of lung cancer

    Institute of Scientific and Technical Information of China (English)

    YIN Yong; CHEN Jin-hu; LI Bao-sheng; LIU Tong-hai; LU jie; BAI Tong; DONG Xiao-ling; YU Jin-ming

    2009-01-01

    Background The lung functional status could be displayed on lung perfusion images. With the images, the radiotherapy plans of lung cancer could be guided to more optimized. This study aimed to assess quantitatively the impact of incorporating functional lung imaging into 3-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiation therapy (IMRT) planning for non-small cell lung cancer (NSCLC).Methods Ten patients with NSCLC who had undergone radiotherapy were included in this study. Before radiotherapy,each patient underwent CT simulation and lung perfusion imaging with single photon emission computed tomography (SPECT). The SPECT images were registered with simulation planning CT and used to contour functional lung (lung-F) and non-functional lung (lung-NF). Two 3DCRT plans and two IMRT plans were designed and compared in each patient:two anatomic plans using simulation CT alone and two functional plans using SPECT-CT in addition to the simulation CT.Dosimetric parameters of the four types of plans were compared in terms of tumor coverage and avoidance of normal tissues. Total radiation dose was set at 66 Gy (2 Gy×33 fractions).Results In incorporating perfusion information in 3DCRT and IMRT planning, the reductions on average in the mean doses to the functional lung in the functional plan were 168 cGy and 89 cGy, respectively, compared with those in the anatomic plans. The median reductions in the percentage of volume irradiated with >5 Gy, >10 Gy, >20 Gy, >30 Gy and >40 Gy for functional lung in the functional plans were 6.50%, 10.21%, 14.02%, 22.30% and 23.46% in 3DCRT planning,respectively, and 3.05%, 15.52%, 14.16%, 4.87%, and 3.33% in IMRT planning, respectively. No greater degree of sparing of the functional lung was achieved in functional IMRT than in 3DCRT.Conclusion Function-guided 3DCRT and IMRT plannings both appear to be effective in preserving functional lung in NSCLC patients.

  17. Australasian Gastrointestinal Trials Group (AGITG) Contouring Atlas and Planning Guidelines for Intensity-Modulated Radiotherapy in Anal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Ng, Michael, E-mail: mng@radoncvic.com.au [Radiation Oncology Victoria, Victoria (Australia); Leong, Trevor [Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria (Australia); University of Melbourne (Australia); Chander, Sarat; Chu, Julie [Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria (Australia); Kneebone, Andrew [Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, NSW (Australia); University of Sydney (Australia); Carroll, Susan [Department of Radiation Oncology, Sydney Cancer Centre, Royal Prince Alfred Hospital, NSW (Australia); University of Sydney (Australia); Wiltshire, Kirsty [Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria (Australia); Ngan, Samuel [Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria (Australia); University of Melbourne (Australia); Kachnic, Lisa [Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, MA (United States)

    2012-08-01

    Purpose: To develop a high-resolution target volume atlas with intensity-modulated radiotherapy (IMRT) planning guidelines for the conformal treatment of anal cancer. Methods and Materials: A draft contouring atlas and planning guidelines for anal cancer IMRT were prepared at the Australasian Gastrointestinal Trials Group (AGITG) annual meeting in September 2010. An expert panel of radiation oncologists contoured an anal cancer case to generate discussion on recommendations regarding target definition for gross disease, elective nodal volumes, and organs at risk (OARs). Clinical target volume (CTV) and planning target volume (PTV) margins, dose fractionation, and other IMRT-specific issues were also addressed. A steering committee produced the final consensus guidelines. Results: Detailed contouring and planning guidelines and a high-resolution atlas are provided. Gross tumor and elective target volumes are described and pictorially depicted. All elective regions should be routinely contoured for all disease stages, with the possible exception of the inguinal and high pelvic nodes for select, early-stage T1N0. A 20-mm CTV margin for the primary, 10- to 20-mm CTV margin for involved nodes and a 7-mm CTV margin for the elective pelvic nodal groups are recommended, while respecting anatomical boundaries. A 5- to 10-mm PTV margin is suggested. When using a simultaneous integrated boost technique, a dose of 54 Gy in 30 fractions to gross disease and 45 Gy to elective nodes with chemotherapy is appropriate. Guidelines are provided for OAR delineation. Conclusion: These consensus planning guidelines and high-resolution atlas complement the existing Radiation Therapy Oncology Group (RTOG) elective nodal ano-rectal atlas and provide additional anatomic, clinical, and technical instructions to guide radiation oncologists in the planning and delivery of IMRT for anal cancer.

  18. The use of virtual reality and intelligent database systems for procedure planning, visualisation, and real-time component tracking in remote handling operations

    International Nuclear Information System (INIS)

    The organisation of remote handling (RH) operations in fusion environments is increasingly critical as the number of tasks, components and tooling that RH operations teams must deal with inexorably rises. During the recent JET EP1 RH shutdown the existing virtual reality (VR) and procedural database systems proved essential for visualisation and tracking of operations, particularly due to the increasing complexity of remote tasks. A new task planning system for RH operations is in development, and is expected to be ready for use during the next major shutdown, planned for 2009. The system will make use of information available from the remote operations procedures, the RH equipment human-machine interfaces, the on-line RH equipment control systems and also the virtual reality (VR) system to establish a complete database for the location of plant items and RH equipment as RH operations progress. It is intended that the system be used during both preparation and implementation of shutdowns. In the preparations phase the system can be used to validate procedures and overall logistics by allowing an operator to increment through each operation step and to use the VR system to visualise the location and status of all components, manipulators and RH tools. During task development the RH operations engineers can plan and visualise movement of components and tooling to examine handling concepts and establish storage requirements. In the implementation of operations the daily work schedules information will be integrated with the RH operations procedures tracking records to enable the VR system to provide a visual representation of the status of remote operations in real time. Monitoring of the usage history of items will allow estimates of radiation dosage and contaminant exposure to be made. This paper describes the overall aims, structure and use of the system, discusses its application to JET and also considers potential future developments.

  19. A randomised controlled trial of forward-planned radiotherapy (IMRT) for early breast cancer: Baseline characteristics and dosimetry results

    International Nuclear Information System (INIS)

    Background and purpose: This large trial was designed to investigate whether correction of dose inhomogeneities using intensity-modulated radiotherapy (IMRT) reduces late toxicity and improves quality of life in patients with early breast cancer. This paper reports baseline characteristics of trial participants and dosimetry results. Materials and methods: Standard tangential plans of 1145 trials were analysed. Patients with inhomogeneous plans, defined by ICRU recommendations, were randomised to forward-planned IMRT or standard radiotherapy. Results: Twenty-nine percentage of patients had adequate dosimetry with standard 2D radiotherapy. In the randomised patients, the decreases in mean volumes receiving greater than 107% (Vol > 107) and less than 95% (Vol 3 (95% CI 26.4-41.6; P 3 (95% CI 34.4-61.9; P 107 > 2 cm3 on standard radiotherapy plans. Conclusion: This large trial, in which patients with all breast sizes were eligible, confirmed that breast dosimetry can be significantly improved with a simple method of forward-planned IMRT and has little impact on radiotherapy resources. It is shown that patients with larger breasts are more likely to have dose inhomogeneities and breast separation gives some indication of this likelihood. Photographic assessment of patients at 2 years after radiotherapy, as the next part of this randomised controlled trial, will show whether these results for IMRT translate into improved cosmetic outcome in patients with early breast cancer. This would provide impetus for the widespread adoption of 3D planning and IMRT.

  20. Dosimetric evaluation of a simple planning method for improving intensity-modulated radiotherapy for stage III lung cancer.

    Science.gov (United States)

    Lu, Jia-Yang; Lin, Zhu; Zheng, Jing; Lin, Pei-Xian; Cheung, Michael Lok-Man; Huang, Bao-Tian

    2016-01-01

    This study aimed to evaluate the dosimetric outcomes of a base-dose-plan-compensation (BDPC) planning method for improving intensity-modulated radiotherapy (IMRT) for stage III lung cancer. For each of the thirteen included patients, three types of planning methods were applied to obtain clinically acceptable plans: (1) the conventional optimization method (CO); (2) a split-target optimization method (STO), in which the optimization objectives were set higher dose for the target with lung density; (3) the BDPC method, which compensated for the optimization-convergence error by further optimization based on the CO plan. The CO, STO and BDPC methods were then compared regarding conformity index (CI), homogeneity index (HI) of the target, organs at risk (OARs) sparing and monitor units (MUs). The BDPC method provided better HI/CI by 54%/7% on average compared to the CO method and by 38%/3% compared to the STO method. The BDPC method also spared most of the OARs by up to 9%. The average MUs of the CO, STO and BDPC plans were 890, 937 and 1023, respectively. Our results indicated that the BDPC method can effectively improve the dose distribution in IMRT for stage III lung cancer, at the expense of more MUs. PMID:27009235

  1. Predictors of physical activity among rural and small town breast cancer survivors: an application of the theory of planned behaviour.

    Science.gov (United States)

    Vallance, Jeff K; Lavallee, Celeste; Culos-Reed, Nicole S; Trudeau, Marc G

    2012-01-01

    The primary objective of this study was to investigate the utility of the two-component theory of planned behaviour (TPB) in understanding physical activity intentions and behaviour in rural and small town breast cancer survivors. The secondary objective was to elicit the most common behavioural, normative and control beliefs of rural and small town survivors regarding physical activity. Using a cross-sectional survey design, 524 rural and small town breast cancer survivors completed a mailed survey that assessed physical activity and TPB variables. Physical activity intention explained 12% of the variance in physical activity behaviour (p activity intention (p activity determinants among rural and small town breast cancer survivors. These data can be used in the development and establishment of physical activity behaviour interventions and health promotion materials designed to facilitate physical activity behaviour among rural and small town breast cancer survivors.

  2. Comparison of CT based-CTV plan and CT based-ICRU38 plan in brachytherapy planning of uterine cervix cancer

    Energy Technology Data Exchange (ETDEWEB)

    Shim, Jin Sup; Jo, Jung Kun; Si, Chang Keun; Lee, Ki Ho; Lee, Du Hyun; Choi, Kye Suk [Proton Therapy Center, National Cancer Center, Seoul (Korea, Republic of)

    2004-09-15

    Although Improve of CT, MRI Radio-diagnosis and Radiation Therapy Planing, but we still use ICRU38 Planning system(2D film-based) broadly. 3-Dimensional ICR plan(CT image based) is not only offer tumor and normal tissue dose but also support DVH information. On this study, we plan irradiation-goal dose on CTV(CTV plan) and irradiation-goal dose on ICRU 38 point(ICRU38 plan) by use CT image. And compare with tumor-dose, rectal-dose, bladder-dose on both planning, and analysis DVH Sample 11 patients who treated by Ir-192 HDR. After 40 Gy external radiation therapy, ICR plan established. All the patients carry out CT-image scanned by CT-simulator. And we use PLATO(Nucletron) v.14.2 planing system. We draw CTV, rectum, bladder on the CT image. And establish plan irradiation- dose on CTV(CTV plan) and irradiation- dose on A-point(ICRU38 plan) CTV volume(average{+-}SD) is 21.8{+-}26.6 cm{sup 3}, rectum volume(average{+-}SD) is 60.9{+-}25.0 cm{sup 3}, bladder volume(average{+-}SD) is 116.1{+-}40.1cm{sup 3} sampled 11 patients. The volume including 100% dose is 126.7{+-}18.9 cm{sup 3} on ICRU plan and 98.2{+-}74.5 cm{sup 3} on CTV plan. On ICRU planning, the other one's 22.0 cm{sup 3} CTV volume who residual tumor size excess 4cm is not including 100% isodose. 8 patient's 12.9{+-}5.9 cm{sup 3} tumor volume who residual tumor size below 4 cm irradiated 100% dose. Bladder dose(recommended by ICRU 38) is 90.1{+-}21.3 % on ICRU plan, 68.7{+-}26.6% on CTV plan, and rectal dose is 86.4{+-}18.3%, 76.9{+-}15.6%. Bladder and Rectum maximum dose is 137.2{+-}5.9%, 101.1{+-}41.8% on ICRU plan, 107.6{+-}47.9%, 86.9{+-}30.8% on CTV plan. Therefore CTV plan more less normal issue-irradiated dose than ICRU plan. But one patient case who residual tumor size excess 4 cm, Normal tissue dose more higher than critical dose remarkably on CTV plan. 80% over-Irradiated rectal dose(V80rec) is 1.8{+-}2.4 cm{sup 3} on ICRU plan, 0.7{+-}1.0 cm{sup 3} on CTV plan. 80% over-Irradiated bladder

  3. Correlates of exercise motivation and behavior in a population-based sample of endometrial cancer survivors: an application of the Theory of Planned Behavior

    OpenAIRE

    Dundas George; Pearcey Robert G; Campbell Kristin L; Courneya Kerry S; Karvinen Kristina H; Capstick Valerie; Tonkin Katia S

    2007-01-01

    Abstract Background Despite evidence of the benefits of exercise in cancer survivors, exercise participation rates tend to decline after treatments. Few studies have examined the determinants of exercise in less common cancer sites. In this study, we examined medical, demographic, and social cognitive correlates of exercise in endometrial cancer survivors using the Theory of Planned Behavior (TPB). Methods A mailed survey was completed by 354 endometrial cancer survivors (1 to 10 years postdi...

  4. Knowledge-based radiation therapy (KBRT) treatment planning versus planning by experts: validation of a KBRT algorithm for prostate cancer treatment planning

    International Nuclear Information System (INIS)

    A knowledge-based radiation therapy (KBRT) treatment planning algorithm was recently developed. The purpose of this work is to investigate how plans that are generated with the objective KBRT approach compare to those that rely on the judgment of the experienced planner. Thirty volumetric modulated arc therapy plans were randomly selected from a database of prostate plans that were generated by experienced planners (expert plans). The anatomical data (CT scan and delineation of organs) of these patients and the KBRT algorithm were given to a novice with no prior treatment planning experience. The inexperienced planner used the knowledge-based algorithm to predict the dose that the OARs receive based on their proximity to the treated volume. The population-based OAR constraints were changed to the predicted doses. A KBRT plan was subsequently generated. The KBRT and expert plans were compared for the achieved target coverage and OAR sparing. The target coverages were compared using the Uniformity Index (UI), while 5 dose-volume points (D10, D30, D50, D70 and D90) were used to compare the OARs (bladder and rectum) doses. Wilcoxon matched-pairs signed rank test was used to check for significant differences (p < 0.05) between both datasets. The KBRT and expert plans achieved mean UI values of 1.10 ± 0.03 and 1.10 ± 0.04, respectively. The Wilcoxon test showed no statistically significant difference between both results. The D90, D70, D50, D30 and D10 values of the two planning strategies, and the Wilcoxon test results suggests that the KBRT plans achieved a statistically significant lower bladder dose (at D30), while the expert plans achieved a statistically significant lower rectal dose (at D10 and D30). The results of this study show that the KBRT treatment planning approach is a promising method to objectively incorporate patient anatomical variations in radiotherapy treatment planning

  5. Hypnosis for procedure-related pain and distress in pediatric cancer patients: a systematic review of effectiveness and methodology related to hypnosis interventions.

    Science.gov (United States)

    Richardson, Janet; Smith, Joanna E; McCall, Gillian; Pilkington, Karen

    2006-01-01

    The aim of this study was to systematically review and critically appraise the evidence on the effectiveness of hypnosis for procedure-related pain and distress in pediatric cancer patients. A comprehensive search of major biomedical and specialist complementary and alternative medicine databases was conducted. Citations were included from the databases' inception to March 2005. Efforts were made to identify unpublished and ongoing research. Controlled trials were appraised using predefined criteria. Clinical commentaries were obtained for each study. Seven randomized controlled clinical trials and one controlled clinical trial were found. Studies report positive results, including statistically significant reductions in pain and anxiety/distress, but a number of methodological limitations were identified. Systematic searching and appraisal has demonstrated that hypnosis has potential as a clinically valuable intervention for procedure-related pain and distress in pediatric cancer patients. Further research into the effectiveness and acceptability of hypnosis for pediatric cancer patients is recommended. PMID:16442484

  6. Dosimetric impact of applicator displacement during high dose rate (HDR) Cobalt-60 brachytherapy for cervical cancer: A planning study

    Science.gov (United States)

    Yong, J. S.; Ung, N. M.; Jamalludin, Z.; Malik, R. A.; Wong, J. H. D.; Liew, Y. M.; Ng, K. H.

    2016-02-01

    We investigated the dosimetric impact of applicator displacement on dose specification during high dose rate (HDR) Cobalt-60 (Co-60) brachytherapy for cervical cancer through a planning study. Eighteen randomly selected HDR full insertion plans were restrospectively studied. The tandem and ovoids were virtually shifted translationally and rotationally in the x-, y- and z-axis directions on the treatment planning system. Doses to reference points and volumes of interest in the plans with shifted applicators were compared with the original plans. The impact of dose displacement on 2D (point-based) and 3D (volume-based) treatment planning techniques was also assessed. A ±2 mm translational y-axis applicator shift and ±4° rotational x-axis applicator shift resulted in dosimetric changes of more than 5% to organs at risk (OAR) reference points. Changes to the maximum doses to 2 cc of the organ (D2cc) in 3D planning were statistically significant and higher than the reference points in 2D planning for both the rectum and bladder (p<0.05). Rectal D2cc was observed to be the most sensitive to applicator displacement among all dose metrics. Applicator displacement that is greater than ±2 mm translational y-axis and ±4° rotational x-axis resulted in significant dose changes to the OAR. Thus, steps must be taken to minimize the possibility of applicator displacement during brachytherapy.

  7. SU-E-J-125: A Novel IMRT Planning Technique to Spare Sacral Bone Marrow in Pelvic Cancer Patients

    Energy Technology Data Exchange (ETDEWEB)

    McGuire, S; Bhatia, S; Sun, W; Menda, Y; Ponto, L; Gross, B; Buatti, J [University Of Iowa, Iowa City, IA (United States)

    2015-06-15

    Purpose: Develop an IMRT planning technique that can preferentially spare sacral bone marrow for pelvic cancer patients. Methods: Six pelvic cancer patients (two each with anal, cervical, and rectal cancer) were enrolled in an IRB approved protocol to obtain FLT PET images at simulation, during, and post chemoradiation therapy. Initially, conventional IMRT plans were created to maintain target coverage and reduce dose to OARs such as bladder, bowel, rectum, and femoral heads. Simulation FLT PET images were used to create IMRT plans to spare bone marrow identified as regions with SUV of 2 or greater (IMRT-BMS) within the pelvic bones from top of L3 to 5mm below the greater trochanter without compromising PTV coverage or OAR sparing when compared to the initial IMRT plan. IMRT-BMS plans used 8–10 beam angles that surrounded the subject. These plans were used for treatment. Retrospectively, the same simulation FLT PET images were used to create IMRT plans that spared bone marrow located in the sacral pelvic bone region (IMRT-FAN) also without compromising PTV coverage or OAR sparing. IMRT-FAN plans used 16 beam angles every 12° anteriorly from 90° – 270°. Optimization objectives for the sacral bone marrow avoidance region were weighted to reduce ≥V10. Results: IMRT-FAN reduced dose to the sacral bone marrow for all six subjects. The average V5, V10, V20, and V30 differences from the IMRT-BMS plan were −2.2 ± 1.7%, −11.4 ± 3.6%, −17.6 ± 5.1%, and −19.1 ± 8.1% respectively. Average PTV coverage change was 0.5% ± 0.8% from the conventional IMRT plan. Conclusion: An IMRT planning technique that uses beams from the anterior and lateral directions reduced the volume of sacral bone marrow that receives ≤10Gy while maintaining PTV coverage and OAR sparing. Additionally, the volume of sacral bone marrow that received 20 or 30 Gy was also reduced.

  8. SU-E-J-125: A Novel IMRT Planning Technique to Spare Sacral Bone Marrow in Pelvic Cancer Patients

    International Nuclear Information System (INIS)

    Purpose: Develop an IMRT planning technique that can preferentially spare sacral bone marrow for pelvic cancer patients. Methods: Six pelvic cancer patients (two each with anal, cervical, and rectal cancer) were enrolled in an IRB approved protocol to obtain FLT PET images at simulation, during, and post chemoradiation therapy. Initially, conventional IMRT plans were created to maintain target coverage and reduce dose to OARs such as bladder, bowel, rectum, and femoral heads. Simulation FLT PET images were used to create IMRT plans to spare bone marrow identified as regions with SUV of 2 or greater (IMRT-BMS) within the pelvic bones from top of L3 to 5mm below the greater trochanter without compromising PTV coverage or OAR sparing when compared to the initial IMRT plan. IMRT-BMS plans used 8–10 beam angles that surrounded the subject. These plans were used for treatment. Retrospectively, the same simulation FLT PET images were used to create IMRT plans that spared bone marrow located in the sacral pelvic bone region (IMRT-FAN) also without compromising PTV coverage or OAR sparing. IMRT-FAN plans used 16 beam angles every 12° anteriorly from 90° – 270°. Optimization objectives for the sacral bone marrow avoidance region were weighted to reduce ≥V10. Results: IMRT-FAN reduced dose to the sacral bone marrow for all six subjects. The average V5, V10, V20, and V30 differences from the IMRT-BMS plan were −2.2 ± 1.7%, −11.4 ± 3.6%, −17.6 ± 5.1%, and −19.1 ± 8.1% respectively. Average PTV coverage change was 0.5% ± 0.8% from the conventional IMRT plan. Conclusion: An IMRT planning technique that uses beams from the anterior and lateral directions reduced the volume of sacral bone marrow that receives ≤10Gy while maintaining PTV coverage and OAR sparing. Additionally, the volume of sacral bone marrow that received 20 or 30 Gy was also reduced

  9. Volumetric-modulated arc therapy vs c-IMRT in esophageal cancer: A treatment planning comparison

    Institute of Scientific and Technical Information of China (English)

    Li Yin; Bo Xu; Guang-Ying Zhu; Hao Wu; Jian Gong; Jian-Hao Geng; Fan Jiang; An-Hui Shi; Rong Yu; Yong-Heng Li; Shu-Kui Han

    2012-01-01

    AIM:To compare the volumetric-modulated arc therapy (VMAT) plans with conventional sliding window intensity-modulated radiotherapy (c-IMRT) plans in esophageal cancer (EC).METHODS:Twenty patients with EC were selected,including 5 cases located in the cervical,the upper,the middle and the lower thorax,respectively.Five plans were generated with the eclipse planning system:three using c-IMRT with 5 fields (5F),7 fields (7F) and 9 fields (9F),and two using VMAT with a single arc (1A) and double arcs (2A).The treatment plans were designed to deliver a dose of 60 Gy to the planning target volume (PTV) with the same constrains in a 2.0 Gy daily fraction,5 d a week.Plans were normalized to 95% of the PTV that received 100% of the prescribed dose.We examined the dose-volume histogram parameters of PTV and the organs at risk (OAR) such as lungs,spinal cord and heart.Monitor units (MU) and normal tissue complication probability (NTCP) of OAR were also reported.RESULTS:Both c-IMRT and VMAT plans resulted in abundant dose coverage of PTV for EC of different locations.The dose conformity to PTV was improved as the number of field in c-IMRT or rotating arc in VMAT was increased.The doses to PTV and OAR in VMAT plans were not statistically different in comparison with c-IMRT plans,with the following exceptions:in cervical and upper thoracic EC,the conformity index (CI) was higher in VMAT (1A 0.78 and 2A 0.8) than in c-IMRT (SF 0.62,7F 0.66 and 9F 0.73) and homogeneity was slightly better in c-IMRT (7F 1.09 and 9F 1.07) than in VMAT (1A 1.1 and 2A 1.09).Lung V30 was lower in VMAT (1A 12.52 and 2A 12.29) than in c-IMRT (7F 14.35 and 9F 14.81).The humeral head doses were significantly increased in VMAT as against c-IMRT.In the middle and lower thoracic EC,CI in VMAT (1A 0.76 and 2A 0.74) was higher than in c-IMRT (5F 0.63 Gy and 7F 0.67 Gy),and homogeneity was almost similar between VMAT and c-IMRT.V20 (2A 21.49 Gy vs 7F 24.59 Gy and 9F 24.16 Gy) and V30 (2A 9.73 Gy vs 5F 12

  10. Dosimetric study comparing intensity modulated and conformal pelvic radiotherapy boost plans in locally advanced cancer cervix in NCI-Cairo

    Institute of Scientific and Technical Information of China (English)

    Mohamed Mahmoud; Hesham A. EL-Hossiny; Nashaat A. Diab; Mahmoud Shosha

    2013-01-01

    Objective: This study was to compare 5 field conformal technique to the intensity modulated radiotherapy (IMRT) 8 fields technique in boosting locally advanced cancer cervix cases after external beam radiotherapy with respect to target volume coverage and dose to normal tissues. Methods: We conducted a single institutional comparative dosimetric analysis of 10 patients with cancer cervix who was presented to radiotherapy department in National Cancer Institute, Cairo in period between June 2012 to September 2012 and received a CRT boost in the place of planned brachytherapy after large field pelvic radiotherapy (PRT) with concurrent chemotherapy were retrospectively identified. All tumors were situated in the low central pelvis. Two plans were done for every patient; one using the 8 fields IMRT and the second one using 5 fields' 3DCRT the two techniques were then compared using dose volume histogram (DVH) analysis for the PTV, bladder, rectum and both femoral heads. Results: Comparing different DVHs, it was found that the planning target volume (PTV) was adequately covered in both plans while it was demonstrates that the 8 fields IMRT technique carried less doses reaching OARs (rectum, bladder, both femoral heads). Conclusion: From the present study, it is concluded that IMRT technique spared more efficiently OARs than CRT technique but both techniques covered the PTV adequately so whenever possible IMRT technique should be used.

  11. Dosimetric impact of mixed-energy volumetric modulated arc therapy plans for high-risk prostate cancer

    Directory of Open Access Journals (Sweden)

    Shyam Pokharel

    2013-10-01

    Full Text Available Purpose: This study investigated the dosimetric impact of mixing low and high energy treatment plans for prostate cancer treated with volumetric modulated arc therapy (VMAT technique in the form of RapidArc.Methods: A cohort of 12 prostate cases involving proximal seminal vesicles and lymph nodes was selected for this retrospective study. For each prostate case, the single-energy plans (SEPs and mixed-energy plans (MEPs were generated.  First, the SEPs were created using 6 mega-voltage (MV energy for both the primary and boost plans. Second, the MEPs were created using 16 MV energy for the primary plan and 6 MV energy for the boost plan. The primary and boost MEPs used identical beam parameters and same dose optimization values as in the primary and boost SEPs for the corresponding case. The dosimetric parameters from the composite plans (SEPs and MEPs were evaluated. Results: The dose to the target volume was slightly higher (on average <1% in the SEPs than in the MEPs. The conformity index (CI and homogeneity index (HI values between the SEPs and MEPs were comparable. The dose to rectum and bladder was always higher in the SEPs (average difference up to 3.7% for the rectum and up to 8.4% for the bladder than in the MEPs. The mean dose to femoral heads was higher by about 0.8% (on average in the MEPs than in the SEPs. The number of monitor units and integral dose were higher in the SEPs compared to the MEPs by average differences of 9.1% and 5.5%, respectively.Conclusion: The preliminary results from this study suggest that use of mixed-energy VMAT plan for high-risk prostate cancer could potentially reduce the integral dose and minimize the dose to rectum and bladder, but for the higher femoral head dose.-----------------------------------------------Cite this article as:Pokharel S. Dosimetric impact of mixed-energy volumetric modulated arc therapy plans for high-risk prostate cancer. Int J Cancer Ther Oncol 2013;1(1:01011.DOI: http

  12. Expected treatment dose construction and adaptive inverse planning optimization: Implementation for offline head and neck cancer adaptive radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Yan Di; Liang Jian [Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan 48073 (United States)

    2013-02-15

    Purpose: To construct expected treatment dose for adaptive inverse planning optimization, and evaluate it on head and neck (h and n) cancer adaptive treatment modification. Methods: Adaptive inverse planning engine was developed and integrated in our in-house adaptive treatment control system. The adaptive inverse planning engine includes an expected treatment dose constructed using the daily cone beam (CB) CT images in its objective and constrains. Feasibility of the adaptive inverse planning optimization was evaluated retrospectively using daily CBCT images obtained from the image guided IMRT treatment of 19 h and n cancer patients. Adaptive treatment modification strategies with respect to the time and the number of adaptive inverse planning optimization during the treatment course were evaluated using the cumulative treatment dose in organs of interest constructed using all daily CBCT images. Results: Expected treatment dose was constructed to include both the delivered dose, to date, and the estimated dose for the remaining treatment during the adaptive treatment course. It was used in treatment evaluation, as well as in constructing the objective and constraints for adaptive inverse planning optimization. The optimization engine is feasible to perform planning optimization based on preassigned treatment modification schedule. Compared to the conventional IMRT, the adaptive treatment for h and n cancer illustrated clear dose-volume improvement for all critical normal organs. The dose-volume reductions of right and left parotid glands, spine cord, brain stem and mandible were (17 {+-} 6)%, (14 {+-} 6)%, (11 {+-} 6)%, (12 {+-} 8)%, and (5 {+-} 3)% respectively with the single adaptive modification performed after the second treatment week; (24 {+-} 6)%, (22 {+-} 8)%, (21 {+-} 5)%, (19 {+-} 8)%, and (10 {+-} 6)% with three weekly modifications; and (28 {+-} 5)%, (25 {+-} 9)%, (26 {+-} 5)%, (24 {+-} 8)%, and (15 {+-} 9)% with five weekly modifications. Conclusions

  13. Windscale planning application. Statement of submissions by British Nuclear Fuels Limited pursuant to rule 6(6) of the town and country planning (inquiries procedure) rules, 1974

    International Nuclear Information System (INIS)

    This is an outline planning application for plant for reprocessing irradiated oxide nuclear fuels and support site services. The general background of the application is stated and the history of the negotiations with the Secretary of State for the Environment and other planning authorities. The activities of the company are described; and the importance of reprocessing in the economy of nuclear power, and in relation to radioactive waste management is discussed. The application continues under the following headings: the need for the proposed plant, plutonium risks, method of reprocessing, the treatment storage and disposal of waste, radiological protection. Matters of local importance are also dealt with, such as visual impact, employment, and site services. (U.K.)

  14. Conformal radiotherapy for prostate cancer - Longer duration of acute genitourinary toxicity in patients with prior history of invasive urological procedure

    Energy Technology Data Exchange (ETDEWEB)

    Odrazka, Karel; Vanasek, Jaroslav; Vaculikova, Miloslava; Petera, Jiri; Zouhar, Milan; Zoul, Zdenk; Stejskal, Jan; Skrabkova, Zuzana; Kadeka, David [Charles Univ. Medical School and Teaching Hospital, Hradec Kralove (Czech Republic). Dept. of Radiotherapy and Oncology

    2001-11-01

    The incidence and predictors of acute toxicity were evaluated in patients treated with three-dimensional conformal radiotherapy (3D-CRT) for localized prostate cancer. Between December 1997 and November 1999, 116 patients with T1-T3 prostatic carcinoma were enrolled in the study. Ninety patients were treated with 70 Gy and 26 patients with T3 tumors received 74 Gy. Of the 116 patients 42 (36.2%) had a prior history of invasive urological procedure (IUP) (transurethral resection of the prostate or transvesical prostatectomy for benign prostatic hyperplasia). Acute gastrointestinal (GI) and genitourinary (GU) symptoms were graded according to the EORTC/RTOG scoring system. Toxicity duration after the completion of 3D-CRT was recorded. The majority of patients experienced only mild or no (Grade 1) acute toxicities. Medications for GI and GU symptoms (Grade 2) were required by 28.4% and 12.9% of patients, respectively. Only one case of Grade 3 GI toxicity (0.9%) was observed. Seven patients (6.1%) experienced severe GU toxicity (Grade 3 or 4). No correlation was found between acute toxicity and age, stage, dose (70 Gy vs. 74 Gy), IUP and pelvic lymphadenectomy. A significant relationship was observed between the duration of acute GU toxicity and prior IUP. Symptoms persisted for more than 4 weeks in 51.9% and 26.0% of patients with and without a prior history of IUP, respectively (p = 0.02). The incidence of acute complications, associated with 3D-CRT for prostate cancer, was acceptable in our cohort of patients. A prior history of IUP resulted in a significantly longer duration of acute GU toxicity.

