WorldWideScience

Sample records for cancer planning procedures

  1. 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 ...

  2. 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 ...

  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: ... pancreas, a pancreaticoduodenectomy, more commonly known as a Whipple, could be an option. 00:00:57 H. ...

  6. 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 ...

  7. 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 ...

  8. 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 ...

  9. 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...

  10. 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...

  11. 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

  12. 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 ...

  13. Whipple Procedure for Pancreatic Cancer

    Medline Plus

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

  14. 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 ...

  15. 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 ...

  16. 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 ...

  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 ... involves removing not only the cancer but the tissues in the immediate vicinity of the cancer that ... cutting through the skin and then the subcutaneous tissues. Let's just proceed straight through that