  15. New procedures. Comprehensive staging of lung cancer by MRI; Neue Verfahren. Umfassendes Staging des Lungenkarzinoms mit der MRT

    Energy Technology Data Exchange (ETDEWEB)

    Hintze, C. [Universitaetsklinikum Schleswig-Holstein, Campus Kiel, Klinik fuer Diagnostische Radiologie, Kiel (Germany); Deutsches Krebsforschungszentrum (DKFZ) Heidelberg, Abteilung Radiologie (E010), Heidelberg (Germany); Dinkel, J. [Deutsches Krebsforschungszentrum (DKFZ) Heidelberg, Abteilung Radiologie (E010), Heidelberg (Germany); Biederer, J. [Universitaetsklinikum Schleswig-Holstein, Campus Kiel, Klinik fuer Diagnostische Radiologie, Kiel (Germany); Heussel, C.P. [Thoraxklinik Heidelberg, Abteilung Diagnostische und Interventionelle Radiologie, Heidelberg (Germany); Puderbach, M. [Deutsches Krebsforschungszentrum (DKFZ) Heidelberg, Abteilung Radiologie (E010), Heidelberg (Germany); Thoraxklinik Heidelberg, Abteilung Diagnostische und Interventionelle Radiologie, Heidelberg (Germany)

    2010-08-15

    Lung cancer staging according to the TNM system is based on morphological assessment of the primary cancer, lymph nodes and metastases. All aspects of this important oncological classification are measurable with MRI. Pulmonary nodules can be detected at the clinically relevant size of 4-5 mm in diameter. The extent of mediastinal, hilar and supraclavicular lymph node affection can be assessed at the same time. The predominant metastatic spread to the adrenal glands and spine can be detected in coronal orientation during dedicated MRI of the lungs. Search focused whole body MRI completes the staging. Various additional MR imaging techniques provide further functional and clinically relevant information during a single examination. In the oncological context the most important techniques are imaging of perfusion and tumor motion. Functional MRI of the lungs complements the pure staging and improves surgical approaches and radiotherapy planning. (orig.) [German] Das Staging des Lungenkarzinoms nach dem TNM-System basiert auf der morphologischen Einschaetzung des Primarius, der Lymphknoten und Metastasen. Alle Aspekte dieser onkologisch wichtigen Beurteilung lassen sich mit der MRT erfassen. Pulmonale Rundherde sind ab der klinisch relevanten Groesse von 4-5 mm Durchmesser sicher erkennbar. Die Groesse der mediastinalen, hilaeren und supraklavikulaeren Lymphknoten kann in einem Untersuchungsgang bestimmt werden. In der koronaren Schichtfuehrung der dedizierten MRT der Lunge werden die Bereiche der bevorzugten Metastasierung in Nebennieren und weite Teile der Wirbelsaeule miterfasst. Durch eine gezielte Ganzkoerper-MRT als Suchmethode wird der letzte Teil des Stagings erfuellt. Die MRT bietet vielfaeltige Moeglichkeiten, zusaetzliche funktionelle, klinisch relevante Informationen innerhalb einer Untersuchung zu erheben. Im onkologischen Kontext sind die Perfusionsbildgebung der Lunge und die Bewegungsabschaetzung der Tumoren am bedeutendsten. Die funktionelle MRT der

  16. SU-E-J-52: Dosimetric Benefit of Adaptive Re-Planning in Lung Cancer Stereotactic Body Radiotherapy (SBRT)

    International Nuclear Information System (INIS)

    Purpose: To investigate the dosimetric benefit of adaptive re-planning for lung stereotactic body radiotherapy(SBRT). Methods: Five lung cancer patients with SBRT treatment were retrospectively investigated. Our in-house supercomputing online re-planning environment (SCORE) was used to realize the re-planning process. First a deformable image registration was carried out to transfer contours from treatment planning CT to each treatment CBCT. Then an automatic re-planning using original plan DVH guided fluence-map optimization is performed to get a new plan for the up-to-date patient geometry. We compared the re-optimized plan to the original plan projected on the up-to-date patient geometry in critical dosimetric parameters, such as PTV coverage, spinal cord maximum and volumetric constraint dose, esophagus maximum and volumetric constraint dose. Results: The average volume of PTV covered by prescription dose for all patients was improved by 7.56% after the adaptive re-planning. The volume of the spinal cord receiving 14.5Gy and 23Gy (V14.5, V23) decreased by 1.48% and 0.68%, respectively. For the esophagus, the volume receiving 19.5Gy (V19.5) reduced by 1.37%. Meanwhile, the maximum dose dropped off by 2.87% for spinal cord and 4.80% for esophagus. Conclusion: Our experimental results demonstrate that adaptive re-planning for lung SBRT has the potential to minimize the dosimetric effect of inter-fraction deformation and thus improve target coverage while reducing the risk of toxicity to nearby normal tissues

  17. THE PRINCIPLES AND PROCEDURES FOR THE PLANNING AND ORGANIZATION OF INVESTMENT ACTIVITY IN ORDER TO ENSURE A COMPREHENSIVE RECONSTRUCTION

    Directory of Open Access Journals (Sweden)

    N. I. Verhoglyadova

    2010-06-01

    Full Text Available The paper is devoted to an analysis of actual condition of a system of formation of investment projects on the complex reconstruction of territory of great cities as well as to the principles and order of planning and organizing the investment activity aimed at providing this task.

  18. THE PRINCIPLES AND PROCEDURES FOR THE PLANNING AND ORGANIZATION OF INVESTMENT ACTIVITY IN ORDER TO ENSURE A COMPREHENSIVE RECONSTRUCTION

    OpenAIRE

    Verhoglyadova, N. I.; Levchynsky, D. L.

    2010-01-01

    The paper is devoted to an analysis of actual condition of a system of formation of investment projects on the complex reconstruction of territory of great cities as well as to the principles and order of planning and organizing the investment activity aimed at providing this task.

  19. Technical progress, the concept of individualized cancer treatment and the innovation of computer-assisted radiotherapy planning

    International Nuclear Information System (INIS)

    After a first step of cancerogenesis, the further development of the tumor is an individual process. At the end of this process the tumor is formed as an individual in the individual. The individuality of cancer exists on the level of organs, tissues and cells and includes an individual tumor-host relationship. Today, optimized cancer treatment requires a most precise biological characterization possible of the tumor and of the tumor-host relationship, which will provide objective information about the individual character of every tumor. Routine analysis and strict therapeutic consideration of the clinical and biological individuality of human cancer can offer real chances for the improvement of cancer treatment. A routine acquisition of individual tumor characteristics will be possible only if methods and equipment are available for the registration of suitable parameters. In this context technical innovations have an essential influence on the realization of the concept of individualized cancer treatment. With the method of flow cytophotometry and other techniques examples are given in how far the ideas of individual cancer management can be realized by introduction of new technical solutions into medical research and clinical practice. Unfortunately there is still a lack of methodology in individualizing cancer treatment. The individualization of radiotherapy is connected to an extremely high degree of technical innovations. Particularly this refers to the topometrical description of the target volume in relation to the adjacent anatomical structures and the body contour as well as the fitting of isodoses to the shape and size of the target volume. As an example of innovation of a technical solution for individual radiotherapy planning the computer-assisted radiotherapy planning system DOPSY is described. (author)

  20. The National LGBT Cancer Action Plan: A White Paper of the 2014 National Summit on Cancer in the LGBT Communities

    OpenAIRE

    Burkhalter, Jack E.; Margolies, Liz; Sigurdsson, Hrafn Oli; Walland, Jonathan; Radix, Asa; Rice, David; Buchting, Francisco O.; Sanchez, Nelson F.; Bare, Michael G; Boehmer, Ulrike; Cahill, Sean; Griebling, Tomas L; Bruessow, Diane; Maingi, Shail

    2016-01-01

    Abstract Despite growing social acceptance of lesbians, gay men, bisexuals, and transgender (LGBT) persons and the extension of marriage rights for same-sex couples, LGBT persons experience stigma and discrimination, including within the healthcare system. Each population within the LGBT umbrella term is likely at elevated risk for cancer due to prevalent, significant cancer risk factors, such as tobacco use and human immunodeficiency virus infection; however, cancer incidence and mortality d...

  1. PET/CT-guided treatment planning for paediatric cancer patients: a simulation study of proton and conventional photon therapy

    DEFF Research Database (Denmark)

    Kornerup, Josefine S.; Brodin, N. P.; Bjork-Eriksson, T.;

    2015-01-01

    scan information, on duplicate CT sets. RT plans were generated for three-dimensional conformal photon RT (3DCRT) and intensity-modulated proton therapy (IMPT). The results were evaluated by comparison of target volumes, target dose coverage parameters, normal tissue complication probability (NTCP...... or decreasing irradiated volumes, suggesting that the long-term morbidity of RT in childhood would on average remain largely unaffected. ADVANCES IN KNOWLEDGE: (18)F-FDG PET-based RT planning does not systematically change NTCP or SC risk for paediatric cancer patients compared with CT only. 3 out of 11...

  2. A hybrid strategy of offline adaptive planning and online image guidance for prostate cancer radiotherapy

    Science.gov (United States)

    Lei, Yu; Wu, Qiuwen

    2010-04-01

    Offline adaptive radiotherapy (ART) has been used to effectively correct and compensate for prostate motion and reduce the required margin. The efficacy depends on the characteristics of the patient setup error and interfraction motion through the whole treatment; specifically, systematic errors are corrected and random errors are compensated for through the margins. In online image-guided radiation therapy (IGRT) of prostate cancer, the translational setup error and inter-fractional prostate motion are corrected through pre-treatment imaging and couch correction at each fraction. However, the rotation and deformation of the target are not corrected and only accounted for with margins in treatment planning. The purpose of this study was to investigate whether the offline ART strategy is necessary for an online IGRT protocol and to evaluate the benefit of the hybrid strategy. First, to investigate the rationale of the hybrid strategy, 592 cone-beam-computed tomography (CBCT) images taken before and after each fraction for an online IGRT protocol from 16 patients were analyzed. Specifically, the characteristics of prostate rotation were analyzed. It was found that there exist systematic inter-fractional prostate rotations, and they are patient specific. These rotations, if not corrected, are persistent through the treatment fraction, and rotations detected in early fractions are representative of those in later fractions. These findings suggest that the offline adaptive replanning strategy is beneficial to the online IGRT protocol with further margin reductions. Second, to quantitatively evaluate the benefit of the hybrid strategy, 412 repeated helical CT scans from 25 patients during the course of treatment were included in the replanning study. Both low-risk patients (LRP, clinical target volume, CTV = prostate) and intermediate-risk patients (IRP, CTV = prostate + seminal vesicles) were included in the simulation. The contours of prostate and seminal vesicles were

  3. A hybrid strategy of offline adaptive planning and online image guidance for prostate cancer radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Lei Yu [Department of Radiation Oncology, Wayne State University, 4100 John R, Detroit, MI 48201 (United States); Wu Qiuwen [Department of Radiation Oncology, William Beaumont Hospital, 3601 West 13 Mile Rd, Royal Oak, MI 48073 (United States)], E-mail: Qiuwen.Wu@Duke.edu

    2010-04-21

    Offline adaptive radiotherapy (ART) has been used to effectively correct and compensate for prostate motion and reduce the required margin. The efficacy depends on the characteristics of the patient setup error and interfraction motion through the whole treatment; specifically, systematic errors are corrected and random errors are compensated for through the margins. In online image-guided radiation therapy (IGRT) of prostate cancer, the translational setup error and inter-fractional prostate motion are corrected through pre-treatment imaging and couch correction at each fraction. However, the rotation and deformation of the target are not corrected and only accounted for with margins in treatment planning. The purpose of this study was to investigate whether the offline ART strategy is necessary for an online IGRT protocol and to evaluate the benefit of the hybrid strategy. First, to investigate the rationale of the hybrid strategy, 592 cone-beam-computed tomography (CBCT) images taken before and after each fraction for an online IGRT protocol from 16 patients were analyzed. Specifically, the characteristics of prostate rotation were analyzed. It was found that there exist systematic inter-fractional prostate rotations, and they are patient specific. These rotations, if not corrected, are persistent through the treatment fraction, and rotations detected in early fractions are representative of those in later fractions. These findings suggest that the offline adaptive replanning strategy is beneficial to the online IGRT protocol with further margin reductions. Second, to quantitatively evaluate the benefit of the hybrid strategy, 412 repeated helical CT scans from 25 patients during the course of treatment were included in the replanning study. Both low-risk patients (LRP, clinical target volume, CTV = prostate) and intermediate-risk patients (IRP, CTV = prostate + seminal vesicles) were included in the simulation. The contours of prostate and seminal vesicles were

  4. Forward-planned intensity modulated radiation therapy using a cobalt source: A dosimetric study in breast cancer

    Directory of Open Access Journals (Sweden)

    Savino Cilla

    2013-01-01

    Full Text Available This analysis evaluates the feasibility and dosimetric results of a simplified intensity-modulated radiotherapy (IMRT treatment using a cobalt-therapy unit for post-operative breast cancer. Fourteen patients were included. Three plans per patient were produced by a cobalt-60 source: A standard plan with two wedged tangential beams, a standard tangential plan optimized without the use of wedges and a plan based on the forward-planned "field-in-field" IMRT technique (Co-FinF where the dose on each of the two tangential beams was split into two different segments and the two segments weight was determined with an iterative process. For comparison purposes, a 6-MV photon standard wedged tangential treatment plan was generated. D mean , D 98% , D 2% , V 95% , V 107%, homogeneity, and conformity indices were chosen as parameters for comparison. Co-FinF technique improved the planning target volume dose homogeneity compared to other cobalt-based techniques and reduced maximum doses (D 2% and high-dose volume (V 110% . Moreover, it showed a better lung and heart dose sparing with respect to the standard approach. The higher dose homogeneity may encourage the adoption of accelerated-hypofractionated treatments also with the cobalt sources. This approach can promote the spread of breast conservative treatment in developing countries.

  5. The Effect of Interleukin-6 on the Proliferation of Prostate Cancer Cells in Vitro and the Modulation of This Procedure

    Institute of Scientific and Technical Information of China (English)

    XING Yifei; XIAO Yajun; ZHANG Qijun; LU Gongcheng

    2001-01-01

    The role of interleukin-6 (IL-6) in the growth of an androgen-independent prostate cancer cell line (PC-3m) was defined and the effect of dexamethasone, which was previously shown to modulate IL-6/IL-6 receptor (IL-6R) on this procedure was investigated. By using a pretty sensitive and specific enzyme immunoassay (ELISA), it was found that PC-3m produced certain IL-6, but there was no difference in IL-6 secretion between the group with or without dexamethasone treatment. It was also found that PC-3m cells could not be stimulated to grow by exogenous IL-6 (P>0.05), while it could be inhibited to grow by anti-IL-6 monoclonal antibody and dexamethasone with a dose-dependent fashion. Our observation indicated that IL-6 acted as an autocrine growth factor for PC-3m, and dexamethasone could inhibit cell proliferation by a mechanism independent of its effect on IL-6 mRNA expression.

  6. CT and MRI matching for radiotherapy planning in head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Rasch, C.; Keus, R.; Touw, A.; Lebesque, J.; Van Herk, M. [Nederlands Kanker Inst. `Antoni van Leeuwenhoekhuis`, Amsterdam (Netherlands)

    1995-12-01

    The objective of this study was to evaluate the impact of matched CT and MRI information on target delineation in radiotherapy planning for head and neck tumors. MRI images of eight patients with head and neck cancer in supine position, not necessarily obtained in radiotherapy treatment position were matched to the CT scans made in radiotherapy position using automatic three-dimensional chamfer-matching of bony structures. Four independent observers delineated the Gross Tumor Volume (GTV) in CT scans and axial and sagittal MR scans. The GTV`s were compared, overlapping volumes and non-overlapping volumes between the different datasets and observers were determined. In all patients a good match of CT and MRI information was accomplished in the head region. The combined information provided a better visualisation of the GTV, oedema and normal tissues compared with CT or MRI alone. Determination of overlapping and non-overlapping volumes proved to be a valuable tool to measure uncertainties in the determination of the GTV. CT-MRI matching in patients with head and neck tumors is feasible and makes a more accurate irradiation with higher tumor doses and less normal tissue complications possible. Remaining uncertainties in the determination of the GTV can be quantified using the combined information of MRI and CT.

  7. A novel four-dimensional radiotherapy method for lung cancer: imaging, treatment planning and delivery

    Science.gov (United States)

    Alasti, H.; Cho, Y. B.; Vandermeer, A. D.; Abbas, A.; Norrlinger, B.; Shubbar, S.; Bezjak, A.

    2006-06-01

    We present treatment planning methods based on four-dimensional computed tomography (4D-CT) to incorporate tumour motion using (1) a static field and (2) a dynamic field. Static 4D fields are determined to include the target in all breathing phases, whereas dynamic 4D fields are determined to follow the shape of the tumour assessed from 4D-CT images with a dynamic weighting factor. The weighting factor selection depends on the reliability of patient breathing and limitations of the delivery system. The static 4D method is compared with our standard protocol for gross tumour volume (GTV) coverage, mean lung dose and V20. It was found that the GTV delineated on helical CT without incorporating breathing motion does not adequately represent the target compared to the GTV delineated from 4D-CT. Dosimetric analysis indicates that the static 4D-CT based technique results in a reduction of the mean lung dose compared with the standard protocol. Measurements on a moving phantom and simulations indicated that 4D radiotherapy (4D-RT) synchronized with respiration-induced motion further reduces mean lung dose and V20, and may allow safe application of dose escalation and CRT/IMRT. The motions of the chest cavity, tumour and thoracic structures of 24 lung cancer patients are also analysed.

  8. Target splitting in radiation therapy for lung cancer: further developments and exemplary treatment plans

    International Nuclear Information System (INIS)

    Reporting further developments evolved since the first report about this conformal technique. Technical progress focused on optimization of the quality assurance (QA) program, especially regarding the required work input; and on optimization of beam arrangements. Besides performing the regular QA program, additional time consuming dosimetric measurements and verifications no longer have to be accomplished. 'Class solutions' of treatment plans for six patients with non-resected non-small cell lung cancer in locally advanced stages are presented. Target configurations comprise one central and five peripheral tumor sites with different topographic positions to hilus and mediastinum. The mean dose to the primary tumor is 81,9 Gy (range 79,2–90,0 Gy), to macroscopically involved nodes 61,2 Gy (range 55,8–63,0 Gy), to electively treated nodes 45,0 Gy. Treatments are performed twice daily, with fractional doses of 1,8 Gy at an interval of 11 hours. Median overall treatment time is 33 days. The set-up time at the linac does not exceed the average time for any other patient. Target splitting is a highly conformal and nonetheless non-expensive method with regard to linac and staff time. It enables secure accelerated high-dose treatments of patients with NSCLC

  9. Six versus fewer planned cycles of first-line platinum-based chemotherapy for non-small-cell lung cancer

    DEFF Research Database (Denmark)

    Rossi, Antonio; Chiodini, Paolo; Sun, Jong-Mu;

    2014-01-01

    BACKGROUND: Platinum-based chemotherapy is the standard first-line treatment for patients with advanced non-small-cell lung cancer. However, the optimum number of treatment cycles remains controversial. Therefore, we did a systematic review and meta-analysis of individual patient data to compare...... the efficacy of six versus fewer planned cycles of platinum-based chemotherapy. METHODS: All randomised trials comparing six versus fewer planned cycles of first-line platinum-based chemotherapy for patients with advanced non-small-cell lung cancer were eligible for inclusion in this systematic review and meta...... included 1139 patients-568 of whom were assigned to six cycles, and 571 to three cycles (two trials) or four cycles (two trials). Patients received cisplatin (two trials) or carboplatin (two trials). No evidence indicated a benefit of six cycles of chemotherapy on overall survival (median 9·54 months [95...

  10. Delivered dose to scrotum in rectal cancer radiotherapy by thermoluminescence dosimetry comparing to dose calculated by planning software

    Directory of Open Access Journals (Sweden)

    Peiman Haddad

    2014-02-01

    Conclusion: In this study, the mean testis dose of radiation was 3.77 Gy, similar to the dose calculated by the planning software (4.11 Gy. This dose could be significantly harmful for spermatogenesis, though low doses of scattered radiation to the testis in fractionated radiotherapy might be followed with better recovery. Based on above findings, careful attention to testicular dose in radiotherapy of rectal cancer for the males desiring continued fertility seems to be required.

  11. Comparison of planning target volumes based on three-dimensional and four-dimensional CT imaging of thoracic esophageal cancer

    OpenAIRE

    Wang, Wei; LI, JIANBIN; Zhang, Yingjie; SHAO, QIAN; Xu, Min; Fan, Tingyong; Wang, Jinzhi

    2016-01-01

    Wei Wang, Jianbin Li, Yingjie Zhang, Qian Shao, Min Xu, Tingyong Fan, Jinzhi Wang Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Shandong, People’s Republic of China Background and purpose: To investigate the definition of planning target volumes (PTVs) based on four-dimensional computed tomography (4DCT) compared with conventional PTV definition and PTV definition using asymmetrical margins for t...

  12. Evaluating Higher Education Policy in Turkey: Assessment of the Admission Procedure to Architecture, Planning and Engineering Schools

    OpenAIRE

    Kemal Mert Cubukcu; Ebru Cubukcu

    2009-01-01

    The admission procedure to higher education institutions in Turkey is based on the student’s high school grades and Central University Entrance Examination (CUEE) score, with a much greater weight on the latter. However, whether the CUEE is an appropriate measure in the admission process to universities is still a much-debated question. This study assesses the validity of the CUEE as a selection tool for design-based departments by examining the relationship between CUEE scores and success in...

  13. Test plan/procedure for the checkout of the USA cable communications test configuration for the electromagnetic compatibility (EMC) tests

    Science.gov (United States)

    Perry, J. C.

    1975-01-01

    A series of electromagnetic compatibility (EMC) tests were conducted in May, 1975 in the Soviet Union. The purpose of the EMC tests was to determine the effects of the operating environment of the Soviet aircraft, Soyuz, upon the electrical performance of the USA's cable communications equipment located in Soyuz. The test procedures necessary to check out the cable communications test configuration in preparation for the EMC tests are presented.

  14. TSUNAMI RISK MITIGATION THROUGH STRATEGIC LAND-USE PLANNING AND EVACUATION PROCEDURES FOR COASTAL COMMUNITIES IN SRI LANKA

    OpenAIRE

    Woharika Kaumudi Weerasinghe; Akihiko Hokugo; Yuko Ikenouchi

    2011-01-01

    Safety measures against the future disaster risk are considered as the main aspect of post disaster reconstructions. The majority of post-disaster villages/settlements and due projects on Sri Lankan coastline are apparently lacking behind the proper safety measures and adequate evacuation procedures. Therefore the immediate necessities of proper safety measures have to be emphasized in order to mitigate future tsunami risks. This paper introduces a number of post disaster coastal villages/set...

  15. Planning, simulation, and augmented reality for robotic cardiac procedures: The STARS system of the ChIR team.

    Science.gov (United States)

    Coste-Manière, Eve; Adhami, Louaï; Mourgues, Fabien; Carpentier, Alain

    2003-04-01

    This paper presents STARS (Simulation and Transfer Architecture for Robotic Surgery), a versatile system that aims at enhancing minimally invasive robotic surgery through patient-dependent optimized planning, realistic simulation, safe supervision, and augmented reality. The underlying architecture of the proposed approach is presented, then each component is detailed. An experimental validation is conducted on a dog for a coronary bypass intervention using the Da Vinci(TM) surgical system focusing on planing, registration, and augmented reality trials. PMID:12838484

  16. A scenario for a web-based radiation treatment planning structure: A new tool for quality assurance procedure?

    Science.gov (United States)

    Kouloulias, V E; Ntasis, E; Poortmans, Ph; Maniatis, T A; Nikita, K S

    2003-01-01

    The desire to develop web-based platforms for remote collaboration among physicians and technologists is becoming a great challenge. In this paper we describe a web-based radiotherapy treatment planning (WBRTP) system to facilitate decentralized radiotherapy services by allowing remote treatment planning and quality assurance (QA) of treatment delivery. Significant prerequisites are digital storage of relevant data as well as efficient and reliable telecommunication system between collaborating units. The system of WBRTP includes video conferencing, display of medical images (CT scans, dose distributions etc), replication of selected data from a common database, remote treatment planning, evaluation of treatment technique and follow-up of the treated patients. Moreover the system features real-time remote operations in terms of tele-consulting like target volume delineation performed by a team of experts at different and distant units. An appraisal of its possibilities in quality assurance in radiotherapy is also discussed. As a conclusion, a WBRTP system would not only be a medium for communication between experts in oncology but mainly a tool for improving the QA in radiotherapy. PMID:12697952

  17. SU-E-J-68: Adaptive Radiotherapy of Head and Neck Cancer: Re-Planning Based On Prior Dose

    Energy Technology Data Exchange (ETDEWEB)

    Dogan, N; Padgett, K [University of Miami Miller School of Medicine, Miami, FL (United States); Evans, J; Sleeman, W; Song, S [Virginia Commonwealth University, Richmond, VA (United States); Fatyga, M [Mayo Clinic Arizona, Phoenix, AZ (United States)

    2015-06-15

    Purpose: Adaptive Radiotherapy (ART) with frequent CT imaging has been used to improve dosimetric accuracy by accounting for anatomical variations, such as primary tumor shrinkage and/or body weight loss, in Head and Neck (H&N) patients. In most ART strategies, the difference between the planned and the delivered dose is estimated by generating new plans on repeated CT scans using dose-volume constraints used with the initial planning CT without considering already delivered dose. The aim of this study was to assess the dosimetric gains achieved by re-planning based on prior dose by comparing them to re-planning not based-on prior dose for H&N patients. Methods: Ten locally-advanced H&N cancer patients were selected for this study. For each patient, six weekly CT imaging were acquired during the course of radiotherapy. PTVs, parotids, cord, brainstem, and esophagus were contoured on both planning and six weekly CT images. ART with weekly re-plans were done by two strategies: 1) Generating a new optimized IMRT plan without including prior dose from previous fractions (NoPriorDose) and 2) Generating a new optimized IMRT plan based on the prior dose given from previous fractions (PriorDose). Deformable image registration was used to accumulate the dose distributions between planning and six weekly CT scans. The differences in accumulated doses for both strategies were evaluated using the DVH constraints for all structures. Results: On average, the differences in accumulated doses for PTV1, PTV2 and PTV3 for NoPriorDose and PriorDose strategies were <2%. The differences in Dmean to the cord and brainstem were within 3%. The esophagus Dmean was reduced by 2% using PriorDose. PriorDose strategy, however, reduced the left parotid D50 and Dmean by 15% and 14% respectively. Conclusion: This study demonstrated significant parotid sparing, potentially reducing xerostomia, by using ART with IMRT optimization based on prior dose for weekly re-planning of H&N cancer patients.

  18. SU-E-J-68: Adaptive Radiotherapy of Head and Neck Cancer: Re-Planning Based On Prior Dose

    International Nuclear Information System (INIS)

    Purpose: Adaptive Radiotherapy (ART) with frequent CT imaging has been used to improve dosimetric accuracy by accounting for anatomical variations, such as primary tumor shrinkage and/or body weight loss, in Head and Neck (H&N) patients. In most ART strategies, the difference between the planned and the delivered dose is estimated by generating new plans on repeated CT scans using dose-volume constraints used with the initial planning CT without considering already delivered dose. The aim of this study was to assess the dosimetric gains achieved by re-planning based on prior dose by comparing them to re-planning not based-on prior dose for H&N patients. Methods: Ten locally-advanced H&N cancer patients were selected for this study. For each patient, six weekly CT imaging were acquired during the course of radiotherapy. PTVs, parotids, cord, brainstem, and esophagus were contoured on both planning and six weekly CT images. ART with weekly re-plans were done by two strategies: 1) Generating a new optimized IMRT plan without including prior dose from previous fractions (NoPriorDose) and 2) Generating a new optimized IMRT plan based on the prior dose given from previous fractions (PriorDose). Deformable image registration was used to accumulate the dose distributions between planning and six weekly CT scans. The differences in accumulated doses for both strategies were evaluated using the DVH constraints for all structures. Results: On average, the differences in accumulated doses for PTV1, PTV2 and PTV3 for NoPriorDose and PriorDose strategies were <2%. The differences in Dmean to the cord and brainstem were within 3%. The esophagus Dmean was reduced by 2% using PriorDose. PriorDose strategy, however, reduced the left parotid D50 and Dmean by 15% and 14% respectively. Conclusion: This study demonstrated significant parotid sparing, potentially reducing xerostomia, by using ART with IMRT optimization based on prior dose for weekly re-planning of H&N cancer patients

  19. Multicriteria optimization informed VMAT planning

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Huixiao; Craft, David L.; Gierga, David P., E-mail: dgierga@partners.org

    2014-04-01

    We developed a patient-specific volumetric-modulated arc therapy (VMAT) optimization procedure using dose-volume histogram (DVH) information from multicriteria optimization (MCO) of intensity-modulated radiotherapy (IMRT) plans. The study included 10 patients with prostate cancer undergoing standard fractionation treatment, 10 patients with prostate cancer undergoing hypofractionation treatment, and 5 patients with head/neck cancer. MCO-IMRT plans using 20 and 7 treatment fields were generated for each patient on the RayStation treatment planning system (clinical version 2.5, RaySearch Laboratories, Stockholm, Sweden). The resulting DVH of the 20-field MCO-IMRT plan for each patient was used as the reference DVH, and the extracted point values of the resulting DVH of the MCO-IMRT plan were used as objectives and constraints for VMAT optimization. Weights of objectives or constraints of VMAT optimization or both were further tuned to generate the best match with the reference DVH of the MCO-IMRT plan. The final optimal VMAT plan quality was evaluated by comparison with MCO-IMRT plans based on homogeneity index, conformity number of planning target volume, and organ at risk sparing. The influence of gantry spacing, arc number, and delivery time on VMAT plan quality for different tumor sites was also evaluated. The resulting VMAT plan quality essentially matched the 20-field MCO-IMRT plan but with a shorter delivery time and less monitor units. VMAT plan quality of head/neck cancer cases improved using dual arcs whereas prostate cases did not. VMAT plan quality was improved by fine gantry spacing of 2 for the head/neck cancer cases and the hypofractionation-treated prostate cancer cases but not for the standard fractionation–treated prostate cancer cases. MCO-informed VMAT optimization is a useful and valuable way to generate patient-specific optimal VMAT plans, though modification of the weights of objectives or constraints extracted from resulting DVH of MCO

  20. Association of Early Patient-Physician Care Planning Discussions and End-of-Life Care Intensity in Advanced Cancer

    Science.gov (United States)

    Tisnado, Diana M.; Walling, Anne M.; Dy, Sydney M.; Asch, Steven M.; Ettner, Susan L.; Kim, Benjamin; Pantoja, Philip; Schreibeis-Baum, Hannah C.; Lorenz, Karl A.

    2015-01-01

    Abstract Background: Early patient-physician care planning discussions may influence the intensity of end-of-life (EOL) care received by veterans with advanced cancer. Objective: The study objective was to evaluate the association between medical record documentation of patient-physician care planning discussions and intensity of EOL care among veterans with advanced cancer. Methods: This was a retrospective cohort study. Subjects were 665 veteran decedents diagnosed with stage IV colorectal, lung, or pancreatic cancer in 2008, and followed till death or the end of the study period in 2011. We estimated the effect of patient-physician care planning discussions documented within one month of metastatic diagnosis on the intensity of EOL care measured by receipt of acute care, intensive interventions, chemotherapy, and hospice care, using multivariate logistic regression models. Results: Veterans in our study were predominantly male (97.1%), white (74.7%), with an average age at diagnosis of 66.4 years. Approximately 31% received some acute care, 9.3% received some intensive intervention, and 6.5% had a new chemotherapy regimen initiated in the last month of life. Approximately 41% of decedents received no hospice or were admitted within three days of death. Almost half (46.8%) had documentation of a care planning discussion within the first month after diagnosis and those who did were significantly less likely to receive acute care at EOL (OR: 0.67; p=0.025). Documented discussions were not significantly associated with intensive interventions, chemotherapy, or hospice care. Conclusion: Early care planning discussions are associated with lower rates of acute care use at the EOL in a system with already low rates of intensive EOL care. PMID:26186553

  1. Acute small bowel toxicity and preoperative chemoradiotherapy for rectal cancer: Investigating dose-volume relationships and role for inverse planning

    International Nuclear Information System (INIS)

    Purpose: The relationship between volume of irradiated small bowel (VSB) and acute toxicity in rectal cancer radiotherapy is poorly quantified, particularly in patients receiving concurrent preoperative chemoradiotherapy. Using treatment planning data, we studied a series of such patients. Methods and Materials: Details of 41 patients with locally advanced rectal cancer were reviewed. All received 45 Gy in 25 fractions over 5 weeks, 3-4 fields three-dimensional conformal radiotherapy with daily 5-fluorouracil and folinic acid during Weeks 1 and 5. Toxicity was assessed prospectively in a weekly clinic. Using computed tomography planning software, the VSB was determined at 5 Gy dose intervals (V5, V1, etc.). Eight patients with maximal VSB had dosimetry and radiobiological modeling outcomes compared between inverse and conformal three-dimensional planning. Results: VSB correlated strongly with diarrheal severity at every dose level (p 5 and V15. Conclusions: A strong dose-volume relationship exists between VSB and acute diarrhea at all dose levels during preoperative chemoradiotherapy. Our constructed model may be useful in predicting toxicity, and this has been derived without the confounding influence of surgical excision on bowel function. Inverse planning can reduce calculated dose to small bowel and late NTCP, and its clinical role warrants further investigation

  2. Comparison of before and after CBCT image registration based on the lung cancer intensity-modulated planning

    International Nuclear Information System (INIS)

    Objective: To study the CBCT image registration of PTV enlarging distance and IMRT planning (CT-1) for patients with lung cancer,and evaluate their characters. Methods: Ten patients with lung cancer were included in the study. Two sets image, before and after radiotherapy, were acquired every week. Then delineated the targeted volume and made the planning (CT-2) according the enlarging distance data. To compare the parameters of DVH for lung and spinal cord, volumes and dose of PTV and NTCP with CT-1 and CT-2. The difference of two plan was analyzed by covariance analysis or Wilcoxson's z-test. Results: The max, min and mean dose of PTV, the lung V5, V10, V20, V30, V50 were similar in both plans (P =0.242-0.663). There was superiority in CT-2 of PTV and lung's mean dose (P =0.049, 0.035). The NTCP had the decent tendency followed by the increasing of lung V5, V10, V20 (P =0.146, 0.053, 0.000). Conclusions: CBCT based image registration can reduce PTV, the mean dose of lung, NTCP, and increase PTV dose. This provides a tool for exploring accurate radiotherapy strategies. (authors)

  3. Clinical Outcomes of Computed Tomography–Based Volumetric Brachytherapy Planning for Cervical Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Simpson, Daniel R., E-mail: drsimpson@ucsd.edu [Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California (United States); Scanderbeg, Daniel J.; Carmona, Ruben; McMurtrie, Riley M.; Einck, John; Mell, Loren K. [Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California (United States); McHale, Michael T.; Saenz, Cheryl C.; Plaxe, Steven C.; Harrison, Terry [Department of Gynecologic Oncology, University of California San Diego, La Jolla, California (United States); Mundt, Arno J.; Yashar, Catheryn M. [Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California (United States)

    2015-09-01

    Purpose/Objectives: A report of clinical outcomes of a computed tomography (CT)-based image guided brachytherapy (IGBT) technique for treatment of cervical cancer. Methods and Materials: Seventy-six women with International Federation of Gynecology and Obstetrics stage IB to IVA cervical carcinoma diagnosed between 2007 and 2014 were treated with definitive external beam radiation therapy (EBRT) with or without concurrent chemotherapy followed by high-dose-rate (HDR) IGBT. All patients underwent planning CT simulation at each implantation. A high-risk clinical target volume (HRCTV) encompassing any visible tumor and the entire cervix was contoured on the simulation CT. When available, magnetic resonance imaging (MRI) was performed at implantation to assist with tumor delineation. The prescription dose was prescribed to the HRCTV. Results: The median follow-up time was 17 months. Thirteen patients (17%) had an MRI done before brachytherapy, and 16 patients (21%) were treated without MRI guidance. The mean EBRT/IGBT sum 2-Gy equivalent dose (EQD2) delivered to the 90% volume of the HRCTV was 86.3 Gy. The mean maximum EQD2s delivered to 2 cm{sup 3} of the rectum, sigmoid, and bladder were 67.5 Gy, 66.2 Gy, and 75.3 Gy, respectively. The 2-year cumulative incidences of local, locoregional, and distant failure were 5.8% (95% confidence interval [CI]: 1.4%-14.8%), 15.1% (95% CI: 5.4%-29.4%), and 24.3% (95% CI: 12.1%-38.9%), respectively. The 2-year overall and disease-free survival rates were 75% (95% CI, 61%-91%) and 73% (95% CI, 60%-90%), respectively. Twenty-nine patients (38%) experienced grade ≥2 acute toxicity, with 5 cases of acute grade 3 toxicity and no grade ≥4 toxicities. One patient experienced grade 3 gastrointestinal toxicity. No other late grade ≥3 events were observed. Conclusions: This is the largest report to date of CT/MRI-based IGBT for the treatment of cervical cancer. The results are promising, with excellent local control and acceptable

  4. The effect of partially used high energy photon on intensity-modulated radiation therapy plan for head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Nam Joon; Seok, Jin Yong; Won, Hui Su; Hong, Joo Wan; Choi, Ji Hun; Park, Jin Hong [Dept. of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2013-03-15

    A selection of proper energy in treatment planning is very important because of having different dose distribution in body as photon energy. In generally, the low energy photon has been used in intensity-modulated radiation therapy (IMRT) for head and neck (H and N) cancer. The aim of this study was to evaluate the effect of partially used high energy photon at posterior oblique fields on IMRT plan for H and N cancer. The study was carried out on 10 patients (nasopharyngeal cancer 5, tonsilar cancer 5) treated with IMRT in Seoul National University Bundang Hospital. CT images were acquired 3 mm of thickness in the same condition and the treatment plan was performed by Eclipse (Ver.7.1, Varian, Palo Alto, USA). Two plans were generated under same planing objectives, dose volume constraints, and eight fields setting: (1) The low energy plan (LEP) created using 6 MV beam alone, (2) the partially used high energy plan (PHEP) created partially using 15 MV beam at two posterior oblique fields with deeper penetration depths, while 6 MV beam was used at the rest of fields. The plans for LEP and PHEP were compared in terms of coverage, conformity index (CI) and homogeneity index (HI) for planning target volume (PTV). For organs at risk (OARs), D{sub mean} and D{sub 50%} were analyzed on both parotid glands and D{sub max}, D{sub 1%} for spinal cord were analyzed. Integral dose (ID) and total monitor unit (MU) were compared as addition parameters. For the comparing dose to normal tissue of posterior neck, the posterior-normal tissue volume (P-NTV) was set on the patients respectively. The D{sub mean}, V{sub 20Gy} and V{sub 25Gy} for P-NTV were evaluated by using dose volume histogram (DVH). The dose distributions were similar with regard to coverage, CI and HI for PTV between the LEP and PHEP. No evident difference was observed in the spinal cord. However, the D{sub mean}, D{sub 50%} for both parotid gland were slightly reduced by 0.6%, 0.7% in PHEP. The ID was reduced by 1

  5. Treatment planning and dose analysis for interstitial photodynamic therapy of prostate cancer

    Science.gov (United States)

    Davidson, Sean R. H.; Weersink, Robert A.; Haider, Masoom A.; Gertner, Mark R.; Bogaards, Arjen; Giewercer, David; Scherz, Avigdor; Sherar, Michael D.; Elhilali, Mostafa; Chin, Joseph L.; Trachtenberg, John; Wilson, Brian C.

    2009-04-01

    With the development of new photosensitizers that are activated by light at longer wavelengths, interstitial photodynamic therapy (PDT) is emerging as a feasible alternative for the treatment of larger volumes of tissue. Described here is the application of PDT treatment planning software developed by our group to ensure complete coverage of larger, geometrically complex target volumes such as the prostate. In a phase II clinical trial of TOOKAD vascular targeted photodynamic therapy (VTP) for prostate cancer in patients who failed prior radiotherapy, the software was used to generate patient-specific treatment prescriptions for the number of treatment fibres, their lengths, their positions and the energy each delivered. The core of the software is a finite element solution to the light diffusion equation. Validation against in vivo light measurements indicated that the software could predict the location of an iso-fluence contour to within approximately ±2 mm. The same software was used to reconstruct the treatments that were actually delivered, thereby providing an analysis of the threshold light dose required for TOOKAD-VTP of the post-irradiated prostate. The threshold light dose for VTP-induced prostate damage, as measured one week post-treatment using contrast-enhanced MRI, was found to be highly heterogeneous, both within and between patients. The minimum light dose received by 90% of the prostate, D90, was determined from each patient's dose-volume histogram and compared to six-month sextant biopsy results. No patient with a D90 less than 23 J cm-2 had complete biopsy response, while 8/13 (62%) of patients with a D90 greater than 23 J cm-2 had negative biopsies at six months. The doses received by the urethra and the rectal wall were also investigated.

  6. Treatment planning and dose analysis for interstitial photodynamic therapy of prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Davidson, Sean R H; Gertner, Mark R; Bogaards, Arjen; Sherar, Michael D; Wilson, Brian C [Division of Biophysics and Bioimaging, Ontario Cancer Institute, University Health Network, 610 University Avenue, Toronto, Ontario M5G 2M9 (Canada); Weersink, Robert A; Giewercer, David [Laboratory for Applied Biophysics, Ontario Cancer Institute, University Health Network, 610 University Avenue, Toronto, Ontario M5G 2M9 (Canada); Haider, Masoom A [Joint Department of Medical Imaging, University Health Network, 610 University Avenue, Toronto, Ontario M5G 2M9 (Canada); Scherz, Avigdor [Department of Plant Science, Weizmann Institute of Science, PO Box 26, Rehovot 76100 (Israel); Elhilali, Mostafa [Department of Surgery, McGill University, 3655 Promenade Sir William Osler, Montreal, Quebec H3G 1Y6 (Canada); Chin, Joseph L [Department of Oncology, University of Western Ontario, 800 Commissioners Road East, PO Box 5010, London, Ontario N6A 5W9 (Canada); Trachtenberg, John [Department of Urology, University Health Network, 610 University Avenue, Toronto, Ontario M5G 2M9 (Canada)], E-mail: wilson@uhnres.utoronto.ca

    2009-04-21

    With the development of new photosensitizers that are activated by light at longer wavelengths, interstitial photodynamic therapy (PDT) is emerging as a feasible alternative for the treatment of larger volumes of tissue. Described here is the application of PDT treatment planning software developed by our group to ensure complete coverage of larger, geometrically complex target volumes such as the prostate. In a phase II clinical trial of TOOKAD vascular targeted photodynamic therapy (VTP) for prostate cancer in patients who failed prior radiotherapy, the software was used to generate patient-specific treatment prescriptions for the number of treatment fibres, their lengths, their positions and the energy each delivered. The core of the software is a finite element solution to the light diffusion equation. Validation against in vivo light measurements indicated that the software could predict the location of an iso-fluence contour to within approximately {+-}2 mm. The same software was used to reconstruct the treatments that were actually delivered, thereby providing an analysis of the threshold light dose required for TOOKAD-VTP of the post-irradiated prostate. The threshold light dose for VTP-induced prostate damage, as measured one week post-treatment using contrast-enhanced MRI, was found to be highly heterogeneous, both within and between patients. The minimum light dose received by 90% of the prostate, D{sub 90}, was determined from each patient's dose-volume histogram and compared to six-month sextant biopsy results. No patient with a D{sub 90} less than 23 J cm{sup -2} had complete biopsy response, while 8/13 (62%) of patients with a D{sub 90} greater than 23 J cm{sup -2} had negative biopsies at six months. The doses received by the urethra and the rectal wall were also investigated.

  7. New multileaf collimator with a leaf width of 5 mm improves plan quality compared to 10 mm in step-and-shoot IMRT of HNC using integrated boost procedure

    Energy Technology Data Exchange (ETDEWEB)

    Zwicker, Felix; Roeder, Falk; Timke, Carmen; Zabel-du Bois, Angelika; Huber, Peter E. [Dept. of Radiation Oncology, Univ. of Heidelberg (Germany); Clinical Cooperation Unit Radiation Oncology, DKFZ, Heidelberg (Germany); Hauswald, Henrik; Debus, Juergen [Dept. of Radiation Oncology, Univ. of Heidelberg (Germany); Nill, Simeon; Rhein, Bernhard [Div. of Medical Physics in Radiation Oncology, DKFZ, Heidelberg (Germany); Thieke, Christian [Clinical Cooperation Unit Radiation Oncology, DKFZ, Heidelberg (Germany)

    2010-06-15

    Purpose: to investigate whether a new multileaf collimator with a leaf width of 5 mm (MLC-5) over the entire field size of 40 x 40 cm{sup 2} improves plan quality compared to a leaf width of 10 mm (MLC-10) in intensity-modulated radiotherapy (IMRT) with integrated boost for head and neck cancer. Patients and methods: a plan comparison was performed for ten patients with head and neck cancer. For each patient, seven plans were calculated: one plan with MLC-10 and nine beams, four plans with MLC-5 and nine beams (with different intensity levels and two-dimensional median filter sizes [2D-MFS]), and one seven-beam plan with MLC-5 and MLC-10, respectively. Isocenter, beam angles and planning constraints were not changed. Mean values of common plan parameters over all ten patients were estimated, and plan groups of MLC-5 and MLC-10 with nine and seven beams were compared. Results: the use of MLC-5 led to a significantly higher conformity index and an improvement of the 90% coverage of PTV1 (planning target volume) and PTV2 compared with MLC-10. This was noted in the nine- and seven-beam plans. Within the nine-beam group with MLC-5, a reduction of the segment number by up to 25% at reduced intensity levels and for increased 2D-MFS did not markedly worsen plan quality. Interestingly, a seven-beam IMRT with MLC-5 was inferior to a nine-beam IMRT with MLC-5, but superior to a nine-beam IMRT with MLC-10. Conclusion: the use of an MLC-5 has significant advantages over an MLC-10 with respect to target coverage and protection of normal tissues in step-and-shoot IMRT of head and neck cancer. (orig.)

  8. Rapid Automated Treatment Planning Process to Select Breast Cancer Patients for Active Breathing Control to Achieve Cardiac Dose Reduction

    International Nuclear Information System (INIS)

    Purpose: To evaluate a rapid automated treatment planning process for the selection of patients with left-sided breast cancer for a moderate deep inspiration breath-hold (mDIBH) technique using active breathing control (ABC); and to determine the dose reduction to the left anterior descending coronary artery (LAD) and the heart using mDIBH. Method and Materials: Treatment plans were generated using an automated method for patients undergoing left-sided breast radiotherapy (n = 53) with two-field tangential intensity-modulated radiotherapy. All patients with unfavorable cardiac anatomy, defined as having >10 cm3 of the heart receiving 50% of the prescribed dose (V50) on the free-breathing automated treatment plan, underwent repeat scanning on a protocol using a mDIBH technique and ABC. The doses to the LAD and heart were compared between the free-breathing and mDIBH plans. Results: The automated planning process required approximately 9 min to generate a breast intensity-modulated radiotherapy plan. Using the dose–volume criteria, 20 of the 53 patients were selected for ABC. Significant differences were found between the free-breathing and mDIBH plans for the heart V50 (29.9 vs. 3.7 cm3), mean heart dose (317 vs. 132 cGy), mean LAD dose (2,047 vs. 594 cGy), and maximal dose to 0.2 cm3 of the LAD (4,155 vs. 1,507 cGy, all p 50 using the mDIBH technique. The 3 patients who had had a breath-hold threshold 50. Conclusions: A rapid automated treatment planning process can be used to select patients who will benefit most from mDIBH. For selected patients with unfavorable cardiac anatomy, the mDIBH technique using ABC can significantly reduce the dose to the LAD and heart, potentially reducing the cardiac risks.

  9. Use of PET/CT for staging and radiation therapy planning in patients with non-small cell lung cancer.

    Science.gov (United States)

    Mac Manus, M P

    2010-10-01

    Positron emission tomography (PET) and more recently PET/computed tomography (CT) scanning represent major advances in the imaging of lung cancer and have an especially high impact on the management of patients who are candidates for potentially curative or "radical" radiotherapy (RT). This article reviews the current status of PET and PET/CT for staging patients before RT and considers the use of PET and PET/CT images for target volume definition. The relevant literature on the use of PET for staging lung cancer is reviewed and placed in the context of patients who are candidates for RT. Research that specifically considers the use of PET for RT planning is considered critically and some promising areas for future research are discussed. The available literature is almost exclusively devoted to non small cell lung cancer (NSCLC) with few relevant studies of small cell lung cancer (SCLC). The primary PET radiopharmaceutical shown to have value for staging and RT planning is 18F-fluorodeoxyglucose (FDG). In prospective studies where PET imaging was used to stage radical RT candidates, 25-30% of patients were excluded from radical therapy because of PET detected advanced disease. In all studies where "PET-assisted" and conventional target or treatment volumes were compared, there were major differences between PET and conventional volumes. Because PET-assisted staging is proven to be significantly more accurate than conventional staging and because all studies show major differences between PET-assisted and conventional treatment volumes in NSCLC, routine use of PET/CT for RT planning is recommended.

  10. Positron emission mammography in breast cancer presurgical planning: comparisons with magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Schilling, Kathy; The, Juliette; Velasquez, Maria Victoria; Kahn, Simone; Saady, Matthew; Mahal, Ravinder; Chrystal, Larraine [Boca Raton Regional Hospital, Radiology Department, Boca Raton, FL (United States); Narayanan, Deepa [Naviscan, Inc., San Diego, CA (United States); National Cancer Institute, Bethesda, MD (United States); Kalinyak, Judith E. [Naviscan, Inc., San Diego, CA (United States)

    2011-01-15

    The objective of this study was to compare the performance characteristics of {sup 18}F-fluorodeoxyglucose (FDG) positron emission mammography (PEM) with breast magnetic resonance imaging (MRI) as a presurgical imaging and planning option for index and ipsilateral lesions in patients with newly diagnosed, biopsy-proven breast cancer. Two hundred and eight women >25 years of age (median age = 59.7 {+-} 14.1 years) with biopsy-proven primary breast cancer enrolled in this prospective, single-site study. MRI, PEM, and whole-body positron emission tomography (WBPET) were conducted on each patient within 7 business days. PEM and WBPET images were acquired on the same day after intravenous administration of 370 MBq of FDG (median = 432.9 MBq). PEM and MRI images were blindly evaluated, compared with final surgical histopathology, and the sensitivity determined. Substudy analysis compared the sensitivity of PEM versus MRI in patients with different menopausal status, breast density, and use of hormone replacement therapy (HRT) as well as determination of performance characteristics for additional ipsilateral lesion detection. Two hundred and eight patients enrolled in the study of which 87% (182/208) were analyzable. Of these analyzable patients, 26.4% (48/182), 7.1% (13/182), and 64.2% (120/182) were pre-, peri-, and postmenopausal, respectively, and 48.4% (88/182) had extremely or heterogeneously dense breast tissue, while 33.5% (61/182) had a history of HRT use. Ninety-two percent (167/182) underwent core biopsy for index lesion diagnosis. Invasive cancer was found in 77.5% (141/182), while ductal carcinoma in situ (DCIS) and/or Paget's disease were found in 22.5% (41/182) of patients. Both PEM and MRI had index lesion depiction sensitivity of 92.8% and both were significantly better than WBPET (67.9%, p < 0.001, McNemar's test). For index lesions, PEM and MRI had equivalent sensitivity of various tumors, categorized by tumor stage as well as similar invasive

  11. Dosimetric comparison between helical tomotherapy and intensity-modulated radiation therapy plans for non-small cell lung cancer

    Institute of Scientific and Technical Information of China (English)

    MENG Ling-ling; FENG Lin-chun; WANG Yun-lai; DAI Xiang-kun; XIE Chuan-bin

    2011-01-01

    Background Helical tomotherapy (HT) is a new image-guided intensity-modulated radiation therapy (IMRT) technique.It is reported that HT plan for non-small-cell lung cancer (NSCLC) can give better dose uniformity, dose gradients, and protection for the lung than IMRT plan. We compared the dosimetric characteristics of HT for NSCLC with those of conventional IMRT to observe the superiority of HT.Methods There was a comparative case series comprising 10 patients with NSCLC. Computed tomographic (CT) images of delineated targets were transferred to the PrecisePlan planning system (IMRT) and Tomo planning system (HT). The prescription doses were 70 Gy/33F for the gross tumor volume (GTV) and the visible lymph nodes (GTVnd),and 60 Gy/33F for the clinical target volume (CTV) and the clinical target volume of the visible lymph nodes (CTVnd). The dose restrictions for organs at risk were as follows: the maximum dose to spinal cord ≤45 Gy, V20 to the total lungs <30%,V50 to the heart <50%, and V55 to the esophagus <50%. Both plans were evaluated by means of the dose coverage of the targets, dose-volume histograms (DVHs), and other dosimetric indices.Results The dose coverage, conformity, and homogeneity of the targets' volumes were found to be satisfactory in both plans, but the homogeneity of the HT plan was better than that of IMRT. The high-dose radiation volume (V20-V30) to the lung and the mean lung dose (MLD) decreased (P<0.05), but the low-dose radiation volume (V5-V10) increased slightly in the HT plan (P>0.05). The maximum doses to the spinal cord, heart, esophagus and trachea in the HT plan were lower than those in the IMRT plan, but the differences were not statistically significant.Conclusions The HT plan provids better dose uniformity, dose gradients, and protectiqn for the organs at risk. It can reduce the high-dose radiation volume for lung and the MLD, but may deliver a larger lung volume of low-dose radiation.

  12. A solution procedure for mixed-integer nonlinear programming formulation of supply chain planning with quantity discounts under demand uncertainty

    Science.gov (United States)

    Yin, Sisi; Nishi, Tatsushi

    2014-11-01

    Quantity discount policy is decision-making for trade-off prices between suppliers and manufacturers while production is changeable due to demand fluctuations in a real market. In this paper, quantity discount models which consider selection of contract suppliers, production quantity and inventory simultaneously are addressed. The supply chain planning problem with quantity discounts under demand uncertainty is formulated as a mixed-integer nonlinear programming problem (MINLP) with integral terms. We apply an outer-approximation method to solve MINLP problems. In order to improve the efficiency of the proposed method, the problem is reformulated as a stochastic model replacing the integral terms by using a normalisation technique. We present numerical examples to demonstrate the efficiency of the proposed method.

  13. View planning and mesh refinement effects on a semi-automatic three-dimensional photorealistic texture mapping procedure

    Science.gov (United States)

    Shih, Chihhsiong; Yang, Yuanfan

    2012-02-01

    A novel three-dimensional (3-D) photorealistic texturing process is presented that applies a view-planning and view-sequencing algorithm to the 3-D coarse model to determine a set of best viewing angles for capturing the individual real-world objects/building's images. The best sequence of views will generate sets of visible edges in each view to serve as a guide for camera field shots by either manual adjustment or equipment alignment. The best view tries to cover as many objects/building surfaces as possible in one shot. This will lead to a smaller total number of shots taken for a complete model reconstruction requiring texturing with photo-realistic effects. The direct linear transformation method (DLT) is used for reprojection of 3-D model vertices onto a two-dimensional (2-D) images plane for actual texture mapping. Given this method, the actual camera orientations do not have to be unique and can be set arbitrarily without heavy and expensive positioning equipment. We also present results of a study on the texture-mapping precision as a function of the level of visible mesh subdivision. In addition, the control points selection for the DLT method used for reprojection of 3-D model vertices onto 2-D textured images is also investigated for its effects on mapping precision. By using DLT and perspective projection theories on a coarse model feature points, this technique will allow accurate 3-D texture mapping of refined model meshes of real-world buildings. The novel integration flow of this research not only greatly reduces the human labor and intensive equipment requirements of traditional methods, but also generates a more appealing photo-realistic appearance of reconstructed models, which is useful in many multimedia applications. The roles of view planning (VP) are multifold. VP can (1) reduce the repetitive texture-mapping computation load, (2) can present a set of visible model wireframe edges that can serve as a guide for images with sharp edges and

  14. Helical Tomotherapy Planning for Lung Cancer Based on Ventilation Magnetic Resonance Imaging

    International Nuclear Information System (INIS)

    To investigate the feasibility of lung ventilation-based treatment planning, computed tomography and hyperpolarized (HP) helium-3 (He-3) magnetic resonance imaging (MRI) ventilation images of 6 subjects were coregistered for intensity-modulated radiation therapy planning in Tomotherapy. Highly-functional lungs (HFL) and less-functional lungs (LFL) were contoured based on their ventilation image intensities, and a cylindrical planning-target-volume was simulated at locations adjacent to both HFL and LFL. Annals of an anatomy-based plan (Plan 1) and a ventilation-based plan (Plan 2) were generated. The following dosimetric parameters were determined and compared between the 2 plans: percentage of total/HFL volume receiving ≥20 Gy, 15 Gy, 10 Gy, and 5 Gy (TLV20, HFLV20, TLV15, HFLV15, TLV10, HFLV10, TLV5, HFLV5), mean total/HFL dose (MTLD/HFLD), maximum doses to all organs at risk (OARs), and target dose conformality. Compared with Plan 1, Plan 2 reduced mean HFLD (mean reduction, 0.8 Gy), MTLD (mean reduction, 0.6 Gy), HFLV20 (mean reduction, 1.9%), TLV20 (mean reduction, 1.5%), TLV15 (mean reduction, 1.7%), and TLV10 (mean reduction, 2.1%). P-values of the above comparisons are less than 0.05 using the Wilcoxon signed rank test. For HFLV15, HFLV10, TLV5, and HTLV5, Plan 2 resulted in lower values than plan 1 but the differences are not significant (P-value range, 0.063–0.219). Plan 2 did not significantly change maximum doses to OARs (P-value range, 0.063–0.563) and target conformality (P = 1.000). HP He-3 MRI of patients with lung disease shows a highly heterogeneous ventilation capacity that can be utilized for functional treatment planning. Moderate but statistically significant improvements in sparing functional lungs were achieved using helical tomotherapy plans.

  15. PET/CT-guided treatment planning for paediatric cancer patients: a simulation study of proton and conventional photon therapy

    Science.gov (United States)

    Brodin, N P; Björk-Eriksson, T; Birk Christensen, C; Kiil-Berthelsen, A; Aznar, M C; Hollensen, C; Markova, E; Munck af Rosenschöld, P

    2015-01-01

    Objective: To investigate the impact of including fluorine-18 fludeoxyglucose (18F-FDG) positron emission tomography (PET) scanning in the planning of paediatric radiotherapy (RT). Methods: Target volumes were first delineated without and subsequently re-delineated with access to 18F-FDG PET scan information, on duplicate CT sets. RT plans were generated for three-dimensional conformal photon RT (3DCRT) and intensity-modulated proton therapy (IMPT). The results were evaluated by comparison of target volumes, target dose coverage parameters, normal tissue complication probability (NTCP) and estimated risk of secondary cancer (SC). Results: Considerable deviations between CT- and PET/CT-guided target volumes were seen in 3 out of the 11 patients studied. However, averaging over the whole cohort, CT or PET/CT guidance introduced no significant difference in the shape or size of the target volumes, target dose coverage, irradiated volumes, estimated NTCP or SC risk, neither for IMPT nor 3DCRT. Conclusion: Our results imply that the inclusion of PET/CT scans in the RT planning process could have considerable impact for individual patients. There were no general trends of increasing or decreasing irradiated volumes, suggesting that the long-term morbidity of RT in childhood would on average remain largely unaffected. Advances in knowledge: 18F-FDG PET-based RT planning does not systematically change NTCP or SC risk for paediatric cancer patients compared with CT only. 3 out of 11 patients had a distinct change of target volumes when PET-guided planning was introduced. Dice and mismatch metrics are not sufficient to assess the consequences of target volume differences in the context of RT. PMID:25494657

  16. TEST PLAN AND PROCEDURE FOR THE EXAMINATION OF TANK 241-AY-101 MULTI-PROBE CORROSION MONITORING SYSTEM

    Energy Technology Data Exchange (ETDEWEB)

    WYRWAS RB; PAGE JS; COOKE GS

    2012-04-19

    This test plan describes the methods to be used in the forensic examination of the Multi-probe Corrosion Monitoring System (MPCMS) installed in the double-shell tank 241-AY-101 (AY-101). The probe was designed by Applied Research and Engineering Sciences (ARES) Corporation. The probe contains four sections, each of which can be removed from the tank independently (H-14-107634, AY-101 MPCMS Removable Probe Assembly) and one fixed center assembly. Each removable section contains three types of passive corrosion coupons: bar coupons, round coupons, and stressed C-rings (H-14-l07635, AY-101 MPCMS Details). Photographs and weights of each coupon were recorded and reported on drawing H-14-107634 and in RPP-RPT-40629, 241-AY-101 MPCMS C-Ring Coupon Photographs. The coupons will be the subject of the forensic analyses. The purpose of this examination will be to document the nature and extent of corrosion of the 29 coupons. This documentation will consist of photographs and photomicrographs of the C-rings and round coupons, as well as the weights of the bar and round coupons during corrosion removal. The total weight loss of the cleaned coupons will be used in conjunction with the surface area of each to calculate corrosion rates in mils per year. The bar coupons were presumably placed to investigate the liquid-air-interface. An analysis of the waste level heights in the waste tank will be investigated as part of this examination.

  17. Visual Sample Plan (VSP) Statistical Software as Related to the CTBTO’s On-Site Inspection Procedure

    Energy Technology Data Exchange (ETDEWEB)

    Pulsipher, Trenton C.; Walsh, Stephen J.; Pulsipher, Brent A.; Milbrath, Brian D.

    2010-09-01

    In the event of a potential nuclear weapons test the Comprehensive Nuclear-Test-Ban Treaty Organization (CTBTO) is commissioned to conduct an on-site investigation (OSI) of the suspected test site in an effort to find confirmatory evidence of the nuclear test. The OSI activities include collecting air, surface soil, and underground samples to search for indications of a nuclear weapons test - these indicators include radionuclides and radioactive isotopes Ar and Xe. This report investigates the capability of the Visual Sample Plan (VSP) software to contribute to the sampling activities of the CTBTO during an OSI. VSP is a statistical sampling design software, constructed under data quality objectives, which has been adapted for environmental remediation and contamination detection problems for the EPA, US Army, DoD and DHS among others. This report provides discussion of a number of VSP sample designs, which may be pertinent to the work undertaken during an OSI. Examples and descriptions of such designs include hot spot sampling, combined random and judgment sampling, multiple increment sampling, radiological transect surveying, and a brief description of other potentially applicable sampling methods. Further, this work highlights a potential need for the use of statistically based sample designs in OSI activities. The use of such designs may enable canvassing a sample area without full sampling, provide a measure of confidence that radionuclides are not present, and allow investigators to refocus resources in other areas of concern.

  18. A planning comparison of 7 irradiation options allowed in RTOG 1005 for early-stage breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Guang-Pei, E-mail: gpchen@mcw.edu [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI (United States); Liu, Feng [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI (United States); White, Julia [Department of Radiation Oncology, The Ohio State University, Columbus, OH (United States); Vicini, Frank A. [Michigan Healthcare Professionals/21st Century Oncology, Farmington Hills, MI (United States); Freedman, Gary M. [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA (United States); Arthur, Douglas W. [Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA (United States); Li, X. Allen [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI (United States)

    2015-04-01

    This study compared the 7 treatment plan options in achieving the dose-volume criteria required by the Radiation Therapy Oncology Group (RTOG) 1005 protocol. Dosimetry plans were generated for 15 representative patients with early-stage breast cancer (ESBC) based on the protocol-required dose-volume criteria for each of the following 7 treatment options: 3D conformal radiotherapy (3DCRT), whole-breast irradiation (WBI) plus 3DCRT lumpectomy boost, 3DCRT WBI plus electron boost, 3DCRT WBI plus intensity-modulated radiation therapy (IMRT) boost, IMRT WBI plus 3DCRT boost, IMRT WBI plus electron boost, IMRT WBI plus IMRT boost, and simultaneous integrated boost (SIB) with IMRT. A variety of dose-volume parameters, including target dose conformity and uniformity and normal tissue sparing, were compared for these plans. For the patients studied, all plans met the required acceptable dose-volume criteria, with most of them meeting the ideal criteria. When averaged over patients, most dose-volume goals for all plan options can be achieved with a positive gap of at least a few tenths of standard deviations. The plans for all 7 options are generally comparable. The dose-volume goals required by the protocol can in general be easily achieved. IMRT WBI provides better whole-breast dose uniformity than 3DCRT WBI does, but it causes no significant difference for the dose conformity. All plan options are comparable for lumpectomy dose uniformity and conformity. Patient anatomy is always an important factor when whole-breast dose uniformity and conformity and lumpectomy dose conformity are considered.

  19. Use of PET/CT instead of CT-only when planning for radiation therapy does not notably increase life years lost in children being treated for cancer

    DEFF Research Database (Denmark)

    Kornerup, Josefine S.; Brodin, Nils Patrik; Christensen, Charlotte Birk;

    2015-01-01

    used for radiation therapy planning in children with cancer, and compare to the risks attributable to the cancer treatment. MATERIALS AND METHODS: Organ doses and effective doses were estimated for 40 children (2-18 years old) who had been scanned using PET/CT as part of radiation therapy planning......BACKGROUND: PET/CT may be more helpful than CT alone for radiation therapy planning, but the added risk due to higher doses of ionizing radiation is unknown. OBJECTIVE: To estimate the risk of cancer induction and mortality attributable to the [F-18]2-fluoro-2-deoxyglucose (FDG) PET and CT scans....... Multivariate linear regression was performed to find predictors for a high contribution to life years lost from the radiation therapy planning diagnostics. RESULTS: The mean contribution from PET to the effective dose from one PET/CT scan was 24% (range: 7-64%). The average proportion of life years lost...

  20. Conforming to cancer staging, prognostic indicators and national treatment guidelines.

    Science.gov (United States)

    Dykstra-Long, Gwendylen R

    2011-01-01

    Clinical cancer staging and prognostic indicators guide treatment planning, and as such the American College of Surgeons Commission on Cancer Commission on Cancer (ACoS CoC) and the American Joint Committee on Cancer (AJCC) have recognized this as quality patient care. Overton Brooks Veterans Administration (OBVAMC) developed an organizational policy and procedure, flow algorithms, treatment plan templates, and education strategies in order to conform to this quality care approach. The purpose of this article is to share this systematic approach that is able to support clinical and working cancer stage and prognostic indicators which have been recognized by national standard setting organizations as quality patient care.

  1. Automatic identification of organ/tissue regions in CT image data for the implementation of patient specific phantoms for treatment planning in cancer therapy

    Science.gov (United States)

    Sparks, Richard Blaine

    In vivo targeted radiotherapy has the potential to be an effective treatment for many types of cancer. Agents which show preferred uptake by cancerous tissue are labeled with radio-nuclides and administered to the patient. The preferred uptake by the cancerous tissue allows for the delivery of therapeutically effective radiation absorbed doses to tumors, while sparing normal tissue. Accurate absorbed dose estimation for targeted radiotherapy would be of great clinical value in a patient's treatment planning. One of the problems with calculating absorbed dose involves the use of geometric mathematical models of the human body for the simulation of the radiation transport. Since many patients differ markedly from these models, errors in the absorbed dose estimation procedure result from using these models. Patient specific models developed using individual patient's anatomical structure would greatly enhance the accuracy of dosimetry calculations. Patient specific anatomy data is available from CT or MRI images, but the very time consuming process of manual organ and tissue identification limits its practicality for routine clinical use. This study uses a statistical classifier to automatically identify organs and tissues from CT image data. In this study, image ``slices'' from thirty- five different subjects at approximately the same anatomical position are used to ``train'' the statistical classifier. Multi-dimensional probability distributions of image characteristics, such as location and intensity, are generated from the training images. Statistical classification rules are then used to identify organs and tissues in five previously unseen images. A variety of pre-processing and post-processing techniques are then employed to enhance the classification procedure. This study demonstrated the promise of statistical classifiers for solving segmentation problems involving human anatomy where there is an underlying pattern of structure. Despite the poor quality of

  2. [Promotion plan for the promotion of cancer: coping measures at Matsuyama Red Cross Hospital in Ehime prefecture - the current state of affairs at the hospital's cancer treatment promotion office].

    Science.gov (United States)

    Fujii, Motohiro

    2013-05-01

    Recent cancer control strategies in Japan have been aimed at lowering morbidity and mortality rates, based on the Thirdterm Comprehensive 10-year Strategy for Cancer Control initiated by the Japanese government. In April 2007, the Cancer Control Basic Law was promulgated to necessitate promotion of cancer control by national and local authorities. In June 2007, the Japanese Health Ministry released a plan for the promotion of measures to cope with cancer. The cancer control measures adopted by the Matsuyama Red Cross Hospital(MRCH)in Ehime Prefecture were as follows: ·Progress in the promotion of measures to cope with cancer in Ehime, including a review of 2012, problems with new treatment methods for childhood cancer, employment of cancer patients, and promotion of home care. ·Cancer treatment measures adopted by MRCH as a hub medical institution for the past 5 years. ·The distinctive efforts of the intensive professionals team at the Cancer Treatment Promotion Office for cancer treatment at MRCH, and its work on cancer care from the 4 perspectives of the balanced scorecard in accordance with the basic policy of MRCH. PMID:23863580

  3. CANCER

    Directory of Open Access Journals (Sweden)

    N. Kavoussi

    1973-09-01

    Full Text Available There are many carcinogenetic elements in industry and it is for this reason that study and research concerning the effect of these materials is carried out on a national and international level. The establishment and growth of cancer are affected by different factors in two main areas:-1 The nature of the human or animal including sex, age, point and method of entry, fat metabolism, place of agglomeration of carcinogenetic material, amount of material absorbed by the body and the immunity of the body.2 The different nature of the carcinogenetic material e.g. physical, chemical quality, degree of solvency in fat and purity of impurity of the element. As the development of cancer is dependent upon so many factors, it is extremely difficult to determine whether a causative element is principle or contributory. Some materials are not carcinogenetic when they are pure but become so when they combine with other elements. All of this creates an industrial health problem in that it is almost impossible to plan an adequate prevention and safety program. The body through its system of immunity protects itself against small amounts of carcinogens but when this amount increases and reaches a certain level the body is not longer able to defend itself. ILO advises an effective protection campaign against cancer based on the Well –equipped laboratories, Well-educated personnel, the establishment of industrial hygiene within factories, the regular control of safety systems, and the implementation of industrial health principles and research programs.

  4. Micro-and nanodosimetry for radiobiological planning in radiotherapy and cancer risk assessment in radiation environment

    International Nuclear Information System (INIS)

    Full text: Microdosimetry and nanodosimetry can provide unique information for prediction of radiobiological properties of radiation, which is important in radiation therapy for accurate dose planning and in radiation protection for cancer induction risk assessment. This demand measurements of the pattern of energies deposited by ionizing radiation on cellular scale and DNA levels.Silicon microelectronics technology is offering a unique opportunity for replacing gas proportional counters (TEPC) with miniature detectors for regional microdosimetry. Silicon on Insulator (SOI) technology has been used for the development of arrays of micron size sensitive volumes for modelling energy deposited in biological cells. The challenge in silicon microdosimetry is the development of well defined sensitive volume (SV) and full charge collection deposited by ionizing radiation in the SV. First generation SOI microdosimeters were developed at CMRP and investigated in a wide range of radiation fields for proton and neutron therapies and recently on isotopic neutron sources and heavy ions with energy up to lGeV/jj,m which are typical for deep space radiation environment. Microdosimetric spectra were obtained in a phantom that are well matched to TEPC and Monte Carlo simulations. Evidence that radiations with the same LET exhibit different biological effects demand development of new sensors sensitive to the track structure of ions or the type of particle for prediction of radiobiological effect of radiation using radiobiological models. New monolithic Si AE-E telescope of cellular size for simultaneous regional microdosimetry and particle identification will be presented and results will be discussed. The new design of the SOI microdosimeter is based on 3D micron and submicron size of Si SVs. This approach allows improvement in the accuracy of the Si microdosimetry because of full charge collection and the ability to measure low LET as low as 0.01 keV/jjm, which is similar to TEPC

  5. Predictors of physical activity among rural and small town breast cancer survivors: an application of the theory of planned behaviour.

    Science.gov (United States)

    Vallance, Jeff K; Lavallee, Celeste; Culos-Reed, Nicole S; Trudeau, Marc G

    2012-01-01

    The primary objective of this study was to investigate the utility of the two-component theory of planned behaviour (TPB) in understanding physical activity intentions and behaviour in rural and small town breast cancer survivors. The secondary objective was to elicit the most common behavioural, normative and control beliefs of rural and small town survivors regarding physical activity. Using a cross-sectional survey design, 524 rural and small town breast cancer survivors completed a mailed survey that assessed physical activity and TPB variables. Physical activity intention explained 12% of the variance in physical activity behaviour (p behavioural, normative and control beliefs were elicited from the sample. The two-component TPB framework appears to be a suitable model to initiate an understanding of physical activity determinants among rural and small town breast cancer survivors. These data can be used in the development and establishment of physical activity behaviour interventions and health promotion materials designed to facilitate physical activity behaviour among rural and small town breast cancer survivors. PMID:22409699

  6. Planning study to compare dynamic and rapid arc techniques for postprostatectomy radiotherapy of prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Cambria, R.; Cattani, F.; Pansini, F.; Vigorito, S.; Russo, S. [Istituto Europeo di Oncologia, Department of Medical Physics, Milan (Italy); Jereczek-Fossa, B.A.; Orecchia, R. [Istituto Europeo di Oncologia, Department of Radiation Oncology, Milan (Italy); Universita degli Studi di Milano, Milan (Italy); Ciardo, D.; Zerini, D. [Istituto Europeo di Oncologia, Department of Radiation Oncology, Milan (Italy); Cozzi, L. [Oncology Institute of Southern Switzerland, Medical Physics Unit, Bellinzona (Switzerland)

    2014-06-15

    To compare our standard technique for postprostatectomy radiotherapy of prostate cancer, i.e. using two lateral conformal dynamic arcs with volumetric-modulated arc therapy (VMAT) performed with the RapidArc {sup registered} (Varian Medical Systems, Palo Alto, CA, USA). The plans were referred to as DA and RA, respectively. The treatment plans of 44 patients receiving adjuvant/salvage radiotherapy in the first months of 2010 were compared. In all cases, the prescribed total dose was 66-68.2 Gy (2.2 Gy per fraction). Both DA and RA plans were optimized in terms of dose coverage and constraints. Small differences between the techniques were observed for planning target volume (PTV) dose distribution, whereas significant differences in sparing of organs at risk (OARs) were recorded (p < 0.0001). The OAR values (median; 95 % confidence interval, CI) were: rectum: D{sub 30} {sub %} = 60.7 Gy (59.40-62.04 Gy) and 48.2 Gy (46.40-52.72 Gy), D{sub 60} {sub %} = 34.1 Gy (28.50-38.92 Gy) and 27.7 Gy (21.80-31.51 Gy); bladder: D{sub 30} {sub %} = 57.3 Gy (45.83-64.53 Gy) and 46.4 Gy (33.23-61.48 Gy), D{sub 50} {sub %} = 16.4 Gy (11.89-42.38 Gy) and 17.2 Gy (10.97-27.90 Gy), for DA and RA, respectively. Treatment times were very similar, whereas the monitor units (MU) were 550 ± 29 versus 277 ± 3 for RA and DA, respectively. Dose-volume histograms (DVHs) show improvements in OAR sparing with RA. However, the RA technique is associated with almost double the number of MUs compared to DA. Regarding the PTV, DA is slightly superior in terms of D{sub 2} {sub %} and dose homogeneity. On the whole, the results suggest that RA be the favorable technique. (orig.) [German] Vergleich unserer Standardtechnik bei der Strahlentherapie nach Prostatektomie bei Prostatakrebs, ausgefuehrt mit zwei lateral dynamischen Rotationsbestrahlungen, der volumenmodulierten Arc-Therapie (VMAT, DA) und der RapidArc {sup registered} (RA, Varian Medical Systems, Palo Alto, CA, USA). Es wurden die

  7. Role Of Family Planning Practices In The Control And Prevention of Uterine Cervical Cancer- A Multivariate Analysis

    Directory of Open Access Journals (Sweden)

    Sharma S

    1995-01-01

    Full Text Available Research Question: Does acceptance of family planning reduce the risk of uterine cervical cancer? Objective: To study the association between usage of contraceptive methods and cervical carcinogenesis. Study design: Case control study. Settings: Urban Area â€" Hospital Based. Participants: 160 women having different degrees of dysplasia and 173 women having normal pap smears. Statistical Analysis: Multivariate Analysis. Results: None of the three widely prevalent Family Planning practices viz. IUD condoms and tubectomy turned out to be significant in the development of dysplasia, however, age at consummation of marriage before 18 years and illiteracy were significant. Use of IUD offered protection against carcinoma in situ (CIS and disease of invasive nature. Non- users of condoms were also at risk marginally failing to attain statistical significance.

  8. What Is Cancer?

    Science.gov (United States)

    ... Kidney/Wilms Tumor Liver Cancer Lymphoma (Non-Hodgkin) Lymphoma (Hodgkin) Neuroblastoma Osteosarcoma Retinoblastoma Rhabdomyosarcoma Skin Cancer Soft Tissue Sarcoma Thyroid Cancer Understanding Children's Cancer Anxiety Around Procedures Childhood Cancer Statistics Late ...

  9. Understanding Cancer Prognosis

    Medline Plus

    Full Text Available ... Caregivers Questions to Ask about Advanced Cancer Research Managing Cancer Care Finding Health Care Services Advance Directives ... Feelings Planning for Advanced Cancer Advanced Cancer & Caregivers Managing Cancer Care Finding Health Care Services Advance Directives ...

  10. Distinct effects of rectum delineation methods in 3D-confromal vs. IMRT treatment planning of prostate cancer

    Directory of Open Access Journals (Sweden)

    Vordermark Dirk

    2006-09-01

    Full Text Available Abstract Background The dose distribution to the rectum, delineated as solid organ, rectal wall and rectal surface, in 3D conformal (3D-CRT and intensity-modulated radiotherapy treatment (IMRT planning for localized prostate cancer was evaluated. Materials and methods In a retrospective planning study 3-field, 4-field and IMRT treatment plans were analyzed for ten patients with localized prostate cancer. The dose to the rectum was evaluated based on dose-volume histograms of 1 the entire rectal volume (DVH 2 manually delineated rectal wall (DWH 3 rectal wall with 3 mm wall thickness (DWH3 4 and the rectal surface (DSH. The influence of the rectal filling and of the seminal vesicles' anatomy on these dose parameters was investigated. A literature review of the dose-volume relationship for late rectal toxicity was conducted. Results In 3D-CRT (3-field and 4-field the dose parameters differed most in the mid-dose region: the DWH showed significantly lower doses to the rectum (8.7% ± 4.2% compared to the DWH3 and the DSH. In IMRT the differences between dose parameters were larger in comparison with 3D-CRT. Differences were statistically significant between DVH and all other dose parameters and between DWH and DSH. Mean doses were increased by 23.6% ± 8.7% in the DSH compared to the DVH in the mid-dose region. Furthermore, both the rectal filling and the anatomy of the seminal vesicles influenced the relationship between the dose parameters: a significant correlation of the difference between DVH and DWH and the rectal volume was seen in IMRT treatment. Discussion The method of delineating the rectum significantly influenced the dose representation in the dose-volume histogram. This effect was pronounced in IMRT treatment planning compared to 3D-CRT. For integration of dose-volume parameters from the literature into clinical practice these results have to be considered.

  11. Variation in cancer surgical outcomes associated with physician and nurse staffing: a retrospective observational study using the Japanese Diagnosis Procedure Combination Database

    Directory of Open Access Journals (Sweden)

    Yasunaga Hideo

    2012-05-01

    Full Text Available Abstract Background Little is known about the effects of professional staffing on cancer surgical outcomes. The present study aimed to investigate the association between cancer surgical outcomes and physician/nurse staffing in relation to hospital volume. Methods We analyzed 131,394 patients undergoing lung lobectomy, esophagectomy, gastrectomy, colorectal surgery, hepatectomy or pancreatectomy for cancer between July and December, 2007–2008, using the Japanese Diagnosis Procedure Combination database linked to the Survey of Medical Institutions data. Physician-to-bed ratio (PBR and nurse-to-bed ratio (NBR were determined for each hospital. Hospital volume was categorized into low, medium and high for each of six cancer surgeries. Failure to rescue (FTR was defined as a proportion of inhospital deaths among those with postoperative complications. Multi-level logistic regression analysis was performed to examine the association between physician/nurse staffing and FTR, adjusting for patient characteristics and hospital volume. Results Overall inhospital mortality was 1.8%, postoperative complication rate was 15.2%, and FTR rate was 11.9%. After adjustment for hospital volume, FTR rate in the group with high PBR (≥19.7 physicians per 100 beds and high NBR (≥77.0 nurses per 100 beds was significantly lower than that in the group with low PBR ( Conclusions Well-staffed hospitals confer a benefit for cancer surgical patients regarding reduced FTR, irrespective of hospital volume. These results suggest that consolidation of surgical centers linked with migration of medical professionals may improve the quality of cancer surgical management.

  12. Procedures for the quantitative protein determination of urokinase and its inhibitor, PAI-1, in human breast cancer tissue extracts by ELISA.

    Science.gov (United States)

    Schmitt, Manfred; Sturmheit, Alexandra S; Welk, Anita; Schnelldorfer, Christel; Harbeck, Nadia

    2006-01-01

    The determination of the protein content of urokinase-type plasminogen activator (uPA) and its inhibitor, PAI-1, in breast cancer tissue extracts is used clinically to identify patients at risk to experience disease recurrence (metastasis) or early death. The serine protease uPA, in concert with its inhibitor PAI-1, promotes tumor cell adhesion, migration, and proliferation, as well as extracellular matrix degradation and, thus, facilitates tumor cell invasion and metastasis. The various technical steps to recover uPA and PAI-1 protein from archived breast cancer tissues and to quantitatively determine uPA and PAI-1 protein content in tumor tissue extracts by enzyme-linked immunosorbent assay (ELISA) are described in detail. The technical steps involved require fresh-frozen breast cancer tissue, a dismembrator machine (ball mill) to pulverize the tissue in the frozen state, detergent (Triton X-100) containing Tris-buffered saline to extract uPA and PAI-1 from the pulverized breast cancer tissue, an ultracentrifuge to separate the detergent fraction from cellular debris, uPA and PAI-1 ELISA kits, protein determination reagents, and a 96-well spectrophotometer (ELISA reader) to assess uPA, PAI-1, and total protein in the detergent extract. The uPA/PAI-1 ELISAs and the protein determination format described are robust and highly sensitive. In addition to the macromethod of tissue disintegration, we present a simple but sensitive micro-extraction procedure using cryostat sections or core biopsies as the source of breast cancer tissue. Such a technique allows rapid and quantitative determination of uPA and PAI-1, even in small breast cancer specimens.

  13. Awareness and Practice of Cervical Smear as A Screening Procedure for Cervical Cancer among Female Nurses in A Tertiary Hospital in South-South Nigeria

    Directory of Open Access Journals (Sweden)

    Imoh Unang

    2011-12-01

    Full Text Available AIM: Carcinoma of the cervix, the second most common cancer among women remains a public health problem. Though this preventable cancer occurs more commonly in the developing world, it is almost non-existent in developed countries where there are well established screening programs. The aim of this study is to determine the degree of awareness and practice of cervical smear as a screening procedure for cervical cancer among female nurses in a tertiary health facility in south-south Nigeria. METHOD: Semi-structured questionnaires were distributed to all the female nurses at the University of Uyo Teaching Hospital. RESULTS: The ages of the respondents were between 21 - 60 years with the modal age group being 31- 40 years (48.9%. Majority of the respondents were married (59.7% and 36.4% of them had practiced nursing for over 10 years. Majority of the respondents (94.3% had heard of the cervical smear and 79.5% of the nurses knew that cervical smears were used to detect premalignant diseases of the cervix. Only 7.4% of the nurses had undergone screening for cervical cancer. Common reasons given by the respondents who had not screened were not being a candidate for cervical cancer (31.9% and ignorance as to where screening is done (28.8%. The most common sources of information about cervical smear were the hospital (87.5% and textbooks (13.6%. CONCLUSION: The level of awareness of the cervical smear as a preventive tool for cervical cancer was high but utilization of the test was disappointingly low. Modern concepts of cancer prevention and control should be included in the curriculum of the school of nursing and nurses should be involved in the organisation of health talks to members of the community on cervical cancer and its prevention. The print and electronic media should be made to participate in the dissemination of information on the prevention of cervical cancer in our environment. [TAF Prev Med Bull 2011; 10(6.000: 675-680

  14. Comparison of organ-at-risk sparing and plan robustness for spot-scanning proton therapy and volumetric modulated arc photon therapy in head-and-neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Barten, Danique L. J., E-mail: d.barten@vumc.nl; Tol, Jim P.; Dahele, Max; Slotman, Ben J.; Verbakel, Wilko F. A. R. [Department of Radiotherapy, VU University Medical Center, De Boelelaan 1118, Amsterdam 1081 HV (Netherlands)

    2015-11-15

    Purpose: Proton radiotherapy for head-and-neck cancer (HNC) aims to improve organ-at-risk (OAR) sparing over photon radiotherapy. However, it may be less robust for setup and range uncertainties. The authors investigated OAR sparing and plan robustness for spot-scanning proton planning techniques and compared these with volumetric modulated arc therapy (VMAT) photon plans. Methods: Ten HNC patients were replanned using two arc VMAT (RapidArc) and spot-scanning proton techniques. OARs to be spared included the contra- and ipsilateral parotid and submandibular glands and individual swallowing muscles. Proton plans were made using Multifield Optimization (MFO, using three, five, and seven fields) and Single-field Optimization (SFO, using three fields). OAR sparing was evaluated using mean dose to composite salivary glands (Comp{sub Sal}) and composite swallowing muscles (Comp{sub Swal}). Plan robustness was determined for setup and range uncertainties (±3 mm for setup, ±3% HU) evaluating V95% and V107% for clinical target volumes. Results: Averaged over all patients Comp{sub Sal}/Comp{sub Swal} mean doses were lower for the three-field MFO plans (14.6/16.4 Gy) compared to the three-field SFO plans (20.0/23.7 Gy) and VMAT plans (23.0/25.3 Gy). Using more than three fields resulted in differences in OAR sparing of less than 1.5 Gy between plans. SFO plans were significantly more robust than MFO plans. VMAT plans were the most robust. Conclusions: MFO plans had improved OAR sparing but were less robust than SFO and VMAT plans, while SFO plans were more robust than MFO plans but resulted in less OAR sparing. Robustness of the MFO plans did not increase with more fields.

  15. Rapid Automated Treatment Planning Process to Select Breast Cancer Patients for Active Breathing Control to Achieve Cardiac Dose Reduction

    Energy Technology Data Exchange (ETDEWEB)

    Wang Wei; Purdie, Thomas G. [Radiation Medicine Program, Princess Margaret Hospital, University Health Network, Toronto, ON (Canada); Department of Radiation Oncology, University of Toronto, Toronto, ON (Canada); Rahman, Mohammad; Marshall, Andrea [Radiation Medicine Program, Princess Margaret Hospital, University Health Network, Toronto, ON (Canada); Liu Feifei [Radiation Medicine Program, Princess Margaret Hospital, University Health Network, Toronto, ON (Canada); Department of Radiation Oncology, University of Toronto, Toronto, ON (Canada); Fyles, Anthony, E-mail: anthony.fyles@rmp.uhn.on.ca [Radiation Medicine Program, Princess Margaret Hospital, University Health Network, Toronto, ON (Canada); Department of Radiation Oncology, University of Toronto, Toronto, ON (Canada)

    2012-01-01

    Purpose: To evaluate a rapid automated treatment planning process for the selection of patients with left-sided breast cancer for a moderate deep inspiration breath-hold (mDIBH) technique using active breathing control (ABC); and to determine the dose reduction to the left anterior descending coronary artery (LAD) and the heart using mDIBH. Method and Materials: Treatment plans were generated using an automated method for patients undergoing left-sided breast radiotherapy (n = 53) with two-field tangential intensity-modulated radiotherapy. All patients with unfavorable cardiac anatomy, defined as having >10 cm{sup 3} of the heart receiving 50% of the prescribed dose (V{sub 50}) on the free-breathing automated treatment plan, underwent repeat scanning on a protocol using a mDIBH technique and ABC. The doses to the LAD and heart were compared between the free-breathing and mDIBH plans. Results: The automated planning process required approximately 9 min to generate a breast intensity-modulated radiotherapy plan. Using the dose-volume criteria, 20 of the 53 patients were selected for ABC. Significant differences were found between the free-breathing and mDIBH plans for the heart V{sub 50} (29.9 vs. 3.7 cm{sup 3}), mean heart dose (317 vs. 132 cGy), mean LAD dose (2,047 vs. 594 cGy), and maximal dose to 0.2 cm{sup 3} of the LAD (4,155 vs. 1,507 cGy, all p <.001). Of the 17 patients who had a breath-hold threshold of {>=}0.8 L, 14 achieved a {>=}90% reduction in the heart V{sub 50} using the mDIBH technique. The 3 patients who had had a breath-hold threshold <0.8 L achieved a lower, but still significant, reduction in the heart V{sub 50}. Conclusions: A rapid automated treatment planning process can be used to select patients who will benefit most from mDIBH. For selected patients with unfavorable cardiac anatomy, the mDIBH technique using ABC can significantly reduce the dose to the LAD and heart, potentially reducing the cardiac risks.

  16. Dosimetric study of RapidArc plans with flattened beam (FB and flattening filter-free (FFF beam for localized prostate cancer based on physical indices

    Directory of Open Access Journals (Sweden)

    Birendra Kumar Rout

    2014-12-01

    Full Text Available Purpose: To identify the continual diversity between flattening photon beam (FB and Flattening Filter Free (FFF photon beams for localized prostate cancer; and to determine potential benefits and drawbacks of using unflattened beam for this type of treatment.Methods: Eight prostate cases including seminal vesicles selected for this study. The primary planning target volume (PTVP and boost planning target volume (PTVB were contoured. The total prescription dose was 78 Gy (56 Gy to PTVP and an additional 22 Gy to PTVB. For all cases, treatment plans using 6MV with FB and FFF beams with identical dose-volume constraints, arc angles and number of arcs were developed. The dose volume histograms for both techniques were compared for primary target volume and critical structures.Results: A low Sigma index (FFF: 1.65 + 0.361; FB: 1.725 + 0.39 indicating improved dose homogeneity in FFF beam. Conformity index (FFF: 0.994 + 0.01; FB: 0.993 + 0.01 is comparable for both techniques. Minimal difference of Organ at risk mean dose was observed. Normal tissue integral dose in FB plan resulted 1.5% lower than FFF plan. All the plans displayed significant increase (1.18 times for PTVP and 1.11 for PTBB in the average number of necessary MU with FFF beam.Conclusion: Diversity between FB and FFF beam plans were found. FFF beam accelerator has been utilized to develop clinically acceptable Rapid Arc treatment plans for prostate cancer with 6 MV.---------------------------------Cite this article as: Rout BK, Muralidhar KR, Ali M, Shekar MC, Kumar A. Dosimetric study of RapidArc plans with flattened beam (FB and flattening filter-free (FFF beam for localized prostate cancer based on physical indices. Int J Cancer Ther Oncol 2014; 2(4:02046.  DOI: 10.14319/ijcto.0204.6

  17. Optimization of carbon ion and proton treatment plans using the raster-scanning technique for patients with unresectable pancreatic cancer

    International Nuclear Information System (INIS)

    The aim of the thesis is to improve radiation plans of patients with locally advanced, unresectable pancreatic cancer by using carbon ion and proton beams. Using the treatment planning system Syngo RT Planning (Siemens, Erlangen, Germany) a total of 50 treatment plans have been created for five patients with the dose schedule 15 × 3 Gy(RBE). With reference to the anatomy, five field configurations were considered to be relevant. The plans were analyzed with respect to dose distribution and individual anatomy, and compared using a customized index. Within the index the three-field configurations yielded the best results, though with a high variety of score points (field setup 5, carbon ion: median 74 (range 48–101)). The maximum dose in the myelon is low (e.g. case 3, carbon ion: 21.5 Gy(RBE)). A single posterior field generally spares the organs at risk, but the maximum dose in the myelon is high (e.g. case 3, carbon ion: 32.9 Gy(RBE)). Two oblique posterior fields resulted in acceptable maximum doses in the myelon (e.g. case 3, carbon ion: 26.9 Gy(RBE)). The single-field configuration and the two oblique posterior fields had a small score dispersion (carbon ion: median 66 and 58 (range 62–72 and 40–69)). In cases with topographic proximity of the organs at risk to the target volume, the single-field configuration scored as well as the three-field configurations. In summary, the three-field configurations showed the best dose distributions. A single posterior field seems to be robust and beneficial in case of difficult topographical conditions and topographical proximity of organs at risk to the target volume. A setup with two oblique posterior fields is a reasonable compromise between three-field and single-field configurations

  18. Use of PET/CT instead of CT-only when planning for radiation therapy does not notably increase life years lost in children being treated for cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kornerup, Josefine S.; Munck af Rosenschoeld, Per [Rigshospitalet, Section of Radiotherapy, Department of Oncology, Copenhagen (Denmark); The Niels Bohr Institute, Faculty of Science, University of Copenhagen, Copenhagen (Denmark); Brodin, Patrik [Rigshospitalet, Section of Radiotherapy, Department of Oncology, Copenhagen (Denmark); Institute for Onco-Physics, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY (United States); Birk Christensen, Charlotte; Borgwardt, Lise [Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen (Denmark); Bjoerk-Eriksson, Thomas [Sahlgrenska University Hospital, Department of Oncology, Gothenburg (Sweden); Kiil-Berthelsen, Anne [Rigshospitalet, Section of Radiotherapy, Department of Oncology, Copenhagen (Denmark); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen (Denmark)

    2015-04-01

    PET/CT may be more helpful than CT alone for radiation therapy planning, but the added risk due to higher doses of ionizing radiation is unknown. To estimate the risk of cancer induction and mortality attributable to the [F-18]2-fluoro-2-deoxyglucose (FDG) PET and CT scans used for radiation therapy planning in children with cancer, and compare to the risks attributable to the cancer treatment. Organ doses and effective doses were estimated for 40 children (2-18 years old) who had been scanned using PET/CT as part of radiation therapy planning. The risk of inducing secondary cancer was estimated using the models in BEIR VII. The prognosis of an induced cancer was taken into account and the reduction in life expectancy, in terms of life years lost, was estimated for the diagnostics and compared to the life years lost attributable to the therapy. Multivariate linear regression was performed to find predictors for a high contribution to life years lost from the radiation therapy planning diagnostics. The mean contribution from PET to the effective dose from one PET/CT scan was 24% (range: 7-64%). The average proportion of life years lost attributable to the nuclear medicine dose component from one PET/CT scan was 15% (range: 3-41%). The ratio of life years lost from the radiation therapy planning PET/CT scans and that of the cancer treatment was on average 0.02 (range: 0.01-0.09). Female gender was associated with increased life years lost from the scans (P < 0.001). Using FDG-PET/CT instead of CT only when defining the target volumes for radiation therapy of children with cancer does not notably increase the number of life years lost attributable to diagnostic examinations. (orig.)

  19. Clinical Practice Guidance for Radiotherapy Planning After Induction Chemotherapy in Locoregionally Advanced Head-and-Neck Cancer

    International Nuclear Information System (INIS)

    Purpose: The use of induction chemotherapy (IC) for locoregionally advanced head-and-neck cancer is increasing. The response to IC often causes significant alterations in tumor volume and location and shifts in normal anatomy. Proper determination of the radiotherapy (RT) targets after IC becomes challenging, especially with the use of conformal and precision RT techniques. Therefore, a consensus conference was convened to discuss issues related to RT planning and coordination of care for patients receiving IC. Methods and Materials: Ten participants with special expertise in the various aspects of integration of IC and RT for the treatment of locoregionally advanced head-and-neck cancer, including radiation oncologists, medical oncologists, and a medical physicist, participated. The individual members were assigned topics for focused, didactic presentations. Discussion was encouraged after each presentation, and recommendations were formulated. Results: Recommendations and guidelines emerged that emphasize up-front evaluation by all members of the head-and-neck management team, high-quality baseline and postinduction planning scans with the patient in the treatment position, the use of preinduction target volumes, and the use of full-dose RT, even in the face of a complete response. Conclusion: A multidisciplinary approach is strongly encouraged. Although these recommendations were provided primarily for patients treated with IC, many of these same principles apply to concurrent chemoradiotherapy without IC. A rapid response during RT is quite common, requiring the development of two or more plans in a sizeable fraction of patients, and suggesting the need for similar guidance in the rapidly evolving area of adaptive RT.

  20. PET/CT fusion in radiotherapy planning for lung cancer - case reports

    OpenAIRE

    Erak Marko Đ.; Mitrić Milana; Đuran Branislav; Tešanović Dušanka; Vasiljev Sanja

    2016-01-01

    Introduction. Application of imaging methods, namely computed tomography (CT), magnetic resonance imaging (MRI) and in recent years positron emission tomography-computed tomography (PET/CT), and the progress of computer technology have allowed the construction of effective computerized systems for treatment planning (TPS) and introducing the concept of virtual simulation in 3D conformal radiotherapy planning. Case report. We hereby presented two patients wi...

  1. Lung Cancer Patients’ Decisions About Clinical Trials and the Theory of Planned Behavior

    OpenAIRE

    Quinn, Gwendolyn P.; Pratt, Christie L.; Bryant-George, Kathy; Caraway, Vicki D.; Roldan, Tere; Shaffer, Andrea; Shimizu, Cynthia O.; Vaughn, Elizabeth J.; Williams, Charles; Bepler, Gerold

    2011-01-01

    The theory of planned behavior explores the relationship between behavior, beliefs, attitudes, and intentions presupposing that behavioral intention is influenced by a person’s attitude about the behavior and beliefs about whether individuals, who are important to them, approve or disapprove of the behavior (subjective norm). An added dimension to the theory is the idea of perceived behavioral control, or the belief that one has control over performing the behavior. The theory of planned beha...

  2. Association of sarcopenia and observed physical performance with attainment of multidisciplinary team planned treatment in non-small cell lung cancer: an observational study protocol

    OpenAIRE

    Collins, Jemima T.; Noble, Simon; Chester, John; Davies, Helen E; Evans, William D.; Lester, Jason; Parry, Diane; Pettit, Rebecca J.; Byrne, Anthony

    2015-01-01

    Background Non-small cell lung cancer (NSCLC) frequently presents in advanced stages. A significant proportion of those with reportedly good ECOG performance status (PS) fail to receive planned multidisciplinary team (MDT) treatment, often for functional reasons, but an objective decline in physical performance is not well described. Sarcopenia, or loss of muscle mass, is an integral part of cancer cachexia. However, changes in both muscle mass and physical performance may predate clinically ...

  3. Microbeam radiation therapy. Physical and biological aspects of a new cancer therapy and development of a treatment planning system

    Energy Technology Data Exchange (ETDEWEB)

    Bartzsch, Stefan

    2014-11-05

    Microbeam Radiation Therapy (MRT) is a novel treatment strategy against cancer. Highly brilliant synchrotron radiation is collimated to parallel, a few micrometre wide, planar beams and used to irradiate malignant tissues with high doses. The applied peak doses are considerably higher than in conventional radiotherapy, but valley doses between the beams remain underneath the established tissue tolerance. Previous research has shown that these beam geometries spare normal tissue, while being effective in tumour ablation. In this work physical and biological aspects of the therapy were investigated. A therapy planning system was developed for the first clinical treatments at the European Synchrotron Radiation Facility in Grenoble (France) and a dosimetry method based on radiochromic films was created to validate planned doses with measurements on a micrometre scale. Finally, experiments were carried out on a cellular level in order to correlate the physically planned doses with the biological damage caused in the tissue. The differences between Monte Carlo dose and dosimetry are less than 10% in the valley and 5% in the peak regions. Developed alternative faster dose calculation methods deviate from the computational intensive MC simulations by less than 15% and are able to determine the dose within a few minutes. The experiments in cell biology revealed an significant influence of intercellular signalling on the survival of cells close to radiation boundaries. These observations may not only be important for MRT but also for conventional radiotherapy.

  4. Treatment plan comparison of Linac step and shoot,Tomotherapy, RapidArc, and Proton therapy for prostate cancer using dosimetrical and biological index

    CERN Document Server

    Lee, Suk; Chang, Kyung Hwan; Shim, Jang Bo; Kim, Kwang Hyeon; Lee, Nam Kwon; Park, Young Je; Kim, Chul Yong; Cho, Sam Ju; Lee, Sang Hoon; Min, Chul Kee; Kim, Woo Chul; Cho, Kwang Hwan; Huh, Hyun Do; Lim, Sangwook; Shin, Dongho

    2015-01-01

    The purpose of this study was to use various dosimetrical indices to determine the best IMRT modality technique for treating patients with prostate cancer. Ten patients with prostate cancer were included in this study. Intensity modulated radiation therapy plans were designed to include different modalities, including the linac step and shoot, Tomotherapy, RapidArc, and Proton systems. Various dosimetrical indices, like the prescription isodose to target volume (PITV) ratio, conformity index (CI), homogeneity index (HI), target coverage index (TCI), modified dose homogeneity index (MHI), conformation number (CN), critical organ scoring index (COSI), and quality factor (QF) were determined to compare the different treatment plans. Biological indices such as the generalized equivalent uniform dose (gEUD), based tumor control probability (TCP), and normal tissue complication probability (NTCP) were also calculated and used to compare the treatment plans. The RapidArc plan attained better PTV coverage, as evidenc...

  5. MODERN TECHNOLOGIES IN SQUAMOUS-CELL ANAL CANCER RADIOTHERAPY PLANNING AND TREATMENT

    Directory of Open Access Journals (Sweden)

    S. I. Tkachev

    2013-01-01

    Full Text Available Squamous-cell anal cancer is a rare disease that requires a comprehensive approach in treatment and skilled professionals. Modern diagnostics is important for rational choice of treatment tactics. Radiotherapy is the cornerstone of sphincter-sparing anal cancer treatment. Radiotherapy dose, volume and duration are the key factors affecting treatment efficacy and toxicity.3D-conformal radiotherapy is a priority treatment allowing exact reproduction of treatment conditions, controlled by OBI (on-board imager and kV X-Ray and cone-beam CT analysis. Intensity-modulated radiation therapy (IMRT is a next-generation treatment with improved technologies, allowing better protection of normal tissues.Our experience with 21 squamous-cell anal cancer patients treated with IMRT during Nov 2011 – March 2013 is presented in this article.

  6. Functional Image-Guided Radiotherapy Planning in Respiratory-Gated Intensity-Modulated Radiotherapy for Lung Cancer Patients With Chronic Obstructive Pulmonary Disease

    Energy Technology Data Exchange (ETDEWEB)

    Kimura, Tomoki, E-mail: tkkimura@hiroshima-u.ac.jp [Department of Radiation Oncology, Hiroshima University, Graduate School of Biomedical Sciences, Hiroshima City (Japan); Nishibuchi, Ikuno; Murakami, Yuji; Kenjo, Masahiro; Kaneyasu, Yuko; Nagata, Yasushi [Department of Radiation Oncology, Hiroshima University, Graduate School of Biomedical Sciences, Hiroshima City (Japan)

    2012-03-15

    Purpose: To investigate the incorporation of functional lung image-derived low attenuation area (LAA) based on four-dimensional computed tomography (4D-CT) into respiratory-gated intensity-modulated radiotherapy (IMRT) or volumetric modulated arc therapy (VMAT) in treatment planning for lung cancer patients with chronic obstructive pulmonary disease (COPD). Methods and Materials: Eight lung cancer patients with COPD were the subjects of this study. LAA was generated from 4D-CT data sets according to CT values of less than than -860 Hounsfield units (HU) as a threshold. The functional lung image was defined as the area where LAA was excluded from the image of the total lung. Two respiratory-gated radiotherapy plans (70 Gy/35 fractions) were designed and compared in each patient as follows: Plan A was an anatomical IMRT or VMAT plan based on the total lung; Plan F was a functional IMRT or VMAT plan based on the functional lung. Dosimetric parameters (percentage of total lung volume irradiated with {>=}20 Gy [V20], and mean dose of total lung [MLD]) of the two plans were compared. Results: V20 was lower in Plan F than in Plan A (mean 1.5%, p = 0.025 in IMRT, mean 1.6%, p = 0.044 in VMAT) achieved by a reduction in MLD (mean 0.23 Gy, p = 0.083 in IMRT, mean 0.5 Gy, p = 0.042 in VMAT). No differences were noted in target volume coverage and organ-at-risk doses. Conclusions: Functional IGRT planning based on LAA in respiratory-guided IMRT or VMAT appears to be effective in preserving a functional lung in lung cancer patients with COPD.

  7. Functional Image-Guided Radiotherapy Planning in Respiratory-Gated Intensity-Modulated Radiotherapy for Lung Cancer Patients With Chronic Obstructive Pulmonary Disease

    International Nuclear Information System (INIS)

    Purpose: To investigate the incorporation of functional lung image-derived low attenuation area (LAA) based on four-dimensional computed tomography (4D-CT) into respiratory-gated intensity-modulated radiotherapy (IMRT) or volumetric modulated arc therapy (VMAT) in treatment planning for lung cancer patients with chronic obstructive pulmonary disease (COPD). Methods and Materials: Eight lung cancer patients with COPD were the subjects of this study. LAA was generated from 4D-CT data sets according to CT values of less than than −860 Hounsfield units (HU) as a threshold. The functional lung image was defined as the area where LAA was excluded from the image of the total lung. Two respiratory-gated radiotherapy plans (70 Gy/35 fractions) were designed and compared in each patient as follows: Plan A was an anatomical IMRT or VMAT plan based on the total lung; Plan F was a functional IMRT or VMAT plan based on the functional lung. Dosimetric parameters (percentage of total lung volume irradiated with ≥20 Gy [V20], and mean dose of total lung [MLD]) of the two plans were compared. Results: V20 was lower in Plan F than in Plan A (mean 1.5%, p = 0.025 in IMRT, mean 1.6%, p = 0.044 in VMAT) achieved by a reduction in MLD (mean 0.23 Gy, p = 0.083 in IMRT, mean 0.5 Gy, p = 0.042 in VMAT). No differences were noted in target volume coverage and organ-at-risk doses. Conclusions: Functional IGRT planning based on LAA in respiratory-guided IMRT or VMAT appears to be effective in preserving a functional lung in lung cancer patients with COPD.

  8. Independent position correction on tumor and lymph nodes; consequences for bladder cancer irradiation with two combined IMRT plans

    International Nuclear Information System (INIS)

    The application of lipiodol injections as markers around bladder tumors combined with the use of CBCT for image guidance enables daily on-line position correction based on the position of the bladder tumor. However, this might introduce the risk of underdosing the pelvic lymph nodes. In this study several correction strategies were compared. For this study set-up errors and tumor displacements for ten complete treatments were generated; both were based on the data of 10 bladder cancer patients. Besides, two IMRT plans were made for 20 patients, one for the elective field and a boost plan for the tumor. For each patient 10 complete treatments were simulated. For each treatment the dose was calculated without position correction (option 1), correction on bony anatomy (option 2), on tumor only (option 3) and separately on bone for the elective field (option 4). For each method we analyzed the D99% for the tumor, bladder and lymph nodes and the V95% for the small intestines, rectum, healthy part of the bladder and femoral heads. CTV coverage was significantly lower with options 1 and 2. With option 3 the tumor coverage was not significantly different from the treatment plan. The ΔD99% (D99%, option n - D99%, treatment plan) for option 4 was small, but significant. For the lymph nodes the results from option 1 differed not significantly from the treatment plan. The median ΔD99% of the other options were small, but significant. ΔD99% for PTVbladder was small for options 1, 2 and 4, but decreased up to -8.5 Gy when option 3 was applied. Option 4 is the only method where the difference with the treatment plan never exceeds 2 Gy. The V95% for the rectum, femoral heads and small intestines was small in the treatment plan and this remained so after applying the correction options, indicating that no additional hot spots occurred. Applying independent position correction on bone for the elective field and on tumor for the boost separately gives on average the best target

  9. Feasibility of image registration and intensity-modulated radiotherapy planning with hyperpolarized helium-3 magnetic resonance imaging for non-small-cell lung cancer

    OpenAIRE

    Ireland, Rob H.; Bragg, Chris M; McJury, Mark; Woodhouse, Neil; Fichele, Stan; van Beek, Edwin J. R.; Wild, Jim M.; Hatton, Matthew Q.

    2007-01-01

    PURPOSE: To demonstrate the feasibility of registering hyperpolarized helium-3 magnetic resonance images ((3)He-MRI) to X-ray computed tomography (CT) for functionally weighted intensity-modulated radiotherapy (IMRT) planning.METHODS AND MATERIALS: Six patients with non-small-cell lung cancer underwent (3)He ventilation MRI, which was fused with radiotherapy planning CT using rigid registration. Registration accuracy was assessed using an overlap coefficient, calculated as the proportion of t...

  10. Audiotaped social comparison information for cancer patients undergoing radiotherapy : Differential effects of procedural, emotional and coping information

    NARCIS (Netherlands)

    Bennenbroek, FTC; Buunk, BP; Stiegelis, HE; Hagedoorn, M; Sanderman, R; Van den Bergh, ACM; Botke, G; Buunk, Abraham (Bram)

    2003-01-01

    The present study focused on the effects of social comparison information on subjective understanding of radiation therapy, validation of emotions, and self-efficacy of cancer patients undergoing radiation therapy. The effects of three different audiotapes, containing different kinds of social compa

  11. A treatment planning study of the potential of geometrical tracking for intensity modulated proton therapy of lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Munck af Rosenschoeld, Per; Aznar, Marianne C.; Nygaard, Ditte E.; Persson, Gitte F.; Korreman, Stine S.; Engelholm, Svend Aage (Dept. of Radiation Oncology, Copenhagen Univ. Hospital (Rigshospitalet), Copenhagen (Denmark)), E-mail: per.munck@rh.regionh.dk; Nystroem, Haakan (Niels Bohr Inst., Copenhagen Univ., Copenhagen (Denmark))

    2010-10-15

    Background. Proton therapy of lung cancer holds the potential for a reduction of the volume of irradiated normal lung tissue. In this work we investigate the robustness of intensity modulated proton therapy (IMPT) plans to motion, and evaluate a geometrical tumour tracking method to compensate for tumour motion. Material and methods. Seven patients with a nine targets with 4DCT scans were selected. IMPT plans were made on the midventilation phase using a 3-field technique. The plans were transferred and calculated on the remaining nine phases of the 4DCT, and the combined dose distribution was summed using deformable image registration (DIR). An additional set of plans were made in which the proton beam was simply geometrically shifted to the centre of the gross tumour volume (GTV), i.e. simulating tracking of the tumour motion but without on-line adjustment of the proton energies. A possible interplay effect between the dynamics of the spot scanning delivery and the tumour motion has not been considered in this work. Results. Around 97-100% of the GTV was covered by 95% of the prescribed dose (V95) for a tumour displacement of less than about 1 cm with a static beam. For the remaining three of nine targets with a larger motion the tracking method studied provided a marked improvement over static beam; raising the GTV V95 from 95 to 100%, 82 to 98% and 51 to 97%, respectively. Conclusion. The possibility of performing DIR and summing the dose on the 4DCT data set was shown to be feasible. The fairly simplistic tracking method suggested here resulted in a marked improvement in GTV coverage for tumours with large intra-fractional motion (>1 cm displacement), indicating that on-line adjustment of the proton energies may be redundant.

  12. MO-C-17A-06: Online Adaptive Re-Planning to Account for Independent Motions Between Multiple Targets During Radiotherapy of Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Liu, F; Tai, A; Ahunbay, E; Gore, E; Johnstone, C; Li, X [Medical College of Wisconsin, Milwaukee, WI (United States)

    2014-06-15

    Purpose: To quantify interfractional independent motions between multiple targets in radiotherapy (RT) of lung cancer, and to study the dosimetric benefits of an online adaptive replanning method to account for these variations. Methods: Ninety five diagnostic-quality daily CTs acquired for 9 lung cancer patients treated with IGRT using an in-room CT (CTVision, Siemens) were analyzed. On each daily CT set, contours of the targets (GTV, CTV, or involved nodes) and organs at risk were generated by populating the planning contours using an auto-segmentation tool (ABAS, Elekta) with manual editing. For each patient, an IMRT plan was generated based on the planning CT with a prescription dose of 60 Gy in 2Gy fractions. Three plans were generated and compared for each daily CT set: an IGRT (repositioning) plan by copying the original plan with the required shifts, an online adaptive plan by rapidly modifying the aperture shapes and segment weights of the original plan to conform to the daily anatomy, and a new fully re-optimized plan based on the daily CT using a planning system (Panther, Prowess). Results: The daily deviations of the distance between centers of masses of the targets from the plans varied daily from -10 to 8 mm with an average −0.9±4.1 mm (one standard deviation). The average CTV V100 are 99.0±0.7%, 97.9±2.8%, 99.0±0.6%, and 99.1±0.6%, and the lung V20 Gy 928±332 cc, 944±315 cc, 917±300 cc, and 891±295 cc for the original, repositioning, adaptive, and re-optimized plans, respectively. Wilcoxon signed-rank tests show that the adaptive plans are statistically significantly better than the repositioning plans and comparable with the reoptimized plans. Conclusion: There exist unpredictable, interfractional, relative volume changes and independent motions between multiple targets during lung cancer RT which cannot be accounted for by the current IGRT repositioning but can be corrected by the online adaptive replanning method.

  13. MO-C-17A-06: Online Adaptive Re-Planning to Account for Independent Motions Between Multiple Targets During Radiotherapy of Lung Cancer

    International Nuclear Information System (INIS)

    Purpose: To quantify interfractional independent motions between multiple targets in radiotherapy (RT) of lung cancer, and to study the dosimetric benefits of an online adaptive replanning method to account for these variations. Methods: Ninety five diagnostic-quality daily CTs acquired for 9 lung cancer patients treated with IGRT using an in-room CT (CTVision, Siemens) were analyzed. On each daily CT set, contours of the targets (GTV, CTV, or involved nodes) and organs at risk were generated by populating the planning contours using an auto-segmentation tool (ABAS, Elekta) with manual editing. For each patient, an IMRT plan was generated based on the planning CT with a prescription dose of 60 Gy in 2Gy fractions. Three plans were generated and compared for each daily CT set: an IGRT (repositioning) plan by copying the original plan with the required shifts, an online adaptive plan by rapidly modifying the aperture shapes and segment weights of the original plan to conform to the daily anatomy, and a new fully re-optimized plan based on the daily CT using a planning system (Panther, Prowess). Results: The daily deviations of the distance between centers of masses of the targets from the plans varied daily from -10 to 8 mm with an average −0.9±4.1 mm (one standard deviation). The average CTV V100 are 99.0±0.7%, 97.9±2.8%, 99.0±0.6%, and 99.1±0.6%, and the lung V20 Gy 928±332 cc, 944±315 cc, 917±300 cc, and 891±295 cc for the original, repositioning, adaptive, and re-optimized plans, respectively. Wilcoxon signed-rank tests show that the adaptive plans are statistically significantly better than the repositioning plans and comparable with the reoptimized plans. Conclusion: There exist unpredictable, interfractional, relative volume changes and independent motions between multiple targets during lung cancer RT which cannot be accounted for by the current IGRT repositioning but can be corrected by the online adaptive replanning method

  14. Significance of modified Lawrence's reconstuction procedures following total gastrectomy for gastric cancer%全胃切除改良Lawrence法消化道重建的意义

    Institute of Scientific and Technical Information of China (English)

    邹小明; 宋茂力; 聂刚; 李刚; 佟佰峰; 姜浩

    2011-01-01

    目的 探讨胃癌全胃切除术改良Lawrence法消化道重建对患者营养吸收的影响.方法 对76例全胃切除患者,行改良Lawrence法消化道重建3个月和6个月的营养状况及消化道症状进行回顾性分析.结果 76例患者中48例患者于术后3个月行钡餐检查,钡剂排空时间为60~100 min,站立位与平卧位均未见钡剂反流入食管,无吻合口狭窄的征象.分别于术后3个月和6个月复查血红蛋白、总蛋白、体重、进食量,均达到或接近术前水平.结论 该术式使患者在术后短期内恢复正常饮食习惯,手术操作简便、安全,是全胃切除术后一种理想的消化道重建术式.%Objective To explore the influence of modified Lawrence's reconstuction procedures following total gastrectomy for gastric cancer to alimentation of patients. Methods Retrospective analysis of nutritional status and symptoms of digestive tract in 76 patiens of total gastrectomy for gastric cancer while 3 and 6 month after modified Lawrence's reconstuction procedure. Results Examination was given in 48 patients 3 month after operation. Emptying time of barium was 60-100 min, barium meal backflowing to esophagus was not observed in all patients when they were in erect or decubitus position, no sign of narrow of anastomotic stoma. The hemoglobin, total protein, body weight and food-intake of patients 3 or 6 months after operation was as same as them before operation. Conclusion The patients undergoing this reconstuction procedure will recover normal food habits soon after operation, Lawrence's reconstuction procedures is a satisfactory choice in patients of total gastrectomy for gastric cancer because of its safety and convenient.

  15. Advantage of three-dimensional treatment planning for localized radiotherapy of early stage prostatic cancer

    International Nuclear Information System (INIS)

    Conventional two-dimensional (2-d) treatment planning was compared to three-dimensional (3-d) treatment planning for patients with prostatic carcinoma. Both types of treatment planning were performed for all ten patients with five fixed fields. In 3-d planning we used irregular shaped fields. For further evaluation we performed conventional planning in rotation technique in two patients. The target volume included prostate prostate, seminal vesicles and a surrounding security margin of 2 cm. Using the MPR-version of the MEVAPLAN planning system, the three-dimensional dose calculations were performed. For the volumes of interest (VOI's) we discussed quality of the dose distribution concerning homogeneity in the target volume and isodose distribution in the organs at risk, which are the rectum and the urinary bladder. We defined the tumor encompassing reference isodose (ca. 95%) for the calculation of the involved rectum- and bladder volume. Using the five-field technique our results show a reduction of the radiation related rectum- and bladder volume concerning the tumor encompassing reference isodose (ca. 95%) for the rectum inbetween 9.5 and 36.6% (median: 19%, n=10) and for the urinary bladder inbetween 15.7 and 47.8% (median 28%, n=10). Calculated for 80% of the reference isodose the difference for the rectum was 15.7 to 31.3% (median: 23%) and for the urinary bladder 24.5% to 56.7% (median: 42%). A significant reduction of radiation related side-effects concerning rectum and urinary bladder can be expected by a reduction of volume involvement and a consecutive dosage limitation. (orig.)

  16. Is radiation-induced ovarian ablation in breast cancer an obsolete procedure? Results of a meta-analysis

    Directory of Open Access Journals (Sweden)

    Al Asiri M

    2016-05-01

    Full Text Available Mushabbab Al Asiri,1,* Mutahir A Tunio,1,* Reham Abdulmoniem,2,*1Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia; 2Radiation Oncology, National Cancer Institute, Cairo, Egypt *These authors contributed equally to this work Background: A meta-analysis was conducted to assess the impact of radiation-induced ovarian ablation (RT-OA on amenorrhea cessation rates, progression-free survival, and overall survival in pre/perimenopausal women with breast cancer. Materials and methods: The Medline, CANCERLIT, and Cochrane Library databases and search engines were searched to identify randomized controlled studies comparing RT-OA with control for early or metastatic breast cancer. Further, radiotherapy doses, techniques, and associated side effects were evaluated. Results: Six controlled trials with a total patient population of 3,317 were identified. Pooled results from these trials showed significant amenorrhea rates (P<0.00001 and increase in progression-free survival in patients treated with RT-OA (P<0.00001. However, there was no difference in overall survival (P=0.37. The majority of patients were treated with larger field sizes with parallel-opposed anteroposterior and posteroanterior pelvic fields. RT-OA was generally well tolerated. Radiotherapy doses of 1,500 cGy in five fractions, 1,500 cGy in four fractions, 1,600 cGy in four fractions, and 2,000 cGy in ten fractions were associated with excellent amenorrhea rates. The resultant funnel plot showed no publication bias (Egger test P=0.16. Conclusion: RT-OA is cost-effective and can safely be used in pre/perimenopausal women with metastatic breast cancer, or if luteinizing hormone-releasing hormone analogs are contraindicated, or in patients in whom fertility preservation is not an issue. Radiation dose of 1,500 cGy in five fractions, 1,500 cGy in four fractions, 1,600 cGy in four fractions, and 2,000 cGy in ten fractions showed more efficacies

  17. Preliminary evaluation of multifield and single-field optimization for the treatment planning of spot-scanning proton therapy of head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Quan, Enzhuo M.; Liu, Wei; Wu, Richard; Zhang, Xiaodong; Zhu, X. Ronald; Mohan, Radhe [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030 (United States); Li, Yupeng [Varian Medical Systems, Inc., Palo Alto, California 94304 (United States); Frank, Steven J. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030 (United States)

    2013-08-15

    Purpose: Spot-scanning proton therapy (SSPT) using multifield optimization (MFO) can generate highly conformal dose distributions, but it is more sensitive to setup and range uncertainties than SSPT using single-field optimization (SFO). The authors compared the two optimization methods for the treatment of head and neck cancer with bilateral targets and determined the superior method on the basis of both the plan quality and the plan robustness in the face of setup and range uncertainties.Methods: Four patients with head and neck cancer with bilateral targets who received SSPT treatment in the authors' institution were studied. The patients had each been treated with a MFO plan using three fields. A three-field SFO plan (3F-SFO) and a two-field SFO plan (2F-SFO) with the use of a range shifter in the beam line were retrospectively generated for each patient. The authors compared the plan quality and robustness to uncertainties of the SFO plans with the MFO plans. Robustness analysis of each plan was performed to generate the two dose distributions consisting of the highest and the lowest possible doses (worst-case doses) from the spatial and range perturbations at every voxel. Dosimetric indices from the nominal and worst-case plans were compared.Results: The 3F-SFO plans generally yielded D95 and D5 values in the targets that were similar to those of the MFO plans. 3F-SFO resulted in a lower dose to the oral cavity than MFO in all four patients by an average of 9.9 Gy, but the dose to the two parotids was on average 6.7 Gy higher for 3F-SFO than for MFO. 3F-SFO plans reduced the variations of dosimetric indices under uncertainties in the targets by 22.8% compared to the MFO plans. Variations of dosimetric indices under uncertainties in the organs at risk (OARs) varied between organs and between patients, although they were on average 9.2% less for the 3F-SFO plans than for the MFO plans. Compared with the MFO plans, the 2F-SFO plans showed a reduced dose to

  18. Difference in the Set-up Margin between 2D Conventional and 3D CT Based Planning in Patients with Early Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Jo, Sun Mi; Chun, Mi Sun; Kim, Mi Hwa; Oh, Young Taek; Noh, O Kyu [Ajou University School of Medicine, Seoul (Korea, Republic of); Kang, Seung Hee [Inje University, Ilsan Paik Hospital, Ilsan (Korea, Republic of)

    2010-11-15

    Simulation using computed tomography (CT) is now widely available for radiation treatment planning for breast cancer. It is an important tool to help define the tumor target and normal tissue based on anatomical features of an individual patient. In Korea, most patients have small sized breasts and the purpose of this study was to review the margin of treatment field between conventional two-dimensional (2D) planning and CT based three-dimensional (3D) planning in patients with small breasts. Twenty-five consecutive patients with early breast cancer undergoing breast conservation therapy were selected. All patients underwent 3D CT based planning with a conventional breast tangential field design. In 2D planning, the treatment field margins were determined by palpation of the breast parenchyma (In general, the superior: base of the clavicle, medial: midline, lateral: mid - axillary line, and inferior margin: 2 m below the inflamammary fold). In 3D planning, the clinical target volume (CTV) ought to comprise all glandular breast tissue, and the PTV was obtained by adding a 3D margin of 1 cm around the CTV except in the skin direction. The difference in the treatment field margin and equivalent field size between 2D and 3D planning were evaluated. The association between radiation field margins and factors such as body mass index, menopause status, and bra size was determined. Lung volume and heart volume were examined on the basis of the prescribed breast radiation dose and 3D dose distribution. The margins of the treatment field were smaller in the 3D planning except for two patients. The superior margin was especially variable (average, 2.5 cm; range, -2.5 to 4.5 cm; SD, 1.85). The margin of these targets did not vary equally across BMI class, menopause status, or bra size. The average irradiated lung volume was significantly lower for 3D planning. The average irradiated heart volume did not decrease significantly. The use of 3D CT based planning reduced the

  19. Is radiation-induced ovarian ablation in breast cancer an obsolete procedure? Results of a meta-analysis

    Science.gov (United States)

    Asiri, Mushabbab Al; Tunio, Mutahir A; Abdulmoniem, Reham

    2016-01-01

    Background A meta-analysis was conducted to assess the impact of radiation-induced ovarian ablation (RT-OA) on amenorrhea cessation rates, progression-free survival, and overall survival in pre/perimenopausal women with breast cancer. Materials and methods The Medline, CANCERLIT, and Cochrane Library databases and search engines were searched to identify randomized controlled studies comparing RT-OA with control for early or metastatic breast cancer. Further, radiotherapy doses, techniques, and associated side effects were evaluated. Results Six controlled trials with a total patient population of 3,317 were identified. Pooled results from these trials showed significant amenorrhea rates (Pwomen with metastatic breast cancer, or if luteinizing hormone-releasing hormone analogs are contraindicated, or in patients in whom fertility preservation is not an issue. Radiation dose of 1,500 cGy in five fractions, 1,500 cGy in four fractions, 1,600 cGy in four fractions, and 2,000 cGy in ten fractions showed more efficacies. However, further studies incorporating three-dimensional conformal radiotherapy and intensity-modulated radiotherapy are warranted. PMID:27307764

  20. Understanding surgery choices for breast cancer: how might the Theory of Planned Behaviour and the Common Sense Model contribute to decision support interventions?

    NARCIS (Netherlands)

    Sivell, S.; Edwards, A.; Elwyn, G.; Manstead, A.S.

    2011-01-01

    OBJECTIVE: To describe the evidence about factors influencing breast cancer patients' surgery choices and the implications for designing decision support in reference to an extended Theory of Planned Behaviour (TPB) and the Common Sense Model of Illness Representations (CSM). BACKGROUND: A wide rang

  1. Treatment of breast cancer with simultaneous integrated boost in hybrid plan technique. Influence of flattening filter-free beams

    Energy Technology Data Exchange (ETDEWEB)

    Bahrainy, Marzieh; Kretschmer, Matthias; Joest, Vincent; Kasch, Astrid; Wuerschmidt, Florian; Dahle, Joerg; Lorenzen, Joern [Radiologische Allianz, Hamburg (Germany)

    2016-05-15

    The present study compares in silico treatment plans using hybrid plan technique during hypofractionated radiation of mammary carcinoma with simultaneous integrated boost (SIB). The influence of 6 MV photon radiation in flattening filter free (FFF) mode against the clinical standard flattening filter (FF) mode is to be examined. RT planning took place with FF and FFF radiation plans for 10 left-sided breast cancer patients. Hybrid plans were realised with two tangential IMRT fields and one VMAT field. The dose prescription was in line with the guidelines in the ARO-2010-01 study. The dosimetric verification took place with a manufacturer-independent measurement system. Required dose prescriptions for the planning target volumes (PTV) were achieved for both groups. The average dose values of the ipsi- and contralateral lung and the heart did not differ significantly. The overall average incidental dose to the left anterior descending artery (LAD) of 8.24 ± 3.9 Gy in the FFF group and 9.05 ± 3.7 Gy in the FF group (p < 0.05) were found. The dosimetric verifications corresponded to the clinical requirements. FFF-based RT plans reduced the average treatment time by 17 s/fraction. In comparison to the FF-based hybrid plan technique the FFF mode allows further reduction of the average LAD dose for comparable target volume coverage without adverse low-dose exposure of contralateral structures. The combination of hybrid plan technique and 6 MV photon radiation in the FFF mode is suitable for use with hypofractionated dose schemes. The increased dose rate allows a substantial reduction of treatment time and thus beneficial application of the deep inspiration breath hold technique. (orig.) [German] Vergleich der ''In-silico''-Bestrahlungsplaene der klinisch etablierten Hybridplan-Technik bei hypofraktionierter Bestrahlung des Mammakarzinoms mit simultan integriertem Boost (SIB). Untersucht wird der Einfluss von 6MV-Photonenstrahlung im Flattening

  2. Experience in the treatment of IMRT in prostate cancer. Planning, dosimetry and quality control; Experiencia en el tratamiento de IMRT en cancer de prostata. Planificacion, dosimetria y control de calidad

    Energy Technology Data Exchange (ETDEWEB)

    Gomez Barrado, A.; Garcia Vicente, F.; Fernandez Bedoya, V.; Bermudez Luna, R.; Perez Gonzalez, L.; Torres Escobar, J. J.

    2011-07-01

    The aim of this study is to review the treatment of prostate cancer at our center. A description of the entire procedure, involving clinical dosimetry, and procedures for verification of treatment, including physical dosimetry and parallel computing system MSure (Standard Imaging, Inc., Middleton) as part of these procedures. This system is based on the model published by trifuente Yang et al. (Yang et al. 2002) for testing treatments regarding the number of monitor unit (MU) given. In addition, this software has a module for the testing of treatments for intensity modulated radiotherapy (IMRT), which will be analyzed in this study.

  3. SU-E-T-616: Comparison of Plan Dose Accuracy for Anterior Vs. Lateral Fields in Proton Therapy of Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Moteabbed, M; Trofimov, A; Testa, M; Sharp, G; Wang, Y; Paganetti, H; Zietman, A; Efstathiou, J; Lu, H [Massachusetts General Hospital, Boston, MA (United States)

    2014-06-01

    Purpose: With the anticipated introduction of in vivo range verification methods, the use of anterior fields for proton therapy of prostate cancer may become an attractive treatment option, and improve upon the dose distributions achievable with conventional lateral-opposed fields. This study aimed to evaluate and compare the planned dose accuracy for lateral versus anterior oblique field arrangements. Methods: Four patients with low/intermediate risk prostate cancer, participating in a clinical trial at our institution, were selected for this study. All patients were treated using lateral-opposed fields (LAT). The clinical target volume (CTV) received a total dose of 79.2 Gy in 44 fractions. Anterior oblique research plans (ANT) were created using the clinical planning system, and featured beams with ±35-degree gantry angle, 1.2 cm aperture margins, 3-mm range compensator smearing and no range uncertainty margins. Monte Carlo (MC) simulations were performed for both beam arrangements using TOPAS. Dose volume histograms were analyzed and compared for planned and MC dose distributions. Differences between MC and planned DVH parameters were computed as a percentage of the total prescribed dose. Results: For all patients, CTV dose was systematically lower (∼2–2.5%) for MC than the plan. This discrepancy was slightly larger (∼0.5%) for LAT compared to ANT plans for all cases. Although the dose differences for bladder and anterior rectal wall remained within 0.7% for all LAT cases, they were slightly larger for ANT plans, especially for case 3 due to larger patient size and MC-plan range difference. The EUD difference for femoral heads was within 0.6% for both LAT and ANT cases. Conclusion: The dose calculated by the treatment planning system using pencil beam algorithm agrees with MC to within 2.5% and is comparable for lateral and anterior scenarios. The dose agreement in the anterior rectal wall is range- and hence, patient-dependent for ANT treatments.

  4. Effect of deformable registration on the dose calculated in radiation therapy planning CT scans of lung cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Cunliffe, Alexandra R.; Armato, Samuel G.; White, Bradley; Justusson, Julia [Department of Radiology, The University of Chicago, 5841 South Maryland Avenue, Chicago, Illinois 60637 (United States); Contee, Clay; Malik, Renuka; Al-Hallaq, Hania A., E-mail: hal-hallaq@radonc.uchicago.edu [Department of Radiation and Cellular Oncology, The University of Chicago, 5841 South Maryland Avenue, Chicago, Illinois 60637 (United States)

    2015-01-15

    Purpose: To characterize the effects of deformable image registration of serial computed tomography (CT) scans on the radiation dose calculated from a treatment planning scan. Methods: Eighteen patients who received curative doses (≥60 Gy, 2 Gy/fraction) of photon radiation therapy for lung cancer treatment were retrospectively identified. For each patient, a diagnostic-quality pretherapy (4–75 days) CT scan and a treatment planning scan with an associated dose map were collected. To establish correspondence between scan pairs, a researcher manually identified anatomically corresponding landmark point pairs between the two scans. Pretherapy scans then were coregistered with planning scans (and associated dose maps) using the demons deformable registration algorithm and two variants of the Fraunhofer MEVIS algorithm (“Fast” and “EMPIRE10”). Landmark points in each pretherapy scan were automatically mapped to the planning scan using the displacement vector field output from each of the three algorithms. The Euclidean distance between manually and automatically mapped landmark points (d{sub E}) and the absolute difference in planned dose (|ΔD|) were calculated. Using regression modeling, |ΔD| was modeled as a function of d{sub E}, dose (D), dose standard deviation (SD{sub dose}) in an eight-pixel neighborhood, and the registration algorithm used. Results: Over 1400 landmark point pairs were identified, with 58–93 (median: 84) points identified per patient. Average |ΔD| across patients was 3.5 Gy (range: 0.9–10.6 Gy). Registration accuracy was highest using the Fraunhofer MEVIS EMPIRE10 algorithm, with an average d{sub E} across patients of 5.2 mm (compared with >7 mm for the other two algorithms). Consequently, average |ΔD| was also lowest using the Fraunhofer MEVIS EMPIRE10 algorithm. |ΔD| increased significantly as a function of d{sub E} (0.42 Gy/mm), D (0.05 Gy/Gy), SD{sub dose} (1.4 Gy/Gy), and the algorithm used (≤1 Gy). Conclusions: An

  5. Comparison of the dose distribution obtained from dosimetric systems with intensity modulated radiotherapy planning system in the treatment of prostate cancer

    Science.gov (United States)

    Gökçe, M.; Uslu, D. Koçyiǧit; Ertunç, C.; Karalı, T.

    2016-03-01

    The aim of this study is to compare Intensity Modulated Radiation Therapy (IMRT) plan of prostate cancer patients with different dose verification systems in dosimetric aspects and to compare these systems with each other in terms of reliability, applicability and application time. Dosimetric control processes of IMRT plan of three prostate cancer patients were carried out using thermoluminescent dosimeter (TLD), ion chamber (IC) and 2D Array detector systems. The difference between the dose values obtained from the dosimetric systems and treatment planning system (TPS) were found to be about % 5. For the measured (TLD) and calculated (TPS) doses %3 percentage differences were obtained for the points close to center while percentage differences increased at the field edges. It was found that TLD and IC measurements will increase the precision and reliability of the results of 2D Array.

  6. An analysis of 6-MV versus 18-MV photon energy plans for intensity-modulated radiation therapy (IMRT) of lung cancer

    International Nuclear Information System (INIS)

    Purpose: To analyse the supposed benefits of low over high photon energies for the radiotherapy of lung cancer. Materials and methods: For 13 patients, 6- and 18-MV IMRT planning was performed using identical planning objectives and dose constraints. Plans were compared according to dose-volume histogram (DVH) analysis including conformity and homogeneity indices (CI and HI) and overall plan quality (composite score CS), considering also magnitude and location of planning target volumes (PTVs). Results: With 6-MV plans, CSs were better in 11/13, HIs in 10/13 and CIs in 6/13 patients compared with 18-MV plans. Six-MV plans resulted in a better normal tissue sparing except for specified dose levels to the thorax and spinal cord. On average differences between 6 and 18 MV both for the PTV and normal tissues were not statistically significant (p > 0.05). Considering size and location of the PTVs as well as their relative position to normal tissue, overall no significant differences between 6 and 18 MV were observed. Conclusions: On average no clinically or statistically significant differences between 6- and 18-MV plans were observed. High photon energies should therefore not be excluded a priori when a dose-calculation algorithm is utilized that accurately accounts for heterogeneities

  7. Randomized Controlled Trial of Forward-Planned Intensity Modulated Radiotherapy for Early Breast Cancer: Interim Results at 2 Years

    International Nuclear Information System (INIS)

    Purpose: This single-center randomized trial was designed to investigate whether intensity-modulated radiotherapy (IMRT) reduces late toxicity in patients with early-stage breast cancer. Methods and Materials: The standard tangential plans of 1,145 nonselected patients were analyzed. The patients with inhomogeneous plans were randomized to a simple method of forward-planned IMRT or standard radiotherapy (RT). The primary endpoint was serial photographic assessment of breast shrinkage. Results: At 2 years, no significant difference was found in the development of any photographically assessed breast shrinkage between the patients randomized to the interventional or control group (odds ratio, 1.51; 95% confidence interval, 0.83–1.58; p = .41). The patients in the control group were more likely to develop telangiectasia than those in the IMRT group (odds ratio, 1.68; 95% confidence interval 1.13–2.40; p = .009). Poor baseline surgical cosmesis resulted in poor overall cosmesis at 2 years after RT. In patients who had good surgical cosmesis, those randomized to IMRT were less likely to deteriorate to a moderate or poor overall cosmesis than those in the control group (odds ratio, 0.63; 95% confidence interval, 0.39–1.03, p = .061). Conclusions: IMRT can lead to a significant reduction in telangiectasia at comparatively early follow-up of only 2 years after RT completion. An important component of breast induration and shrinkage will actually result from the surgery and not from the RT. Surgical cosmesis is an important determinant of overall cosmesis and could partially mask the longer term benefits of IMRT at this early stage.

  8. Comparative study of four advanced 3d-conformal radiation therapy treatment planning techniques for head and neck cancer.

    Science.gov (United States)

    Herrassi, Mohamed Yassine; Bentayeb, Farida; Malisan, Maria Rosa

    2013-04-01

    For the head-and-neck cancer bilateral irradiation, intensity-modulated radiation therapy (IMRT) is the most reported technique as it enables both target dose coverage and organ-at-risk (OAR) sparing. However, during the last 20 years, three-dimensional conformal radiotherapy (3DCRT) techniques have been introduced, which are tailored to improve the classic shrinking field technique, as regards both planning target volume (PTV) dose conformality and sparing of OAR's, such as parotid glands and spinal cord. In this study, we tested experimentally in a sample of 13 patients, four of these advanced 3DCRT techniques, all using photon beams only and a unique isocentre, namely Bellinzona, Forward-Planned Multisegments (FPMS), ConPas, and field-in-field (FIF) techniques. Statistical analysis of the main dosimetric parameters of PTV and OAR's DVH's as well as of homogeneity and conformity indexes was carried out in order to compare the performance of each technique. The results show that the PTV dose coverage is adequate for all the techniques, with the FPMS techniques providing the highest value for D95%; on the other hand, the best sparing of parotid glands is achieved using the FIF and ConPas techniques, with a mean dose of 26 Gy to parotid glands for a PTV prescription dose of 54 Gy. After taking into account both PTV coverage and parotid sparing, the best global performance was achieved by the FIF technique with results comparable to that of IMRT plans. This technique can be proposed as a valid alternative when IMRT equipment is not available or patient is not suitable for IMRT treatment.

  9. Randomized Controlled Trial of Forward-Planned Intensity Modulated Radiotherapy for Early Breast Cancer: Interim Results at 2 Years

    Energy Technology Data Exchange (ETDEWEB)

    Barnett, Gillian C. [Department of Oncology, University of Cambridge, Cambridge University Hospitals, National Health Service Foundation Trust, Cambridge (United Kingdom); Wilkinson, Jennifer S.; Moody, Anne M.; Wilson, Charles B.; Twyman, Nicola [Oncology Centre, Cambridge University Hospitals, National Health Services Foundation Trust, Cambridge (United Kingdom); Wishart, Gordon C. [Cambridge Breast Unit, Addenbrooke' s Hospital, Cambridge (United Kingdom); Burnet, Neil G. [Department of Oncology, University of Cambridge, Cambridge University Hospitals, National Health Service Foundation Trust, Cambridge (United Kingdom); Coles, Charlotte E., E-mail: charlotte.coles@addenbrookes.nhs.uk [Oncology Centre, Cambridge University Hospitals, National Health Services Foundation Trust, Cambridge (United Kingdom)

    2012-02-01

    Purpose: This single-center randomized trial was designed to investigate whether intensity-modulated radiotherapy (IMRT) reduces late toxicity in patients with early-stage breast cancer. Methods and Materials: The standard tangential plans of 1,145 nonselected patients were analyzed. The patients with inhomogeneous plans were randomized to a simple method of forward-planned IMRT or standard radiotherapy (RT). The primary endpoint was serial photographic assessment of breast shrinkage. Results: At 2 years, no significant difference was found in the development of any photographically assessed breast shrinkage between the patients randomized to the interventional or control group (odds ratio, 1.51; 95% confidence interval, 0.83-1.58; p = .41). The patients in the control group were more likely to develop telangiectasia than those in the IMRT group (odds ratio, 1.68; 95% confidence interval 1.13-2.40; p = .009). Poor baseline surgical cosmesis resulted in poor overall cosmesis at 2 years after RT. In patients who had good surgical cosmesis, those randomized to IMRT were less likely to deteriorate to a moderate or poor overall cosmesis than those in the control group (odds ratio, 0.63; 95% confidence interval, 0.39-1.03, p = .061). Conclusions: IMRT can lead to a significant reduction in telangiectasia at comparatively early follow-up of only 2 years after RT completion. An important component of breast induration and shrinkage will actually result from the surgery and not from the RT. Surgical cosmesis is an important determinant of overall cosmesis and could partially mask the longer term benefits of IMRT at this early stage.

  10. Cancer Research UK procedures in manufacture and toxicology of radiotracers intended for Pre-phase I positron emission tomography studies in cancer patients

    OpenAIRE

    Aboagye, E O; Luthra, S K; Brady, F; Poole, K; Anderson, H.; Jones, T.; Boobis, A; Burtles, S S; Price, P

    2002-01-01

    Radiolabelled compounds formulated for injection (radiopharmaceuticals), are increasingly being employed in drug development studies. These can be used in tracer amounts for either pharmacokinetic or pharmacodynamic studies. Such radiotracer studies can also be carried out early in man, even prior to conventional Phase I clinical testing. The aim of this document is to describe procedures for production and safety testing of oncology radiotracers developed for imaging by positron emission tom...

  11. Clinical Implementation of an Online Adaptive Plan-of-the-Day Protocol for Nonrigid Motion Management in Locally Advanced Cervical Cancer IMRT

    Energy Technology Data Exchange (ETDEWEB)

    Heijkoop, Sabrina T., E-mail: s.heijkoop@erasmusmc.nl; Langerak, Thomas R.; Quint, Sandra; Bondar, Luiza; Mens, Jan Willem M.; Heijmen, Ben J.M.; Hoogeman, Mischa S.

    2014-11-01

    Purpose: To evaluate the clinical implementation of an online adaptive plan-of-the-day protocol for nonrigid target motion management in locally advanced cervical cancer intensity modulated radiation therapy (IMRT). Methods and Materials: Each of the 64 patients had four markers implanted in the vaginal fornix to verify the position of the cervix during treatment. Full and empty bladder computed tomography (CT) scans were acquired prior to treatment to build a bladder volume-dependent cervix-uterus motion model for establishment of the plan library. In the first phase of clinical implementation, the library consisted of one IMRT plan based on a single model-predicted internal target volume (mpITV), covering the target for the whole pretreatment observed bladder volume range, and a 3D conformal radiation therapy (3DCRT) motion-robust backup plan based on the same mpITV. The planning target volume (PTV) combined the ITV and nodal clinical target volume (CTV), expanded with a 1-cm margin. In the second phase, for patients showing >2.5-cm bladder-induced cervix-uterus motion during planning, two IMRT plans were constructed, based on mpITVs for empty-to-half-full and half-full-to-full bladder. In both phases, a daily cone beam CT (CBCT) scan was acquired to first position the patient based on bony anatomy and nodal targets and then select the appropriate plan. Daily post-treatment CBCT was used to verify plan selection. Results: Twenty-four and 40 patients were included in the first and second phase, respectively. In the second phase, 11 patients had two IMRT plans. Overall, an IMRT plan was used in 82.4% of fractions. The main reasons for selecting the motion-robust backup plan were uterus outside the PTV (27.5%) and markers outside their margin (21.3%). In patients with two IMRT plans, the half-full-to-full bladder plan was selected on average in 45% of the first 12 fractions, which was reduced to 35% in the last treatment fractions. Conclusions: The implemented

  12. Comparison of planning target volumes based on three-dimensional and four-dimensional CT imaging of thoracic esophageal cancer

    Directory of Open Access Journals (Sweden)

    Wang W

    2016-08-01

    Full Text Available Wei Wang, Jianbin Li, Yingjie Zhang, Qian Shao, Min Xu, Tingyong Fan, Jinzhi Wang Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Shandong, People’s Republic of China Background and purpose: To investigate the definition of planning target volumes (PTVs based on four-dimensional computed tomography (4DCT compared with conventional PTV definition and PTV definition using asymmetrical margins for thoracic primary esophageal cancer. Materials and methods: Forty-three patients with esophageal cancer underwent 3DCT and 4DCT simulation scans during free breathing. The motions of primary tumors located in the proximal (group A, middle (group B, and distal (group C thoracic esophagus were obtained from the 4DCT scans. PTV3D was defined on 3DCT using the tumor motion measured based on 4DCT, PTV conventional (PTVconv was defined on 3DCT by adding a 1.0 cm margin to the clinical target volume, and PTV4D was defined as the union of the target volumes contoured on the ten phases of the 4DCT images. The centroid positions, volumetric differences, and dice similarity coefficients were evaluated for all PTVs. Results: The median centroid shifts between PTV3D and PTV4D and between PTVconv and PTV4D in all three dimensions were <0.3 cm for the three groups. The median size ratios of PTV4D to PTV3D were 0.80, 0.88, and 0.71, and PTV4D to PTVconv were 0.67, 0.73, and 0.76 (χ2=–3.18, –2.98, and –3.06; P=0.001, 0.003, and 0.002 for groups A, B, and C, respectively. The dice similarity coefficients were 0.87, 0.90, and 0.81 between PTV4D and PTV3D and 0.80, 0.84, and 0.83 between PTV4D and PTVconv (χ2=–3.18, –2.98, and –3.06; P=0.001, 0.003, and 0.002 for groups A, B, and C, respectively. The difference between the degree of inclusion of PTV4D in PTV3D and that of PTV4D in PTVconv was <2% for all groups. Compared with PTVconv, the amount of irradiated normal tissue

  13. Inter-observer variability in contouring the penile bulb on CT images for prostate cancer treatment planning.

    Science.gov (United States)

    Perna, Lucia; Cozzarini, Cesare; Maggiulli, Eleonora; Fellin, Gianni; Rancati, Tiziana; Valdagni, Riccardo; Vavassori, Vittorio; Villa, Sergio; Fiorino, Claudio

    2011-09-24

    Several investigations have recently suggested the existence of a correlation between the dose received by the penile bulb (PB) and the risk of erectile dysfunction (ED) after radical radiotherapy for clinically localized prostate carcinoma. A prospective multi-Institute study (DUE-01) was implemented with the aim to assess the predictive parameters of ED. Previously, an evaluation of inter-observer variations of PB contouring was mandatory in order to quantify its impact on PB dose-volume parameters by means of a dummy run exercise. Fifteen observers, from different Institutes, drew the PB on the planning CT images of ten patients; inter-observer variations were analysed in terms of PB volume variation and cranial/caudal limits. 3DCRT treatment plans were simulated to evaluate the impact of PB contouring inter-variability on dose-volume statistics parameters. For DVH analysis the values of PB mean dose and the volume of PB receiving more than 50 Gy and 70 Gy (V50 and V70, respectively) were considered. Systematic differences from the average values were assessed by the Wilcoxon test. Seven observers systematically overestimated or underestimated the PB volume with deviations from the average volumes ranging between -48% and +34% (p V50 and V70 respectively. In conclusion, despite the large inter-observer variation in contouring PB, a large multi-centric study may have the possibility to detect a possible correlation between PB % dose-volume parameters and ED. The impact of contouring uncertainty could be reduced by "a posteriori" contouring from a single observer or by introducing Magnetic Resonance Imaging (MRI) in the planning procedures and/or in improving the skill of observers through post-dummy run tutoring of those observers showing large systematic deviations from the mean.

  14. Applying 3D-printing technology in planning operations of cancer patients

    Science.gov (United States)

    Kashapov, L. N.; N, A. N. Rudyk A.; Kashapov, R. N.

    2014-12-01

    The purpose of this work was creation 3D model of the front part of the skull of the patient and evaluates the effectiveness of its use in the planning of the operation. To achieve this goal was chosen an operation to remove a tumor of the right eyelid, germinate in the zygomatic bone. 3D printing was performed at different peripheral devices using the method of layering creating physical objects by a digital 3D model as well as the recovery model of the skull with the entire right malar bone for fixation on her titanium frame to maintain the eyeball in a fixed state.

  15. Radiotherapy beyond cancer: Target localization in real-time MRI and treatment planning for cardiac radiosurgery

    Energy Technology Data Exchange (ETDEWEB)

    Ipsen, S. [Radiation Physics Laboratory, Sydney Medical School, The University of Sydney, Sydney, New South Wales 2006, Australia and Institute for Robotics and Cognitive Systems, University of Luebeck, Luebeck 23562 (Germany); Blanck, O.; Rades, D. [Department of Radiation Oncology, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck 23562 (Germany); Oborn, B. [Illawarra Cancer Care Centre (ICCC), Wollongong, New South Wales 2500, Australia and Centre for Medical Radiation Physics (CMRP), University of Wollongong, Wollongong, New South Wales 2500 (Australia); Bode, F. [Medical Department II, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck 23562 (Germany); Liney, G. [Ingham Institute for Applied Medical Research, Liverpool Hospital, Liverpool, New South Wales 2170 (Australia); Hunold, P. [Department of Radiology and Nuclear Medicine, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck 23562 (Germany); Schweikard, A. [Institute for Robotics and Cognitive Systems, University of Luebeck, Luebeck 23562 (Germany); Keall, P. J., E-mail: paul.keall@sydney.edu.au [Radiation Physics Laboratory, Sydney Medical School, The University of Sydney, Sydney, New South Wales 2006 (Australia)

    2014-12-15

    Purpose: Atrial fibrillation (AFib) is the most common cardiac arrhythmia that affects millions of patients world-wide. AFib is usually treated with minimally invasive, time consuming catheter ablation techniques. While recently noninvasive radiosurgery to the pulmonary vein antrum (PVA) in the left atrium has been proposed for AFib treatment, precise target location during treatment is challenging due to complex respiratory and cardiac motion. A MRI linear accelerator (MRI-Linac) could solve the problems of motion tracking and compensation using real-time image guidance. In this study, the authors quantified target motion ranges on cardiac magnetic resonance imaging (MRI) and analyzed the dosimetric benefits of margin reduction assuming real-time motion compensation was applied. Methods: For the imaging study, six human subjects underwent real-time cardiac MRI under free breathing. The target motion was analyzed retrospectively using a template matching algorithm. The planning study was conducted on a CT of an AFib patient with a centrally located esophagus undergoing catheter ablation, representing an ideal case for cardiac radiosurgery. The target definition was similar to the ablation lesions at the PVA created during catheter treatment. Safety margins of 0 mm (perfect tracking) to 8 mm (untracked respiratory motion) were added to the target, defining the planning target volume (PTV). For each margin, a 30 Gy single fraction IMRT plan was generated. Additionally, the influence of 1 and 3 T magnetic fields on the treatment beam delivery was simulated using Monte Carlo calculations to determine the dosimetric impact of MRI guidance for two different Linac positions. Results: Real-time cardiac MRI showed mean respiratory target motion of 10.2 mm (superior–inferior), 2.4 mm (anterior–posterior), and 2 mm (left–right). The planning study showed that increasing safety margins to encompass untracked respiratory motion leads to overlapping structures even in the

  16. Les déterminants du statut “perdu de vue” chez les patients pris en charge pour cancer au Maroc: situation avant le Plan Cancer

    Science.gov (United States)

    Najdi, Adil; Berraho, Mohamed; Bendahhou, Karima; Obtel, Majdouline; Zidouh, Ahmed; Errihani, Hassan; Nejjari, Chakib

    2014-01-01

    Introduction Le cancer au Maroc représente un problème majeur de santé publique, sa prise en charge doit être globale, active et complète pour tous les patients. L'objectif de ce travail était d'estimer la fréquence des perdus de vue « PDV » en oncologie au Maroc durant la première année de suivi et de déterminer les facteurs associés à ce problème. Méthodes Par une étude rétrospective portant sur 2854 dossiers de malades hospitalisés dans les trois principaux centres d'oncologie au Maroc depuis janvier 2003 jusqu’à juin 2007 et concernant les cinq principales localisations de cancer au Maroc, nous avons cherché la date des dernières nouvelles des patients ayant un recul de 18 mois minimum afin de déterminer le statut de ces malades après un an de suivi. Résultats La moyenne d’âge était de 52±14 ans, une proportion féminine de 63%, les sujets actifs constituaient 28%, les mariés 71%, les analphabètes 51%, 70% des patients habitaient en milieu urbain et seulement 11% des malades disposaient d'une couverture sociale. La localisation cancéreuse la plus fréquente était le poumon (23,8%) suivie du colon-rectum (23,5%) puis le col (21,9%), le sein (20,4%) et les lymphomes (10,4%). Le taux des «PDV» à un an de suivi était de 48%, ce statut était significativement lié au sexe, à l’âge, au NSE et au statut matrimonial. Sur le plan médical, le statut «PDV» était lié à la localisation du cancer, au stade de diagnostic et au type de traitement reçu. Conclusion Notre étude a mis en évidence la grande ampleur du problème des PDV en cancérologie au Maroc ainsi que ces déterminants. Ces résultats incitent tous les acteurs dans le domaine de la cancérologie à collaborer ensemble pour prendre les mesures qui s'imposent pour y pallier PMID:25400850

  17. Transanal Pull-Through Procedure with Delayed versus Immediate Coloanal Anastomosis for Anus-Preserving Curative Resection of Lower Rectal Cancer: A Case-Control Study.

    Science.gov (United States)

    Xiong, Yong; Huang, Ping; Ren, Qing-Gui

    2016-06-01

    This case-control study compared the effectiveness and safety of transanal pull-through procedure (TPP) with delayed or immediate coloanal anastomosis (CAA) for anus-preserving curative resection of lower rectal cancer. Lower rectal cancer patients (n = 128) were hospitalized between January 2003 and December 2013 for elective anus-preserving curative resection through a TPP with delayed (n = 72) or immediate (n = 56) CAA. Main outcome measures including surgical safety, resection radicality, and defecation function were assessed. The two groups were comparable in age, sex, gross pathology, histology, and tumor-node-metastasis staging. Both the delayed and immediate CAA TPPs had similar resection radicality and safety profiles. The immediate CAA was associated with a significantly higher risk of anastomotic leakage and defecation impairment. None of patients in the delayed CAA group experienced anastomotic leakage. In conclusion, TPP with delayed CAA may be superior to immediate CAA in minimizing the risk of anastomotic leakage and relevant surgical morbidities, and does not require a temporary ileostomy and second-look restoration of ostomy. PMID:27305886

  18. Effects of Different Operative Procedures on the Digestive and Nutritional Status of Patients Treated with a Gastrectomy for Gastric Cancer

    Institute of Scientific and Technical Information of China (English)

    Han Liang; Xishan Hao

    2006-01-01

    Postgastrectomy syndromes evoked by the loss of several gastric functions after total or subtotal gastrectomy are very common. Different kinds of reconstruction have been developed to overcome the problem. Patients with preservation of a duodenal passage and jejunal interposition with or without a pouch show a better quality of life and minimal symptoms postoperatively. A jejunal interposition with or without a pouch after proximal or distal subtotal gastrictomy seems to improve the nutritional condition and quality of life. The prognostic nutritional index (PNI), Visick score, Spitzer index and the European Organization for Research and Treatment of Cancer (EORTC) questionnaire (QLQ-C30) are available to evaluate the quality of life and nutritional status after gastrectomy.

  19. Magnetic resonance imaging for radiotherapy planning of brain cancer patients using immobilization and surface coils

    International Nuclear Information System (INIS)

    This study investigated the compatibility of a head and neck immobilization device with magnetic resonance imaging (MRI). The immobilization device is used to position a patient in the same way as when receiving a computed tomography (CT) scan for radiotherapy planning and radiation treatment. The advantage of using immobilization in MR is improved accuracy in CT/MR image registration enabling greater confidence in the delineation of structures. The main practical difficulty in using an immobilization device in MRI is that physical constraints make their use incompatible with head imaging coils. Within this paper we describe a method for MR imaging of the brain which allows the use of head and neck immobilization devices. By a series of image quality tests we obtained the same or better image quality as a multi-channel head coil.

  20. Cancer

    Science.gov (United States)

    ... Blood tests (which look for chemicals such as tumor markers) Bone marrow biopsy (for lymphoma or leukemia) Chest ... the case with skin cancers , as well as cancers of the lung, breast, and colon. If the tumor has spread ...

  1. Cancer

    Science.gov (United States)

    Cancer begins in your cells, which are the building blocks of your body. Normally, your body forms ... be benign or malignant. Benign tumors aren't cancer while malignant ones are. Cells from malignant tumors ...

  2. [Imaging protocols for the management of respiratory motions in the radiotherapy planning for early stage lung cancer patients].

    Science.gov (United States)

    Pócza, Tamás; Pesznyák, Csilla; Lövey, József; Bajcsay, András; Szilágyi, András; Almády, Balázs; Major, Tibor; Polgár, Csaba

    2015-06-01

    The aim of our work is to present the imaging techniques used at the National Institute of Oncology for taking into consideration the breathing motion at radiation therapy treatment planning. Internationally recommended imaging techniques, such as 4D CT, respiratory gating and ITV (Internal Target Volume) definition were examined. The different imaging techniques were analysed regarding the delivered dose during imaging, the required time to adapt the technique, and the necessary equipment. The differences in size of PTVs (Planning Target Volume) due to diverse volume defining methods were compared in 5 cases. For 4D CT breath monitoring is crucial, which requires special equipment. To decrease the relatively high exposure of 4D CT it is possible to scan only a few predefined breathing phases. The possible positions of the tumour can be well approximated with CT scans taken in the inhale maximum, the exhale maximum and in intermediate phase. The intermediate phase can be exchanged with an ordinary CT image set, and the extreme phase CT images can be ensured by given verbal instructions for the patient. This way special gating equipment is not required. Based on these 3 breathing phases an ITV can be defined. Using this ITV definition method the margin between the CTV (Clinical Target Volume) and the PTV can be reduced by 1 cm. Using this imaging protocol PTV can be reduced by 30%. A further 10% PTV reduction can be achieved with respiratory gating. In the routine clinical practice respiratory motion management with a 3-phase CT-imaging protocol the PTV for early-stage lung cancer can be significantly reduced without the use of 4D CT and/or respiratory gating. For special, high precision treatment techniques 4D CT is recommended.

  3. SEARCH FOR A NEW PARADIGM OF URBAN PLANNING FROM PROCEDURAL PLANNING TO PLANNING PROCESS%探寻城市地区规划的——从“程序性规划”到“规划过程”新范式

    Institute of Scientific and Technical Information of China (English)

    武廷海

    2001-01-01

    针对当前城市地区空间发展的新形势,指出规划理论与实践的脱节,特别是“程序性规划”的不合时宜,进而提出“规划过程”的概念。规划不只是规划人员的理性思考过程,而是决策与实施相融合、多方参与协调解决问题、公共教育、以及向社会学习的复杂过程;在规划过程中,规划师必须从单纯的、专业性的调查、分析和规划方案走向社会真实,面对城市地区发展中客观存在的问题,研究问题本身并努力加以解决。%The procedural planning is out of date, planning proces s should be promoted. Planning is not the process of the rational thinking of the planners, but the co mbination of the policy-making and implementation, the involvement of the solution of the proble ms, public education and the social learning. In the planning process, the planners must fa ce the society and conquer the practical difficulties, seeking the truth from society instead of th e just doing pure professional survey, analysis and plan drafting.

  4. SU-E-P-48: Evaluation of Intensity Modulated Radiotherapy (IMRT) with Three Different Commercial Planning Systems for the Treatment of Cervical Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Liu, D; Chi, Z; Yang, H; Miao, M; Jing, Z [The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei (China)

    2015-06-15

    Purpose: To investigate the performances of three commercial treatment planning systems (TPS) for intensity modulated radiotherapy (IMRT) optimization regarding cervical cancer. Methods: For twenty cervical cancer patients, three IMRT plans were retrospectively re-planned: one with Pinnacle TPS,one with Oncentra TPS and on with Eclipse TPS. The total prescribed dose was 50.4 Gy delivered for PTV and 58.8 Gy for PTVnd by simultaneous integrated boost technique. The treatments were delivered using the Varian 23EX accelerator. All optimization schemes generated clinically acceptable plans. They were evaluated based on target coverage, homogeneity (HI) and conformity (CI). The organs at risk (OARs) were analyzed according to the percent volume under some doses and the maximum doses. The statistical method of the collected data of variance analysis was used to compare the difference among the quality of plans. Results: IMRT with Eclipse provided significant better HI, CI and all the parameters of PTV. However, the trend was not extension to the PTVnd, it was still significant better at mean dose, D50% and D98%, but plans with Oncentra showed significant better in the hight dosage volume, such as maximum dose and D2%. For the bladder wall, there were not notable difference among three groups, although Pinnacle and Oncentra systems provided a little lower dose sparing at V50Gy of bladder and rectal wall and V40Gy of bladder wall, respectively. V40Gy of rectal wall (p=0.037), small intestine (p=0.001 for V30Gy, p=0.010 for maximum dose) and V50Gy of right-femoral head (p=0.019) from Eclipse plans showed significant better than other groups. Conclusion: All SIB-IMRT plans were clinically acceptable which were generated by three commercial TPSs. The plans with Eclipse system showed advantages over the plans with Oncentra and Pinnacle system in the overwhelming majority of the dose coverage for targets and dose sparing of OARs in cervical cancer.

  5. Deformable anatomical templates for brachytherapy treatment planning in radiotherapy of cervical cancer

    Science.gov (United States)

    Christensen, Gary E.; Williamson, Jeffrey F.; Chao, K. S. C.; Miller, Michael I.; So, F. B.; Vannier, Michael W.

    1997-10-01

    This paper describes a new method to register serial, volumetric x-ray computed tomography (CT) data sets for tracking soft-tissue deformation caused by insertion of intracavity brachytherapy applicators to treat cervical cancer. 3D CT scans collected from the same patient with and without a brachytherapy applicator are registered to aid in computation of the radiation dose to tumor and normal tissue. The 3D CT image volume of pelvic anatomy with the applicator. Initial registration is accomplished by rigid alignment of the pelvic bones and non-rigid alignment of gray scale CT data and hand segmentations of the vagina, cervix, bladder, and rectum. A viscous fluid transformation model is used for non-rigid registration to allow for local, non-linear registration of the vagina, cervix, bladder, and rectum without disturbing the rigid registration of the bony pelvis and adjacent structures. Results are presented in which two 3D CT data sets of the same patient - imaged with and without a brachytherapy applicator - are registered.

  6. Volumetric Modulated Arc Therapy Planning for Primary Prostate Cancer With Selective Intraprostatic Boost Determined by {sup 18}F-Choline PET/CT

    Energy Technology Data Exchange (ETDEWEB)

    Kuang, Yu [Department of Medical Physics, University of Nevada Las Vegas, Las Vegas, Nevada (United States); Wu, Lili [Department of Medical Physics, University of Nevada Las Vegas, Las Vegas, Nevada (United States); Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong (China); Hirata, Emily; Miyazaki, Kyle; Sato, Miles [Hamamatsu/Queen' s PET Imaging Center and Departments of Radiation Oncology and Oncology Research, The Queen' s Medical Center, Honolulu, Hawaii (United States); Kwee, Sandi A., E-mail: kwee@hawaii.edu [Hamamatsu/Queen' s PET Imaging Center and Departments of Radiation Oncology and Oncology Research, The Queen' s Medical Center, Honolulu, Hawaii (United States); John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii (United States)

    2015-04-01

    Purpose: This study evaluated expected tumor control and normal tissue toxicity for prostate volumetric modulated arc therapy (VMAT) with and without radiation boosts to an intraprostatically dominant lesion (IDL), defined by {sup 18}F-choline positron emission tomography/computed tomography (PET/CT). Methods and Materials: Thirty patients with localized prostate cancer underwent {sup 18}F-choline PET/CT before treatment. Two VMAT plans, plan{sub 79} {sub Gy} and plan{sub 100-105} {sub Gy}, were compared for each patient. The whole-prostate planning target volume (PTV{sub prostate}) prescription was 79 Gy in both plans, but plan{sub 100-105} {sub Gy} added simultaneous boost doses of 100 Gy and 105 Gy to the IDL, defined by 60% and 70% of maximum prostatic uptake on {sup 18}F-choline PET (IDL{sub suv60%} and IDL{sub suv70%}, respectively, with IDL{sub suv70%} nested inside IDL{sub suv60%} to potentially enhance tumor specificity of the maximum point dose). Plan evaluations included histopathological correspondence, isodose distributions, dose-volume histograms, tumor control probability (TCP), and normal tissue complication probability (NTCP). Results: Planning objectives and dose constraints proved feasible in 30 of 30 cases. Prostate sextant histopathology was available for 28 cases, confirming that IDL{sub suv60%} adequately covered all tumor-bearing prostate sextants in 27 cases and provided partial coverage in 1 case. Plan{sub 100-105} {sub Gy} had significantly higher TCP than plan{sub 79} {sub Gy} across all prostate regions for α/β ratios ranging from 1.5 Gy to 10 Gy (P<.001 for each case). There were no significant differences in bladder and femoral head NTCP between plans and slightly lower rectal NTCP (endpoint: grade ≥ 2 late toxicity or rectal bleeding) was found for plan{sub 100-105} {sub Gy}. Conclusions: VMAT can potentially increase the likelihood of tumor control in primary prostate cancer while observing normal tissue tolerances through

  7. Dentalmaps: Automatic Dental Delineation for Radiotherapy Planning in Head-and-Neck Cancer

    International Nuclear Information System (INIS)

    Purpose: To propose an automatic atlas-based segmentation framework of the dental structures, called Dentalmaps, and to assess its accuracy and relevance to guide dental care in the context of intensity-modulated radiotherapy. Methods and Materials: A multi-atlas–based segmentation, less sensitive to artifacts than previously published head-and-neck segmentation methods, was used. The manual segmentations of a 21-patient database were first deformed onto the query using nonlinear registrations with the training images and then fused to estimate the consensus segmentation of the query. Results: The framework was evaluated with a leave-one-out protocol. The maximum doses estimated using manual contours were considered as ground truth and compared with the maximum doses estimated using automatic contours. The dose estimation error was within 2-Gy accuracy in 75% of cases (with a median of 0.9 Gy), whereas it was within 2-Gy accuracy in 30% of cases only with the visual estimation method without any contour, which is the routine practice procedure. Conclusions: Dose estimates using this framework were more accurate than visual estimates without dental contour. Dentalmaps represents a useful documentation and communication tool between radiation oncologists and dentists in routine practice. Prospective multicenter assessment is underway on patients extrinsic to the database.

  8. Dentalmaps: Automatic Dental Delineation for Radiotherapy Planning in Head-and-Neck Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Thariat, Juliette, E-mail: jthariat@hotmail.com [Department of Radiation Oncology/Institut de biologie et developpement du cancer (IBDC) centre national de la recherche scientifique (CNRS) unite mixte de recherche UMR 6543, Cancer Center Antoine-Lacassagne, University of Nice Sophia-Antipolis, Nice Cedex (France); Ramus, Liliane [DOSIsoft, Cachan (France); INRIA (Institut National de Recherche en Automatique et en Automatique)-Asclepios Research Project, Sophia-Antipolis (France); Maingon, Philippe [Department of Radiation Oncology, Centre Georges-Francois Leclerc, Dijon Cedex (France); Odin, Guillaume [Department of Head-and-Neck Surgery, Centre Hospitalier Universitaire-Institut Universitaire de la Face et du Cou, Nice Cedex (France); Gregoire, Vincent [Department of Radiation Oncology, St.-Luc University Hospital, Brussels (Belgium); Darcourt, Vincent [Department of Radiation Oncology-Dentistry, Cancer Center Antoine-Lacassagne, University of Nice Sophia-Antipolis, Nice Cedex (France); Guevara, Nicolas [Department of Head-and-Neck Surgery, Centre Hospitalier Universitaire-Institut Universitaire de la Face et du Cou, Nice Cedex (France); Orlanducci, Marie-Helene [Department of Odontology, CHU, Nice (France); Marcie, Serge [Department of Radiation Oncology/Institut de biologie et developpement du cancer (IBDC) centre national de la recherche scientifique (CNRS) unite mixte de recherche UMR 6543, Cancer Center Antoine-Lacassagne, University of Nice Sophia-Antipolis, Nice Cedex (France); Poissonnet, Gilles [Department of Head-and-Neck Surgery, Cancer Center Antoine-Lacassagne-Institut Universitaire de la Face et du Cou, Nice Cedex (France); Marcy, Pierre-Yves [Department of Radiology, Cancer Center Antoine-Lacassagne, University of Nice Sophia-Antipolis, Nice Cedex (France); and others

    2012-04-01

    Purpose: To propose an automatic atlas-based segmentation framework of the dental structures, called Dentalmaps, and to assess its accuracy and relevance to guide dental care in the context of intensity-modulated radiotherapy. Methods and Materials: A multi-atlas-based segmentation, less sensitive to artifacts than previously published head-and-neck segmentation methods, was used. The manual segmentations of a 21-patient database were first deformed onto the query using nonlinear registrations with the training images and then fused to estimate the consensus segmentation of the query. Results: The framework was evaluated with a leave-one-out protocol. The maximum doses estimated using manual contours were considered as ground truth and compared with the maximum doses estimated using automatic contours. The dose estimation error was within 2-Gy accuracy in 75% of cases (with a median of 0.9 Gy), whereas it was within 2-Gy accuracy in 30% of cases only with the visual estimation method without any contour, which is the routine practice procedure. Conclusions: Dose estimates using this framework were more accurate than visual estimates without dental contour. Dentalmaps represents a useful documentation and communication tool between radiation oncologists and dentists in routine practice. Prospective multicenter assessment is underway on patients extrinsic to the database.

  9. Treatment planning study comparing proton therapy, RapidArc and intensity modulated radiation therapy for a synchronous bilateral lung cancer case

    Directory of Open Access Journals (Sweden)

    Suresh Rana

    2014-03-01

    Full Text Available Purpose: The main purpose of this study is to perform a treatment planning study on a synchronous bilateral non-small cell lung cancer case using three treatment modalities: uniform scanning proton therapy, RapidArc, and intensity modulated radiation therapy (IMRT. Methods: The maximum intensity projection (MIP images obtained from the 4 dimensional-computed tomography (4DCT scans were used for delineation of tumor volumes in the left and right lungs. The average 4D-CT was used for the treatment planning among all three modalities with identical patient contouring and treatment planning goal. A proton therapy plan was generated in XiO treatment planning system (TPS using 2 fields for each target. For a comparative purpose, IMRT and RapidArc plans were generated in Eclipse TPS. Treatment plans were generated for a total dose of 74 CGE or Gy prescribed to each planning target volume (PTV (left and right with 2 CGE or Gy per fraction. In IMRT and RapidArc plans, normalization was done based on PTV coverage values in proton plans. Results: The mean PTV dose deviation from the prescription dose was lower in proton plan (within 3.4%, but higher in IMRT (6.5% to 11.3% and RapidArc (3.8% to 11.5% plans. Proton therapy produced lower mean dose to the total lung, heart, and esophagus when compared to IMRT and RapidArc. The relative volume of the total lung receiving 20, 10, and 5 CGE or Gy (V20, V10, and V5, respectively were lower using proton therapy than using IMRT, with absolute differences of 9.71%, 22.88%, and 39.04%, respectively. The absolute differences in the V20, V10, and V5 between proton and RapidArc plans were 4.84%, 19.16%, and 36.8%, respectively, with proton therapy producing lower dosimetric values. Conclusion: Based on the results presented in this case study, uniform scanning proton therapy has a dosimetric advantage over both IMRT and RapidArc for a synchronous bi-lateral NSCLC, especially for the normal lung tissue, heart, and

  10. Strategic Plans to Promote Head and Neck Cancer Translational Research Within the Radiation Therapy Oncology Group: A Report From the Translational Research Program

    International Nuclear Information System (INIS)

    Head and neck cancer is the fifth most common cancer in the United States, with an overall survival rate of approximately 40-50%. In an effort to improve patient outcomes, research efforts designed to maximize benefit and reduce toxicities of therapy are in progress. Basic research in cancer biology has accelerated this endeavor and provided preclinical data and technology to support clinically relevant advances in early detection, prognostic and predictive biomarkers. Recent completion of the Human Genome Project has promoted the rapid development of novel 'omics' technologies that allow more broad based study from a systems biology perspective. However, clinically relevant application of resultant gene signatures to clinical trials within cooperative groups has advanced slowly. In light of the large numbers of variables intrinsic to biomarker studies, validation of preliminary data for clinical implementation presents a significant challenge and may only be realized with large trials that involve significant patient numbers. The Radiation Therapy Oncology Group (RTOG) Head and Neck Cancer Translational Research Program recognizes this problem and brings together three unique features to facilitate this research: (1) availability of large numbers of clinical specimens from homogeneously treated patients through multi-institutional clinical trials; (2) a team of physicians, scientists, and staff focused on patient-oriented head-and-neck cancer research with the common goal of improving cancer care; and (3) a funding mechanism through the RTOG Seed Grant Program. In this position paper we outline strategic plans to further promote translational research within the framework of the RTOG

  11. Inter-observer variability in contouring the penile bulb on CT images for prostate cancer treatment planning

    Directory of Open Access Journals (Sweden)

    Valdagni Riccardo

    2011-09-01

    Full Text Available Abstract Several investigations have recently suggested the existence of a correlation between the dose received by the penile bulb (PB and the risk of erectile dysfunction (ED after radical radiotherapy for clinically localized prostate carcinoma. A prospective multi-Institute study (DUE-01 was implemented with the aim to assess the predictive parameters of ED. Previously, an evaluation of inter-observer variations of PB contouring was mandatory in order to quantify its impact on PB dose-volume parameters by means of a dummy run exercise. Fifteen observers, from different Institutes, drew the PB on the planning CT images of ten patients; inter-observer variations were analysed in terms of PB volume variation and cranial/caudal limits. 3DCRT treatment plans were simulated to evaluate the impact of PB contouring inter-variability on dose-volume statistics parameters. For DVH analysis the values of PB mean dose and the volume of PB receiving more than 50 Gy and 70 Gy (V50 and V70, respectively were considered. Systematic differences from the average values were assessed by the Wilcoxon test. Seven observers systematically overestimated or underestimated the PB volume with deviations from the average volumes ranging between -48% and +34% (p Inter-observer contouring variability strongly impacts on DVH parameters, although standard deviations of inter-patient differences were larger than inter-observer variations: 14.5 Gy versus 6.8 Gy for mean PB dose, 23.0% versus 11.0% and 16.8% versus 9.3% for V50 and V70 respectively. In conclusion, despite the large inter-observer variation in contouring PB, a large multi-centric study may have the possibility to detect a possible correlation between PB % dose-volume parameters and ED. The impact of contouring uncertainty could be reduced by "a posteriori" contouring from a single observer or by introducing Magnetic Resonance Imaging (MRI in the planning procedures and/or in improving the skill of observers

  12. How Is Ovarian Cancer Diagnosed?

    Science.gov (United States)

    ... of the procedure, and spending hours in the bathroom. Just before the procedure, the patient is given ... Symptoms of Cancer Treatments & Side Effects Cancer Facts & Statistics News About Cancer Expert Voices Blog Programs & Services ...

  13. Development of procedures and instrumentation for use of the Nd:YAG laser in the ablation of metastases from colorectal cancer

    Science.gov (United States)

    Bartels, Kenneth E.; Mellow, Mark H.; Kostolich, Marilyn; Henry, George A.; Barnes, Bradley R.; Durville, Frederic M.; Schafer, Steven A.; Krasinski, Jerzy S.; Powell, Richard C.

    1992-06-01

    While many colon cancers are curable, curability relates closely to stage. Once disease is spread beyond the confines of the colon and adjacent lymph nodes, cure is clearly the exception rather than the rule. Recently, surgical resection of solitary liver metastases has been effective in treatment of colon cancer, producing long term survival in approximately 20% of treatable patients. Surgery, however, is technically complex and there is a high perioperative morbidity and substantial perioperative mortality. For patients with multiple hepatic metastases in whom surgical extirpation is not possible, the outlook is dismal. Other modalities including chemotherapy have also resulted in limited success. Recently, a number of investigators have evaluated the effect of low power interstitial Nd:YAG laser irradiation for inducing hyperthermia and coagulative necrosis is hepatic tissue. In treating multiple or large hepatic metastases, the use of a lower power (1 - 5 watts), long duration (50 - 2400 seconds), single fiber laser delivery system has limitations. A computer controlled continuous wave Nd:YAG (1064 nm) laser system using a single fiber 'coupled' to a multiple array of fibers (4 to 6) has been developed for the delivery of low power laser irradiation to hepatic tissue. The advantage of laser energy being delivered simultaneously through multiple fibers is that it expands the area of tissue that can be treated over a given time. Through the use of interventional techniques including percutaneous ultrasound and/or CAT scan directed treatment, laser induced interstitial hyperthermia for large or multiple metastatic lesions could be initiated without the morbidity associated with open surgical procedures.

  14. [18F]fluoroethylcholine-PET/CT imaging for radiation treatment planning of recurrent and primary prostate cancer with dose escalation to PET/CT-positive lymph nodes

    International Nuclear Information System (INIS)

    At present there is no consensus on irradiation treatment volumes for intermediate to high-risk primary cancers or recurrent disease. Conventional imaging modalities, such as CT, MRI and transrectal ultrasound, are considered suboptimal for treatment decisions. Choline-PET/CT might be considered as the imaging modality in radiooncology to select and delineate clinical target volumes extending the prostate gland or prostate fossa. In conjunction with intensity modulated radiotherapy (IMRT) and imaged guided radiotherapy (IGRT), it might offer the opportunity of dose escalation to selected sites while avoiding unnecessary irradiation of healthy tissues. Twenty-six patients with primary (n = 7) or recurrent (n = 19) prostate cancer received Choline-PET/CT planned 3D conformal or intensity modulated radiotherapy. The median age of the patients was 65 yrs (range 45 to 78 yrs). PET/CT-scans with F18-fluoroethylcholine (FEC) were performed on a combined PET/CT-scanner equipped for radiation therapy planning. The majority of patients had intermediate to high risk prostate cancer. All patients received 3D conformal or intensity modulated and imaged guided radiotherapy with megavoltage cone beam CT. The median dose to primary tumours was 75.6 Gy and to FEC-positive recurrent lymph nodal sites 66,6 Gy. The median follow-up time was 28.8 months. The mean SUVmax in primary cancer was 5,97 in the prostate gland and 3,2 in pelvic lymph nodes. Patients with recurrent cancer had a mean SUVmax of 4,38. Two patients had negative PET/CT scans. At 28 months the overall survival rate is 94%. Biochemical relapse free survival is 83% for primary cancer and 49% for recurrent tumours. Distant disease free survival is 100% and 75% for primary and recurrent cancer, respectively. Acute normal tissue toxicity was mild in 85% and moderate (grade 2) in 15%. No or mild late side effects were observed in the majority of patients (84%). One patient had a severe bladder shrinkage (grade 4) after a

  15. Hepatic arterial phase and portal venous phase computed tomography for dose calculation of stereotactic body radiation therapy plans in liver cancer: a dosimetric comparison study

    International Nuclear Information System (INIS)

    To investigate the effect of computed tomography (CT) using hepatic arterial phase (HAP) and portal venous phase (PVP) contrast on dose calculation of stereotactic body radiation therapy (SBRT) for liver cancer. Twenty-one patients with liver cancer were studied. HAP, PVP and non-enhanced CTs were performed on subjects scanned in identical positions under active breathing control (ABC). SBRT plans were generated using seven-field three-dimensional conformal radiotherapy (7 F-3D-CRT), seven-field intensity-modulated radiotherapy (7 F-IMRT) and single-arc volumetric modulated arc therapy (VMAT) based on the PVP CT. Plans were copied to the HAP and non-enhanced CTs. Radiation doses calculated from the three phases of CTs were compared with respect to the planning target volume (PTV) and the organs at risk (OAR) using the Friedman test and the Wilcoxon signed ranks test. SBRT plans calculated from either PVP or HAP CT, including 3D-CRT, IMRT and VMAT plans, demonstrated significantly lower (p <0.05) minimum absorbed doses covering 98%, 95%, 50% and 2% of PTV (D98%, D95%, D50% and D2%) than those calculated from non-enhanced CT. The mean differences between PVP or HAP CT and non-enhanced CT were less than 2% and 1% respectively. All mean dose differences between the three phases of CTs for OARs were less than 2%. Our data indicate that though the differences in dose calculation between contrast phases are not clinically relevant, dose underestimation (IE, delivery of higher-than-intended doses) resulting from CT using PVP contrast is larger than that resulting from CT using HAP contrast when compared against doses based upon non-contrast CT in SBRT treatment of liver cancer using VMAT, IMRT or 3D-CRT

  16. [Cancer].

    Science.gov (United States)

    de la Peña-López, Roberto; Remolina-Bonilla, Yuly Andrea

    2016-09-01

    Cancer is a group of diseases which represents a significant public health problem in Mexico and worldwide. In Mexico neoplasms are the second leading cause of death. An increased morbidity and mortality are expected in the next decades. Several preventable risk factors for cancer development have been identified, the most relevant including tobacco use, which accounts for 30% of the cancer cases; and obesity, associated to another 30%. These factors, in turn, are related to sedentarism, alcohol abuse and imbalanced diets. Some agents are well knokn to cause cancer such as ionizing radiation, viruses such as the papilloma virus (HPV) and hepatitis virus (B and C), and more recently environmental pollution exposure and red meat consumption have been pointed out as carcinogens by the International Agency for Research in Cancer (IARC). The scientific evidence currently available is insufficient to consider milk either as a risk factor or protective factor against different types of cancer. PMID:27603890

  17. Does the IMRT technique allow improvement of treatment plans (e.g. lung sparing) for lung cancer patients with small lung volume: a planning study

    International Nuclear Information System (INIS)

    Aim: We evaluated whether intensity-modulated radiation therapy (IMRT) may offer any advantages in comparison with three-dimensional conformal radiotherapy (3D-CRT) for patients with small lung volume (SLV). Methods: Treatment planning was performed for 10 NSCLC patients with the smallest lung volume (mean: 2241 cc) among 200 patients from our database. For each patient 3D-CRT and IMRT plans were prepared. The goal was to deliver 66 Gy/33 fractions, with dose constraints: mean lung dose (MLD) < 20 Gy, V20 < 35%; spinal cord - Dmax < 45 Gy. When the plan could not meet these criteria, total dose was reduced. The 3D-CRT and IMRT plans were compared. We investigated: prescribed dose, coverage and conformity indices, MLD, V5-V65 in the lung. Results: In 4 out of 10 plans, 3D-CRT did not allow 66 Gy to be delivered, because of predicted pulmonary toxicity. These 4 cases included 3 for which we did not reach 66 Gy with IMRT; still, for these 3 plans the total dose was increased by an average of 9 Gy with IMRT in comparison with 3D-CRT. Coverage indices were similar for both techniques. Conformity indices were better for IMRT plans. MLD was lower in five IMRT and two 3D-CRT plans if equal doses were delivered. The decrease in MLD was seen for cases with large PTV and high PTV/lung volume ratio. Lung V5 was lower for all 3D-CRT plans, 47% vs. 57% for IMRT; V15 and above were larger for 3D-CRT Conclusion: In the planning study, IMRT seems to be a promising technique for cases with SLV, especially when associated with large PT V. (authors)

  18. Does electron and proton therapy reduce the risk of radiation induced cancer after spinal irradiation for childhood medulloblastoma? A comparative treatment planning study

    Energy Technology Data Exchange (ETDEWEB)

    Xiangkui Mu; Zackrisson, Bjoern [Umeaa Univ. (Sweden). Dept. of Radiation Sciences; Bjoerk-Eriksson, Thomas; Johansson, Lennart; Karlsson, Mikael [Sahlgrenska Univ. Hospital, Goeteborg (Sweden). Dept. of Oncology; Nill, Simeon; Oelfke, Uwe [DKFZ-Heidelberg, (Germany). Dept. of Medical Physics; Johansson, Karl-Axel [Sahlgrenska Univ. Hospital, Goeteborg (Sweden). Dept. of Therapeutic Radiation Physics; Gagliardi, Giovanna [Radiumhemmet, Stockholm (Sweden). Dept. of Hospital Physics

    2005-09-01

    The aim of this treatment planning comparison study was to explore different spinal irradiation techniques with respect to the risk of late side-effects, particularly radiation-induced cancer. The radiotherapy techniques compared were conventional photon therapy, intensity modulated x-ray therapy (IMXT), conventional electron therapy, intensity/energy modulated electron therapy (IMET) and proton therapy (IMPT). CT images for radiotherapy use from five children, median age 8 and diagnosed with medulloblastoma, were selected for this study. Target volumes and organs at risk were defined in 3-D. Treatment plans using conventional photon therapy, IMXT, conventional electron therapy, IMET and IMPT were set up. The probability of normal tissue complication (NTCP) and the risk of cancer induction were calculated using models with parameters-sets taken from published data for the general population; dose data were taken from dose volume histograms (DVH). Similar dose distributions in the targets were achieved with all techniques but the absorbed doses in the organs-at-risk varied significantly between the different techniques. The NTCP models based on available data predicted very low probabilities for side-effects in all cases. However, the effective mean doses outside the target volumes, and thus the predicted risk of cancer induction, varied significantly between the techniques. The highest lifetime risk of secondary cancers was estimated for IMXT (30%). The lowest risk was found with IMPT (4%). The risks associated with conventional photon therapy, electron therapy and IMET were 20%, 21% and 15%, respectively. This model study shows that spinal irradiation of young children with photon and electron techniques results in a substantial risk of radiation-induced secondary cancers. Multiple beam IMXT seems to be associated with a particularly high risk of secondary cancer induction. To minimise this risk, IMPT should be the treatment of choice. If proton therapy is not

  19. Superiority of conventional intensity-modulated radiotherapy over helical tomotherapy in locally advanced non-small cell lung cancer. A comparative plan analysis

    Energy Technology Data Exchange (ETDEWEB)

    Song, C. [National Cancer Center, Research Institute and Hospital, Goyang (Korea, Republic of). Proton Therapy Center; Seoul National Univ. College of Medicine (Korea, Republic of). Dept. of Radiation Oncology; Pyo, H.; Kim, J. [Sungkyunkwan Univ. School of Medicine, Samsung Medical Center, Seoul (Korea, Republic of). Dept. of Radiation Oncology; Lim, Y.K.; Kim, D.W.; Cho, K.H. [National Cancer Center, Research Institute and Hospital, Goyang (Korea, Republic of). Proton Therapy Center; Kim, W.C. [Inha Univ. School of Medicine, Incheon (Korea, Republic of). Dept. of Radiation Oncology; Kim, H.J. [Seoul National Univ. College of Medicine (Korea, Republic of). Dept. of Radiation Oncology

    2012-10-15

    Purpose: To compare helical tomotherapy (HT) and conventional intensity-modulated radiotherapy (IMRT) using a variety of dosimetric and radiobiologic indexes in patients with locally advanced non-small cell lung cancer (LA-NSCLC). Patients and methods: A total of 20 patients with LA-NSCLC were enrolled. IMRT plans with 4-6 coplanar beams and HT plans were generated for each patient. Dose distributions and dosimetric indexes for the tumors and critical structures were computed for both plans and compared. Results: Both modalities created highly conformal plans. They did not differ in the volumes of lung exposed to > 20 Gy of radiation. The average mean lung dose, volume receiving {>=} 30 Gy, and volume receiving {>=} 10 Gy in HT planning were 18.3 Gy, 18.5%, and 57.1%, respectively, compared to 19.4 Gy, 25.4%, and 48.9%, respectively, with IMRT (p = 0.004, p < 0.001, and p < 0.001). The differences between HT and IMRT in lung volume receiving {>=} 10-20 Gy increased significantly as the planning target volume (PTV) increased. For 6 patients who had PTV greater than 700 cm{sup 3}, IMRT was superior to HT for 5 patients in terms of lung volume receiving {>=} 5-20 Gy. The integral dose to the entire thorax in HT plans was significantly higher than in IMRT plans. Conclusion: HT gave significantly better control of mean lung dose and volume receiving {>=} 30-40 Gy, whereas IMRT provided better control of the lung volume receiving {>=} 5-15 Gy and the integral dose to entire thorax. In most patients with PTV greater than 700 cm{sup 3}, IMRT was superior to HT in terms of lung volume receiving {>=} 5-20 Gy. It is therefore advised that caution should be exercised when planning LA-NSCLC using HT. (orig.)

  20. Penetration of Recommended Procedures for Lung Cancer Staging and Management in the United States Over 10 Years: A Quality Research in Radiation Oncology Survey

    International Nuclear Information System (INIS)

    Purpose: To document the penetration of clinical trial results, practice guidelines, and appropriateness criteria into national practice, we compared the use of components of staging and treatment for lung cancer among patients treated in 2006-2007 with those used in patients treated in 1998-1999. Methods and Materials: Patient, staging work-up, and treatment characteristics were extracted from the process survey database of the Quality Research in Radiation Oncology (QRRO), consisting of records of 340 patients with locally advanced non-small cell lung cancer (LA-NSCLC) at 44 institutions and of 144 patients with limited-stage small cell lung cancer (LS-SCLC) at 39 institutions. Data were compared for patients treated in 2006-2007 versus those for patients treated in 1998-1999. Results: Use of all recommended procedures for staging and treatment was more common in 2006-2007. Specifically, disease was staged with brain imaging (magnetic resonance imaging or computed tomography) and whole-body imaging (positron emission tomography or bone scanning) in 66% of patients with LA-NSCLC in 2006-2007 (vs 42% in 1998-1999, P=.0001) and in 84% of patients with LS-SCLC in 2006-2007 (vs 58.3% in 1998-1999, P=.0011). Concurrent chemoradiation was used for 77% of LA-NSCLC patients (vs 45% in 1998-1999, P<.0001) and for 90% of LS-SCLC patients (vs 62.5% in 1998-1999, P<.0001). Use of the recommended radiation dose (59-74 Gy for NSCLC and 60-70 Gy as once-daily therapy for SCLC) did not change appreciably, being 88% for NSCLC in both periods and 51% (2006-2007) versus 43% (1998-1999) for SCLC. Twice-daily radiation for SCLC was used for 21% of patients in 2006-2007 versus 8% in 1998-1999. Finally, 49% of patients with LS-SCLC received prophylactic cranial irradiation (PCI) in 2006-2007 (vs 21% in 1998-1999). Conclusions: Although adherence to all quality indicators improved over time, brain imaging and recommended radiation doses for stage III NSCLC were used in <90% of cases. Use

  1. Comparison of three IMRT inverse planning techniques that allow for partial esophagus sparing in patients receiving thoracic radiation therapy for lung cancer.

    Science.gov (United States)

    Xiao, Ying; Werner-Wasik, Maria; Michalski, D; Houser, C; Bednarz, G; Curran, W; Galvin, James

    2004-01-01

    The purpose of this study is to compare 3 intensity-modulated radiation therapy (IMRT) inverse treatment planning techniques as applied to locally-advanced lung cancer. This study evaluates whether sufficient radiotherapy (RT) dose is given for durable control of tumors while sparing a portion of the esophagus, and whether large number of segments and monitor units are required. We selected 5 cases of locally-advanced lung cancer with large central tumor, abutting the esophagus. To ensure that no more than half of the esophagus circumference at any level received the specified dose limit, it was divided into disk-like sections and dose limits were imposed on each. Two sets of dose objectives were specified for tumor and other critical structures for standard dose RT and for dose escalation RT. Plans were generated using an aperture-based inverse planning (ABIP) technique with the Cimmino algorithm for optimization. Beamlet-based inverse treatment planning was carried out with a commercial simulated annealing package (CORVUS) and with an in-house system that used the Cimmino projection algorithm (CIMM). For 3 of the 5 cases, results met all of the constraints from the 3 techniques for the 2 sets of dose objectives. The CORVUS system without delivery efficiency consideration required the most segments and monitor units. The CIMM system reduced the number while the ABIP techniques showed a further reduction, although for one of the cases, a solution was not readily obtained using the ABIP technique for dose escalation objectives. PMID:15324918

  2. Sentinel-lymph node procedure in breast, uterine cervix, prostate, vulva and penile cancers: Practical methodology; La pratique de la technique du ganglion sentinelle dans diverses indications: sein, col uterin, prostate, vulve et verge. Methodologie pratique

    Energy Technology Data Exchange (ETDEWEB)

    Brenot-Rossi, I. [Centre de Lutte Contre le Cancer, Institut Paoli-Calmettes, Service de Medecine Nucleaire, 13 - Marseille (France)

    2008-08-15

    The nodal status is the strongest prognostic factor in early stage cancers. The sentinel-lymph node (S.L.N.) is defined as the first draining lymph node of an organ; the lymph node status is determined by the histological results of S.L.N.. The lymphadenectomy, with high morbidity, is realised only in case of metastatic S.L.N.. The S.L.N. identification, in most of cases, is performed using the combination of blue dye and radiocolloid {sup 99m}Tc injections. The purpose of this article is to give some practical details about the S.L.N. isotopic procedure in breast cancer, vulva and penile cancer, uterine cervix and prostate cancer. (author)

  3. MRI-based IMRT planning for MR-linac: comparison between CT- and MRI-based plans for pancreatic and prostate cancers

    Science.gov (United States)

    Prior, Phil; Chen, Xinfeng; Botros, Maikel; Paulson, Eric S.; Lawton, Colleen; Erickson, Beth; Li, X. Allen

    2016-05-01

    The treatment planning in radiation therapy (RT) can be arranged to combine benefits of computed tomography (CT) and magnetic resonance imaging (MRI) together to maintain dose calculation accuracy and improved target delineation. Our aim is study the dosimetric impact of uniform relative electron density assignment on IMRT treatment planning with additional consideration given to the effect of a 1.5 T transverse magnetic field (TMF) in MR-Linac. A series of intensity modulated RT (IMRT) plans were generated for two representative tumor sites, pancreas and prostate, using CT and MRI datasets. Representative CT-based IMRT plans were generated to assess the impact of different electron density (ED) assignment on plan quality using CT without the presence of a 1.5 T TMF. The relative ED (rED) values used were taken from the ICRU report 46. Four types of rED assignment in the organs at risk (OARs), the planning target volumes (PTV) and in the non-specified tissue (NST) were considered. Dose was recalculated (no optimization) using a Monaco 5.09.07a research planning system employing Monte Carlo calculations with an option to include TMF. To investigate the dosimetric effect of different rED assignment, the dose-volume parameters (DVPs) obtained from these specific rED plans were compared to those obtained from the original plans based on CT. Overall, we found that uniform rED assignment results in differences in DVPs within 3% for the PTV and 5% for OAR. The presence of 1.5 T TMF on IMRT DVPs resulted in differences that were generally within 3% of the Gold St for both the pancreas and prostate. The combination of uniform rED assignment and TMF produced differences in DVPs that were within 4-5% of the Gold St. Larger differences in DVPs were observed for OARs on T2-based plans. The effects of using different rED assignments and the presence of 1.5 T TMF for pancreas and prostate IMRT plans are generally within 3% and 5% of PTV and OAR Gold St values. There are

  4. Dosimetric and geometric evaluation of a hybrid strategy of offline adaptive planning and online image guidance for prostate cancer radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Liu Han; Wu Qiuwen, E-mail: Qiuwen.Wu@Duke.edu [Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710 (United States)

    2011-08-07

    For prostate cancer patients, online image-guided (IG) radiotherapy has been widely used in clinic to correct the translational inter-fractional motion at each treatment fraction. For uncertainties that cannot be corrected online, such as rotation and deformation of the target volume, margins are still required to be added to the clinical target volume (CTV) for the treatment planning. Offline adaptive radiotherapy has been implemented to optimize the treatment for each individual patient based on the measurements at early stages of treatment process. It has been shown that offline adaptive radiotherapy can effectively reduce the required margin. Recently a hybrid strategy of offline adaptive replanning and online IG was proposed and the geometric evaluation was performed. It was found that the planning margins can further be reduced by 1-2 mm compared to online IG only strategy. The purpose of this study was to investigate the dosimetric benefits of such a hybrid strategy on the target and organs at risk. A total of 420 repeated helical computed tomography scans from 28 patients were included in the study. Both low-risk patients (LRP, CTV = prostate) and intermediate-risk patients (IRP, CTV = prostate + seminal vesicles, SV) were included in the simulation. Two registration methods, based on center-of-mass shift of prostate only and prostate plus SV, were performed for IRP. The intensity-modulated radiotherapy was used in the simulation. Criteria on both cumulative and fractional doses were evaluated. Furthermore, the geometric evaluation was extended to investigate the optimal number of fractions necessary to construct the internal target volume (ITV) for the hybrid strategy. The dosimetric margin improvement was smaller than its geometric counterpart and was in the range of 0-1 mm. The optimal number of fractions necessary for the ITV construction is 2 for LRPs and 3-4 for IRPs in a hypofractionation protocol. A new cumulative index of target volume was proposed

  5. Dosimetric and geometric evaluation of a hybrid strategy of offline adaptive planning and online image guidance for prostate cancer radiotherapy

    Science.gov (United States)

    Liu, Han; Wu, Qiuwen

    2011-08-01

    For prostate cancer patients, online image-guided (IG) radiotherapy has been widely used in clinic to correct the translational inter-fractional motion at each treatment fraction. For uncertainties that cannot be corrected online, such as rotation and deformation of the target volume, margins are still required to be added to the clinical target volume (CTV) for the treatment planning. Offline adaptive radiotherapy has been implemented to optimize the treatment for each individual patient based on the measurements at early stages of treatment process. It has been shown that offline adaptive radiotherapy can effectively reduce the required margin. Recently a hybrid strategy of offline adaptive replanning and online IG was proposed and the geometric evaluation was performed. It was found that the planning margins can further be reduced by 1-2 mm compared to online IG only strategy. The purpose of this study was to investigate the dosimetric benefits of such a hybrid strategy on the target and organs at risk. A total of 420 repeated helical computed tomography scans from 28 patients were included in the study. Both low-risk patients (LRP, CTV = prostate) and intermediate-risk patients (IRP, CTV = prostate + seminal vesicles, SV) were included in the simulation. Two registration methods, based on center-of-mass shift of prostate only and prostate plus SV, were performed for IRP. The intensity-modulated radiotherapy was used in the simulation. Criteria on both cumulative and fractional doses were evaluated. Furthermore, the geometric evaluation was extended to investigate the optimal number of fractions necessary to construct the internal target volume (ITV) for the hybrid strategy. The dosimetric margin improvement was smaller than its geometric counterpart and was in the range of 0-1 mm. The optimal number of fractions necessary for the ITV construction is 2 for LRPs and 3-4 for IRPs in a hypofractionation protocol. A new cumulative index of target volume was proposed

  6. The Relevance of the Procedures Related to the Physiotherapy in the Interventions in Patients with Prostate Cancer: Short Review with Practice Approach

    Science.gov (United States)

    Bernardo-Filho, Mario; Barbosa Júnior, Mauro Luis; da Cunha Sá-Caputo, Danúbia; de Aguiar, Eliane de Oliveira Guedes; de Lima, Rafaelle Pacheco Carvalho; Santos-Filho, Sebastião David; de Paoli, Severo; Presta, Giuseppe Antonio; de Oliveira Bravo Monteiro, Milena; Tavares, Ângela

    2014-01-01

    Advances in medical science procedures and their utilization in the field of oncology improved the survival of patients. In consequence, these advances have influenced the practice of physiotherapy. Physiotherapists utilize physical agents with the objective to enhance the health, welfare and quality of life and thus they can play important role in the management and rehabilitation of patients with prostate cancer (PCa). Urinary incontinence (UI) and erectile dysfunction (ED) are effects normally associated with the radical prostatectomy and radiotherapy due to the damage of the muscles of the pelvic floor (MPV). The aim of this work is to present findings related to the PCa and how the physiotherapist can guide the patient in relation to the knowledge and understanding of the anatomic structures related directly with the pelvic floor, the correct breathing and the perception of the MPV, as other muscles of the pelvis. Interventions of the physiotherapy will re-train the muscles of the pelvis by improving the active retention strength of the MPV in order to overcome the insufficiency (mainly the UI and ED) of the injured muscles. In conclusion, it is suggested to consider and to offer to the PCa patients the techniques related to the physiotherapy before and after the treatment. PMID:25018676

  7. Correlates of exercise motivation and behavior in a population-based sample of endometrial cancer survivors: an application of the Theory of Planned Behavior

    Directory of Open Access Journals (Sweden)

    Dundas George

    2007-05-01

    Full Text Available Abstract Background Despite evidence of the benefits of exercise in cancer survivors, exercise participation rates tend to decline after treatments. Few studies have examined the determinants of exercise in less common cancer sites. In this study, we examined medical, demographic, and social cognitive correlates of exercise in endometrial cancer survivors using the Theory of Planned Behavior (TPB. Methods A mailed survey was completed by 354 endometrial cancer survivors (1 to 10 years postdiagnosis residing in Alberta, Canada. The study was cross-sectional. Exercise behavior was assessed using the Godin Leisure Time Exercise Questionnaire and the TPB constructs were assessed with standard self-report scales. Multiple regression analyses were used to determine the independent associations of the TPB constructs with intention and behavior. Results Chi-square analyses indicated that marital status (p = .003, income level (p = .013, and body mass index (BMI (p = .020 were associated with exercise. The TPB explained 34.1% of the variance in exercise behavior with intention (β = .38, p β = .18, p = .029 being independent correlates. For intention, 38.3% of the variance was explained by the TPB with self-efficacy (β = .34, p β = .30, p Conclusion The TPB may be a useful framework for understanding exercise in endometrial cancer survivors. Exercise behavior change interventions based on the TPB should be tested in this growing population.

  8. Intensity-modulated arc therapy with simultaneous integrated boost in the treatment of primary irresectable cervical cancer. Treatment planning, quality control, and clinical implementation

    Energy Technology Data Exchange (ETDEWEB)

    Vandecasteele, Katrien; De Neve, Wilfried; De Gersem, Werner; Paelinck, Leen; Fonteyne, Valerie; De Wagter, Carlos; De Meerleer, Gert [Dept. of Radiotherapy, Ghent Univ. Hospital (Belgium); Delrue, Louke; Villeirs, Geert [Dept. of Radiology, Ghent Univ. Hospital (Belgium); Makar, Amin [Dept. of Gynecology, Ghent Univ. Hospital (Belgium)

    2009-12-15

    Purpose: to report on the planning procedure, quality control, and clinical implementation of intensity-modulated arc therapy (IMAT) delivering a simultaneous integrated boost (SIB) in patients with primary irresectable cervix carcinoma. Patients and methods: six patients underwent PET-CT (positron emission tomography-computed tomography) and MRI (magnetic resonance imaging) before treatment planning. Prescription (25 fractions) was (1) a median dose (D{sub 50}) of 62, 58 and 56 Gy to the primary tumor (GTVcervix), primary clinical target volume (CTVcervix) and its planning target volume (PTVcervix), respectively; (2) a D{sub 50} of 60 Gy to the PET-positive lymph nodes (GTVnodes); (3) a minimal dose (D{sub 98}) of 45 Gy to the planning target volume of the elective lymph nodes (PTVnodes). IMAT plans were generated using an anatomy-based exclusion tool with the aid of weight and leaf position optimization. The dosimetric delivery of IMAT was validated preclinically using radiochromic film dosimetry. Results: five to nine arcs were needed to create valid IMAT plans. Dose constraints on D{sub 50} were not met in two patients (both GTVcervix: 1 Gy and 3 Gy less). D{sub 98} for PTVnodes was not met in three patients (1 Gy each). Film dosimetry showed excellent gamma evaluation. There were no treatment interruptions. Conclusion: IMAT allows delivering an SIB to the macroscopic tumor without compromising the dose to the elective lymph nodes or the organs at risk. The clinical implementation is feasible. (orig.)

  9. Impact of MLC leaf position errors on simple and complex IMRT plans for head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Mu, G; Ludlum, E; Xia, P [Department of Radiation Oncology, University of California, San Francisco, CA (United States)

    2008-01-07

    The dosimetric impact of random and systematic multi-leaf collimator (MLC) leaf position errors is relatively unknown for head and neck intensity-modulated radiotherapy (IMRT) patients. In this report we studied 17 head and neck IMRT patients, including 12 treated with simple plans (<50 segments) and 5 treated with complex plans (>100 segments). Random errors (-2 to +2 mm) and systematic errors ({+-}0.5 mm and {+-}1 mm) in MLC leaf positions were introduced into the clinical plans and the resultant dose distributions were analyzed based on defined endpoint doses. The dosimetric effect was insignificant for random MLC leaf position errors up to 2 mm for both simple and complex plans. However, for systematic MLC leaf position errors, we found significant dosimetric differences between the simple and complex IMRT plans. For 1 mm systematic error, the average changes in D{sub 95%} were 4% in simple plans versus 8% in complex plans. The average changes in D{sub 0.1cc} of the spinal cord and brain stem were 4% in simple plans versus 12% in complex plans. The average changes in parotid glands were 9% in simple plans versus 13% for the complex plans. Overall, simple IMRT plans are less sensitive to leaf position errors than complex IMRT plans.

  10. Gradient-based delineation of the primary GTV on FLT PET in squamous cell cancer of the thoracic esophagus and impact on radiotherapy planning

    International Nuclear Information System (INIS)

    To validate a gradient-based segmentation method for gross tumor volume(GTV) delineation on 8F-fluorothymidine (FLT)positron emission tomography (PET)/ computer tomography (CT) in esophageal squamous cell cancer through pathologic specimen, in comparison with standardized uptake values (SUV) threshold-based methods and CT. The corresponding impact of this GTV delineation method on treatment planning was evaluated. Ten patients with esophageal squamous cell cancer were enrolled. Before radical surgery, all patients underwent FLT-PET/CT. GTVs were delineated by using four methods. GTVGRAD, GTV1.4 and GTV30%max were segmented on FLT PET using a gradient-based method, a fixed threshold of 1.4 SUV and 30% of SUVmax, respectively. GTVCT was based on CT data alone. The maximum longitudinal tumor length of each segmented GTV was compared with the measured tumor length of the pathologic gross tumor length (LPath). GTVGRAD, GTV1.4 and GTV30%max were compared with GTVCT by overlap index. Two radiotherapy plannings (planGRAD) and (planCT) were designed for each patient based on GTVGRAD and GTVCT. The dose-volume parameters for target volume and normal tissues, CI and HI of planGRAD and planCT were compared. The mean ± standard deviation of LPath was 6.47 ± 2.70 cm. The mean ± standard deviation of LGRAD,L1.4, L30%max and LCT were 6.22 ± 2.61, 6.23 ± 2.80, 5.95 ± 2.50,7.17 ± 2.28 cm, respectively. The Pearson correlation coefficients between LPath and each segmentation method were 0.989, 0.920, 0.920 and 0.862, respectively. The overlap indices of GTVGRAD, GTV1.4, GTV30%max when compared with GTVCT were 0.75 ± 0.12, 0.71 ± 0.12, 0.57 ± 0.10, respectively. The V5, V10, V20, V30 and mean dose of total-lung,V30 and mean dose of heart of planGRAD were significantly lower than planCT. The gradient-based method provided the closest estimation of target length. The radiotherapy plannings based on the gradient-based segmentation method reduced the irradiated volume of lung

  11. The Effect of a Contrast Agent on Proton Beam Range in Radiotherapy Planning Using Computed Tomography for Patients With Locoregionally Advanced Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Ui-Jung; Shin, Dong Ho [Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi (Korea, Republic of); Kim, Tae Hyun, E-mail: k2onco@naver.com [Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi (Korea, Republic of); Moon, Sung Ho; Lim, Young Kyung; Jeong, Hojin; Rah, Jeong-Eun; Kim, Sang Soo; Kim, Joo-Young; Kim, Dae Yong; Park, Sung Yong; Cho, Kwan Ho [Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi (Korea, Republic of)

    2011-11-15

    Purpose: We evaluated the effect of a contrast agent (CA) on proton beam range in a treatment planning system (TPS) for patients with locoregionally advanced lung cancer. Methods and Materials: Two sets of computed tomography (CT) images (with and without CA) were obtained from 20 patients with lung cancer. Because the increase in Hounsfield unit ( Increment HU) value of the heart and great vessels due to the effect of CA is most prominent among thoracic structures, to evaluate the effect of CA on proton beam range in the TPS, we compared the calculated distal ranges in the plan with CA-enhanced CT with those with corrected CT, in which the HU values of the heart and great vessels in the CA-enhanced CT were replaced by average HU values obtained from the unenhanced CT. Results: The mean Increment HU value and the longest length of the heart and great vessels within the proton beam path in the field that passed through these structures were 189 {+-} 29 HU (range, 110-250 HU) and 7.1 {+-} 1.1 cm (range, 2.6-11.2 cm), respectively. The mean distal range error in the TPS because of the presence of CA was 1.0 {+-} 0.7 cm (range, 0.2-2.6 cm). Conclusion: If CA-enhanced CT images are used for radiotherapy planning using a proton beam for the treatment of lung cancer, our results suggest that the HU values of the heart and great vessels should be replaced by the average HU values of soft tissue to avoid discrepancies between planned and delivered doses.

  12. The Effect of a Contrast Agent on Proton Beam Range in Radiotherapy Planning Using Computed Tomography for Patients With Locoregionally Advanced Lung Cancer

    International Nuclear Information System (INIS)

    Purpose: We evaluated the effect of a contrast agent (CA) on proton beam range in a treatment planning system (TPS) for patients with locoregionally advanced lung cancer. Methods and Materials: Two sets of computed tomography (CT) images (with and without CA) were obtained from 20 patients with lung cancer. Because the increase in Hounsfield unit (∆HU) value of the heart and great vessels due to the effect of CA is most prominent among thoracic structures, to evaluate the effect of CA on proton beam range in the TPS, we compared the calculated distal ranges in the plan with CA-enhanced CT with those with corrected CT, in which the HU values of the heart and great vessels in the CA-enhanced CT were replaced by average HU values obtained from the unenhanced CT. Results: The mean ∆HU value and the longest length of the heart and great vessels within the proton beam path in the field that passed through these structures were 189 ± 29 HU (range, 110–250 HU) and 7.1 ± 1.1 cm (range, 2.6–11.2 cm), respectively. The mean distal range error in the TPS because of the presence of CA was 1.0 ± 0.7 cm (range, 0.2–2.6 cm). Conclusion: If CA-enhanced CT images are used for radiotherapy planning using a proton beam for the treatment of lung cancer, our results suggest that the HU values of the heart and great vessels should be replaced by the average HU values of soft tissue to avoid discrepancies between planned and delivered doses.

  13. Impact of 18-fluorodeoxyglucose positron emission tomography on computed tomography defined target volumes in radiation treatment planning of esophageal cancer : reduction in geographic misses with equal inter-observer variability

    NARCIS (Netherlands)

    Schreurs, Liesbeth; Busz, D. M.; Paardekooper, G. M. R. M.; Beukema, J. C.; Jager, P. L.; Van der Jagt, E. J.; van Dam, G. M.; Groen, H.; Plukker, J. Th. M.; Langendijk, J. A.

    2010-01-01

    P>Target volume definition in modern radiotherapy is based on planning computed tomography (CT). So far, 18-fluorodeoxyglucose positron emission tomography (FDG-PET) has not been included in planning modality in volume definition of esophageal cancer. This study evaluates fusion of FDG-PET and CT in

  14. Comparison of different application systems and CT-assisted treatment planning procedures in the treatment of primary endometrium carcinoma. Is it technically possible to include the whole uterus volume in the volume treated by brachytherapy?

    International Nuclear Information System (INIS)

    In a consecutive series of 10 patients with primary irradiated endometrial carcinoma we analyzed the correlation between target volume and treated volume using either standard 1-channel applicators or individual Heyman-applicators. Application of the ovoids was followed by a planning CT scan for all patients. Based on this, target volume (uterus volume) was estimated on a 3D-planning system. According to the measurable length of the uterus cavity we determined the corresponding standard 1-channel applicator and calculated the respectively treated volume. Estimating the advantages of an optimized treatment planning strategy for individual Heyman-applications we compared the treated volumes, which result from a standardized and optimized treatment planning procedure. The mean uterus volume was 180 cm3 (range 57 to 316 cm3). Asymmetric uterus configurations with longitudinal or sagittal side differences exceeding 1 cm were found in 40% of the cases. Using standard 1-channel applicators on average 47% (range 25 to 89%) of the uterus volume were enclosed by the treated volume compared to 70% for Heyman-applications. Differentiating these individual applications according to the variable treatment modality values of mean 66% (range 36 to 110%) for the standardized and 73% (range 48 to 95%) for the optimized treatment planning strategy were found. Moreover optimized planning modalities led to an improved coverage of the target volume in 5 out of 10 cases with an increase in volume of 20% on average (range 11 to 32%). In 3 cases changes of less than 5% were noticed (no improvement). In order to protect organs at risk treated volume had to be decreased in 2 cases for 19% and 40% respectively. (orig./MG)

  15. A cone-beam computed tomography triple scan procedure to obtain a three-dimensional augmented virtual skull model appropriate for orthognathic surgery planning.

    NARCIS (Netherlands)

    Swennen, G.R.; Mollemans, W.; Clercq, C. De; Abeloos, J.V.S.; Lamoral, P.; Lippens, F.R.C.; Neyt, N.; Casselman, J.W.; Schutyser, F.A.C.

    2009-01-01

    The aim of this study was to present a new approach to acquire a three-dimensional virtual skull model appropriate for orthognathic surgery planning without the use of plaster dental models and without deformation of the facial soft-tissue mask. A "triple" cone-beam computed tomography (CBCT) scan p

  16. Influence of radioactive sources discretization in the Monte Carlo computational simulations of brachytherapy procedures: a case study on the procedures for treatment of prostate cancer; Influencia da discretizacao das fontes radioativas nas simulacoes computacionais Monte Carlo de procedimentos de braquiterapia: um estudo de caso sobre os procedimentos para tratamento do cancer de prostata

    Energy Technology Data Exchange (ETDEWEB)

    Barbosa, Antonio Konrado de Santana; Vieira, Jose Wilson [Instituto Federal de Educacao, Ciencia e Tecnologia (IFPE), Recife, PE (Brazil); Costa, Kleber Souza Silva [Faculdade Integrada de Pernambuco (FACIPE), Recife, PE (Brazil); Lima, Fernando Roberto de Andrade, E-mail: falima@cnen.gov.b [Centro Regional de Ciencias Nucleares do Nordeste (CRCN-NE/CNEN-PE), Recife, PE (Brazil)

    2011-07-01

    Radiotherapy computational simulation procedures using Monte Carlo (MC) methods have shown to be increasingly important to the improvement of cancer fighting strategies. One of the biases in this practice is the discretization of the radioactive source in brachytherapy simulations, which often do not match with a real situation. This study had the aim to identify and to measure the influence of radioactive sources discretization in brachytherapy MC simulations when compared to those that do not present discretization, using prostate brachytherapy with Iodine-125 radionuclide as model. Simulations were carried out with 108 events with both types of sources to compare them using EGSnrc code associated to MASH phantom in orthostatic and supine positions with some anatomic adaptations. Significant alterations were found, especially regarding bladder, rectum and the prostate itself. It can be concluded that there is a need to discretized sources in brachytherapy simulations to ensure its representativeness. (author)

  17. Comparison and evaluation of volumetric modulated arc therapy and intensity modulated radiation therapy plans for postoperative radiation therapy of prostate cancer patient using a rectal balloon

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Hae Youn; Seok, Jin Yong; Hong, Joo Wan; Chang, Nam Jun; Choi, Byeong Don; Park, Jin Hong [Dept. of Radiation Oncology, Seoul National University Bundang Hospital, Sangnam (Korea, Republic of)

    2015-06-15

    The dose distribution of organ at risk (OAR) and normal tissue is affected by treatment technique in postoperative radiation therapy for prostate cancer. The aim of this study was to compare dose distribution characteristic and to evaluate treatment efficiency by devising VMAT plans according to applying differed number of arc and IMRT plan for postoperative patient of prostate cancer radiation therapy using a rectal balloon. Ten patients who received postoperative prostate radiation therapy in our hospital were compared. CT images of patients who inserted rectal balloon were acquired with 3 mm thickness and 10 MV energy of HD120MLC equipped Truebeam STx (Varian, Palo Alto, USA) was applied by using Eclipse (Version 11.0, Varian, Palo Alto, USA). 1 Arc, 2 Arc VMAT plans and 7-field IMRT plan were devised for each patient and same values were applied for dose volume constraint and plan normalization. To evaluate these plans, PTV coverage, conformity index (CI) and homogeneity index (HI) were compared and R{sub 50%} was calculated to assess low dose spillage as per treatment plan. D{sub 50%} of rectum and bladder Dmean were compared on OAR. And to evaluate the treatment efficiency, total monitor units(MU) and delivery time were considered. Each assessed result was analyzed by average value of 10 patients. Additionally, portal dosimetry was carried out for accuracy verification of beam delivery. There was no significant difference on PTV coverage and HI among 3 plans. Especially CI and R{sub 50%} on 7F-IMRT were the highest as 1.230, 3.991 respectively(p=0.00). Rectum D{sub 50%} was similar between 1A-VMAT and 2A-VMAT. But approximately 7% higher value was observed on 7F-IMRT compare to the others(p=0.02) and bladder Dmean were similar among the all plan(P>0.05). Total MU were 494.7, 479.7, 757.9 respectively(P=0.00) for 1A-VMAT, 2A-VMAT, 7F-IMRT and at the most on 7F-IMRT. The delivery time were 65.2sec, 133.1sec, 145.5sec respectively(p=0.00). The obvious shortest

  18. Dosimetric comparison of stereotactic body radiotherapy using 4D CT and multiphase CT images for treatment planning of lung cancer: Evaluation of the impact on daily dose coverage

    International Nuclear Information System (INIS)

    Purpose: To investigate the dosimetric impact of using 4D CT and multiphase (helical) CT images for treatment planning target definition and the daily target coverage in hypofractionated stereotactic body radiotherapy (SBRT) of lung cancer. Materials and methods: For 10 consecutive patients treated with SBRT, a set of 4D CT images and three sets of multiphase helical CT scans, taken during free-breathing, end-inspiration and end-expiration breath-hold, were obtained. Three separate planning target volumes (PTVs) were created from these image sets. A PTV4D was created from the maximum intensity projection (MIP) reconstructed 4D images by adding a 3 mm margin to the internal target volume (ITV). A PTV3CT was created by generating ITV from gross target volumes (GTVs) contoured from the three multiphase images. Finally, a third conventional PTV (denoted PTVconv) was created by adding 5 mm in the axial direction and 10 mm in the longitudinal direction to the GTV (in this work, GTV = CTV = clinical target volume) generated from free-breathing helical CT scans. Treatment planning was performed based on PTV4D (denoted as Plan-1), and the plan was adopted for PTV3CT and PTVconv to form Plan-2 and Plan-3, respectively, by superimposing 'Plan-1' onto the helical free-breathing CT data set using modified beam apertures that conformed to either PTV3CT or PTVconv. We first studied the impact of PTV design on treatment planning by evaluating the dosimetry of the three PTVs under the three plans, respectively. Then we examined the effect of the PTV designs on the daily target coverage by utilizing pre-treatment localization CT (CT-on-rails) images for daily GTV contouring and dose recalculation. The changes in the dose parameters of D95 and D99 (the dose received by 95% and 99% of the target volume, respectively), and the Vp (the volume receiving the prescription dose) of the daily GTVs were compared under the three plans before and after setup error correction. Results: For all

  19. NOTE: Dosimetric evaluation of inspiration and expiration breath-hold for intensity-modulated radiotherapy planning of non-small cell lung cancer

    Science.gov (United States)

    Tahir, Bilal A.; Bragg, Christopher M.; Lawless, Sarah E.; Hatton, Matthew Q. F.; Ireland, Rob H.

    2010-04-01

    The purpose of this study was to compare target coverage and lung tissue sparing between inspiration and expiration breath-hold intensity-modulated radiotherapy (IMRT) plans for patients with non-small cell lung cancer (NSCLC). In a prospective study, seven NSCLC patients gave written consent to undergo both moderate deep inspiration and end-expiration breath-hold computed tomography (CT), which were used to generate five-field IMRT plans. Dose was calculated with a scatter and an inhomogeneity correction algorithm. The percentage of the planning target volume (PTV) receiving 90% of the prescription dose (PTV90), the volume of total lung receiving >= 10 Gy (V10) and >= 20 Gy (V20) and the mean lung dose (MLD) were compared by the Student's paired t-test. Compared with the expiration plans, the mean ± SD reductions for V10, V20 and MLD on the inspiration plans were 4.0 ± 3.7% (p = 0.031), 2.5 ± 2.3% (p = 0.028) and 1.1 ± 0.7 Gy (p = 0.007), respectively. Conversely, a mean difference of 1.1 ± 1.1% (p = 0.044) in PTV90 was demonstrated in favour of expiration. When using IMRT, inspiration breath-hold can reduce the dose to normal lung tissue while expiration breath-hold can improve the target coverage. The improved lung sparing at inspiration may outweigh the modest improvements in target coverage at expiration.

  20. Planning analysis for locally advanced lung cancer: dosimetric and efficiency comparisons between intensity-modulated radiotherapy (IMRT), single-arc/partial-arc volumetric modulated arc therapy (SA/PA-VMAT)

    OpenAIRE

    Zhou Xiaojuan; Xu Yong; Zhou Lin; Liu Yongmei; Li Tao; Jiang Xiaoqin; Gong Youling

    2011-01-01

    Abstract Purpose To analyze the differences between the intensity-modulated radiotherapy (IMRT), single/partial-arc volumetric modulated arc therapy (SA/PA-VMAT) techniques in treatment planning for locally advanced lung cancer. Materials and methods 12 patients were retrospectively studied. In each patient's case, several parameters were analyzed based on the dose-volume histograms (DVH) of the IMRT, SA/PA-VMAT plans respectively. Also, each plan was delivered to a phantom for time compariso...

  1. CLINICAL VALUE OF MULTISLICE SPIRAL X-RAY COMPUTED TOMOGRAPHY WHEN PLANNING THE TREATMENT OF PATIENTS WITH LARYNGEAL CANCER

    OpenAIRE

    L G Kozhanov; A. L. Yudin; O. A.-K. Kushkhov

    2012-01-01

    Cancers remain a priority for modern society. According to the WHO estimates, global cancer morbidity  and mortality rates will triple in the period 1999 to 2030: from 10 to 30 million new cases and from 6 to 17 million deaths recorded every year, which will exceed deaths from cardiovascular diseases and injuries. The efficiency of treatment in cancer patients and their prediction are determined by timely disease diagnosis, tumor extent estimation, and adequate therapeutic measures. So search...

  2. Utility of Megavoltage Fan-Beam CT for Treatment Planning in a Head-And-Neck Cancer Patient with Extensive Dental Fillings Undergoing Helical Tomotherapy

    International Nuclear Information System (INIS)

    The purpose of this study was to demonstrate the potential utility of megavoltage fan-beam computed tomography (MV-FBCT) for treatment planning in a patient undergoing helical tomotherapy for nasopharyngeal carcinoma in the presence of extensive dental artifact. A 28-year-old female with locally advanced nasopharyngeal carcinoma presented for radiation therapy. Due to the extensiveness of the dental artifact present in the oral cavity kV-CT scan acquired at simulation, which made treatment planning impossible on tomotherapy planning system, MV-FBCT imaging was obtained using the HI-ART tomotherapy treatment machine, with the patient in the treatment position, and this information was registered with her original kV-CT scan for the purposes of structure delineation, dose calculation, and treatment planning. To validate the feasibility of the MV-FBCT-generated treatment plan, an electron density CT phantom (model 465, Gammex Inc., Middleton, WI) was scanned using MV-FBCT to obtain CT number to density table. Additionally, both a 'cheese' phantom (which came with the tomotherapy treatment machine) with 2 inserted ion chambers and a generic phantom called Quasar phantom (Modus Medical Devices Inc., London, ON, Canada) with one inserted chamber were used to confirm dosimetric accuracy. The MV-FBCT could be used to clearly visualize anatomy in the region of the dental artifact and provide sufficient soft-tissue contrast to assist in the delineation of normal tissue structures and fat planes. With the elimination of the dental artifact, the MV-FBCT images allowed more accurate dose calculation by the tomotherapy system. It was confirmed that the phantom material density was determined correctly by the tomotherapy MV-FBCT number to density table. The ion chamber measurements agreed with the calculations from the MV-FBCT generated phantom plan within 2%. MV-FBCT may be useful in radiation treatment planning for nasopharyngeal cancer patients in the setting of extensive

  3. Fully Automated Simultaneous Integrated Boosted-Intensity Modulated Radiation Therapy Treatment Planning Is Feasible for Head-and-Neck Cancer: A Prospective Clinical Study

    Energy Technology Data Exchange (ETDEWEB)

    Wu Binbin, E-mail: binbin.wu@gunet.georgetown.edu [Department of Radiation Oncology and Molecular Radiation Science, Johns Hopkins University, Baltimore, Maryland (United States); Department of Radiation Medicine, Georgetown University Hospital, Washington, DC (United States); McNutt, Todd [Department of Radiation Oncology and Molecular Radiation Science, Johns Hopkins University, Baltimore, Maryland (United States); Zahurak, Marianna [Department of Oncology Biostatistics, Johns Hopkins University, Baltimore, Maryland (United States); Simari, Patricio [Autodesk Research, Toronto, ON (Canada); Pang, Dalong [Department of Radiation Medicine, Georgetown University Hospital, Washington, DC (United States); Taylor, Russell [Department of Computer Science, Johns Hopkins University, Baltimore, Maryland (United States); Sanguineti, Giuseppe [Department of Radiation Oncology and Molecular Radiation Science, Johns Hopkins University, Baltimore, Maryland (United States)

    2012-12-01

    Purpose: To prospectively determine whether overlap volume histogram (OVH)-driven, automated simultaneous integrated boosted (SIB)-intensity-modulated radiation therapy (IMRT) treatment planning for head-and-neck cancer can be implemented in clinics. Methods and Materials: A prospective study was designed to compare fully automated plans (APs) created by an OVH-driven, automated planning application with clinical plans (CPs) created by dosimetrists in a 3-dose-level (70 Gy, 63 Gy, and 58.1 Gy), head-and-neck SIB-IMRT planning. Because primary organ sparing (cord, brain, brainstem, mandible, and optic nerve/chiasm) always received the highest priority in clinical planning, the study aimed to show the noninferiority of APs with respect to PTV coverage and secondary organ sparing (parotid, brachial plexus, esophagus, larynx, inner ear, and oral mucosa). The sample size was determined a priori by a superiority hypothesis test that had 85% power to detect a 4% dose decrease in secondary organ sparing with a 2-sided alpha level of 0.05. A generalized estimating equation (GEE) regression model was used for statistical comparison. Results: Forty consecutive patients were accrued from July to December 2010. GEE analysis indicated that in APs, overall average dose to the secondary organs was reduced by 1.16 (95% CI = 0.09-2.33) with P=.04, overall average PTV coverage was increased by 0.26% (95% CI = 0.06-0.47) with P=.02 and overall average dose to the primary organs was reduced by 1.14 Gy (95% CI = 0.45-1.8) with P=.004. A physician determined that all APs could be delivered to patients, and APs were clinically superior in 27 of 40 cases. Conclusions: The application can be implemented in clinics as a fast, reliable, and consistent way of generating plans that need only minor adjustments to meet specific clinical needs.

  4. Assessment Planning and Evaluation of Renewable Energy Resources: an Interactive Computer Assisted Procedure. [hydroelectricity, biomass, and windpower in the Pittsfield metropolitan region, Massachusetts

    Science.gov (United States)

    Aston, T. W.; Fabos, J. G.; Macdougall, E. B.

    1982-01-01

    Adaptation and derivation were used to develop a procedure for assessing the availability of renewable energy resources on the landscape while simultaneously accounting for the economic, legal, social, and environmental issues required. Done in a step-by-step fashion, the procedure can be used interactively at the computer terminals. Its application in determining the hydroelectricity, biomass, and windpower in a 40,000 acre study area of Western Massachusetts shows that: (1) three existing dam sites are physically capable of being retrofitted for hydropower; (2) each of three general areas has a mean annual windspeed exceeding 14 mph and is conductive to windpower; and (3) 20% of the total land area consists of prime agricultural biomass while 30% of the area is prime forest biomass land.

  5. Multiplanar reformat and volume rendering of a multidetector CT scan for path planning a fluoroscopic procedure on Gasserian ganglion block - a preliminary report

    Energy Technology Data Exchange (ETDEWEB)

    Horiguchi, Jun; Ishifuro, Minoru; Fukuda, Hiroshi; Akiyama, Yuji; Ito, Katsuhide

    2005-02-01

    In the treatment of trigeminal neuralgia, Gasserian block under fluoroscopical guidance may be difficult because of anatomic variability, and difficulty in identification of the foramen ovale. We introduce how to use three-dimensional CT in the preprocedural planning. We determine the skull-rotation angle in which the foramen ovale is best visualized, the relationship (distance, angle) between the virtual puncture point and anatomical landmarks, and the distance between the virtual puncture point and the foramen.

  6. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... ve basically divided the blood supply to the short piece of intestine which is heading back in this direction over ... for the connection between the duodenum and the intestine, and that'll basically ... who had presenting symptoms, as I mentioned at the outset, that were ...

  7. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... prevent any bleeding as we divide this fatty bridge between the -- yes, that's perfect -- between the colon, ... with their treatment, getting state-of-the-science types of therapies. I will just say that that ...

  8. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... them. We look for a lot of different features to indicate whether or not there is a ... on with their treatment, getting state-of-the-science types of therapies. I will just say that ...

  9. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... will be in the hospital for about seven days after this operation, and the convalescence tends to ... generally by about the fourth or the fifth day, we can start with some liquids by mouth. ...

  10. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... varying degrees of complexity in an entirely simulated environment as you can see here, where we actually ... some work here on trying to establish this tunnel between the mesenteric vein and the back of ...

  11. Whipple Procedure for Pancreatic Cancer

    Science.gov (United States)

    ... varying degrees of complexity in an entirely simulated environment as you can see here, where we actually ... some work here on trying to establish this tunnel between the mesenteric vein and the back of ...

  12. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... duct to open up the blockage at the time that he was initially evaluated. So now we' ... again for me, just do that one more time. Yep, very nice. Metzenbaum's please. And let's take ...

  13. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... no bigger than a walnut, and that's the source of his problems. So at this point now ... because they provide us with some important staging information about the extent of spread of the tumor ...

  14. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... was put in when he came to the hospital with a bile duct obstruction. That's something that ... 24:42 Most people will be in the hospital for about seven days after this operation, and ...

  15. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... going to want to be very careful to control appropriately. This is not one. I think you ... be problematic for us, although we could certainly control that. So after this operation, this gentleman, as ...

  16. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... divide them all at once. It's just a measure of efficiency here. Go ahead, yeah. And then ... that that represents just inflammation secondary to the instrumentation of the GI tract, which he had had ...

  17. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... emptied into the intestine in a kind of natural and physiologic way. And that's been a fairly ... on with their treatment, getting state-of-the-science types of therapies. I will just say that ...

  18. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... the new openings for the digestive juices to flow into the intestine. And now the small intestine ... I would say that we qualify as a high-volume center and probably have upwards of 50 ...

  19. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... January 7, 2008 00:00:11 ANNOUNCER: This year, an estimated 37,000 new cases of pancreatic ... surgical resident, Dr. Didi Prostein, and a fourth- year medical student, Sarah Matthew. Also today I have ...

  20. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... that little tissue right there. If those digestive juices leak into the abdominal cavity, they can cause ... out. Just saw a little rush of pancreatic juice there from the center of the pancreas. Almost ...

  1. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... to learn more. Just click on the "Request Information" button on your webcast screen and open the ... but they don't give us entirely accurate information in every case, so that's why we also ...

  2. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... get treated with a combination of treatments, including chemotherapy, radiation, and surgery. And one of the benefits ... this right here. That's why when people get chemotherapy, the intestines are frequently the site of side ...

  3. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... treatments based upon the analysis of the path report, those treatments tend to start sometime within the ... but we'll certainly wait for the final report on that before we make that decision. The ...

  4. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... would include the liver, other sites in the abdominal cavity, and the lymph nodes around the pancreas. We normally perform a high- ... right there -- any spread to the liver or lymph nodes or other areas of the abdomen. So right now, we're going to divide ...

  5. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... and remove the gall bladder, which is a standard part of the Whipple operation, and then continue ... that is now considered to be the gold standard for most patients who need additional treatment after ...

  6. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... stomach and the small intestine so that as food is digested in the stomach, it's emptied into ... this operation. If there's a question about the safety of the operation, we'll do further diagnostic ...

  7. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... think has translated into an improved quality of life for individuals. I'm going to have you ... here. We've done a little bit of work here in the vicinity of what's called the ...

  8. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... stomach and the small intestine so that as food is digested in the stomach, it's emptied into ... will be in the hospital for about seven days after this operation, and the convalescence tends to ...

  9. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... screen and open the door to informed medical care. Now let's join Dr. Richard Alexander at the ... a team of anesthesiologists assisting me in the care of my patient. Dr. Deshpande, who is the ...

  10. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... student, Sarah Matthew. Also today I have a team of anesthesiologists assisting me in the care of ... an anesthesia resident. Most importantly, I have a team of terrific nurses in the operating room. You ...

  11. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... is the University of Maryland Advanced Simulation Training Research and Innovation Center, where among other things, we' ... I would say based upon our currently available technologies, it's not ... important staging information about the extent of spread of the tumor ...

  12. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... be somewhere between three to four weeks at home. If people need to have additional treatments based ... then most people are well enough to go home by a week to ten days, and I ...

  13. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... say I'm very, very circumspect about any injury to the vein under these circumstances because this ... here. I don't want to have any injury to the pancreatic tissues. Okay. Good. Can I ...

  14. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... will recommend that an individual will receive additional therapy to try and reduce the risk of recurrence. ... treatment, getting state-of-the-science types of therapies. I will just say that that was the ...

  15. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... University of Maryland Advanced Simulation Training Research and Innovation Center, where among other things, we're engaged ... with the understanding that this may provide a service to someone else who's in a similar circumstance ...

  16. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... tissue here, we're going to divide a membrane which will then get us into the abdominal ... should not be rushed along. Now, with new technologies - - let me put my hand in there if ...

  17. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... cause a lot of difficulties with the recovery process. So now we're just taking the gall ... like this, it can really delay the healing process and prolong the recovery. Called the pancreaticojejunostomy. This ...

  18. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... PARK, MD: Hello, my name is Adrian Park. I'm the head of General Surgery here at ... 02:44 H. RICHARD ALEXANDER, MD: Good morning. I am Dr. Richard Alexander, and this morning, you ...

  19. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... up, so we'll just take slightly more advances on the small valve, so you're out, ... mm-hmm. Start back at your last stitch, advance within the stitch. Perfect. Okay, we're putting ...

  20. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... not twisted or anything, so we're in good shape. At this point in the operation, we're getting ready to start our reconstruction. The first thing we're going to do is connect the ...

  1. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... that, we have to reflect or move the large intestine, or colon, from its usual position in ... just encountering the gastroduodenal artery. This is a large artery that's going to be coming down -- this ...

  2. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... it. Many times people ask me about the impact on their ability to eat and digest normally ... should not be rushed along. Now, with new technologies - - let me put my hand in there if ...

  3. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... operation like this, it can really delay the healing process and prolong the recovery. Called the pancreaticojejunostomy. ... fus-- will be fused within 24 hours. The healing process, obviously, goes on a lot longer beyond ...

  4. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... should not be rushed along. Now, with new technologies - - let me put my hand in there if ... I would say based upon our currently available technologies, it's not something that I would advocate, because ...

  5. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... very nice. Metzenbaum's please. And let's take some 3-0 ties. The artery's right behind you there. ... and the convalescence tends to be somewhere between three to four weeks at home. If people need ...

  6. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... all at once. It's just a measure of efficiency here. Go ahead, yeah. And then when this ... up there very comfortably. There is generally no problem with getting a piece of intestine to sit ...

  7. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... 62-year-old who went to his local emergency room several weeks ago with a complaint of ... right here, we're going to have to use the LigaSure, maybe, for that if you want. ...

  8. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... or fatty, tissues, which have this pale yellow color. And at the base of them is the ... of them. We look for a lot of different features to indicate whether or not there is ...

  9. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... been able to identify at any sites. The stomach is up here, and the pancreas is behind ... this fatty tissue between the colon and the stomach. And so if I pull up here, do ...

  10. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... hepatic artery, which is looping around the -- the cystic duct. And it's oriented in a slightly abnormal ... liver looked clean. Scissors, please. There was some fibrosis, as you saw early on, adjacent to the ...

  11. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... 62-year-old who went to his local emergency room several weeks ago with a complaint of ... was put in when he came to the hospital with a bile duct obstruction. That's something that ...

  12. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... going to fire that -- we need a GIA load for that. It's a different-sized stapler for ... the intestines are frequently the site of side effects, because they're very sensitive to anything that ...

  13. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... stomach and the small intestine so that as food is digested in the stomach, it's emptied into ... therapists were instrumental in conducting the definitive clinical trial that demonstrated the benefit of radiation and chemotherapy ...

  14. Whipple Procedure for Pancreatic Cancer

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    Full Text Available ... it lengthens the operation considerably. And from the oncologic perspective, that is the ability to cleanly divide ... would be the case here as well. Most patients these days get treated with a combination of ...

  15. Whip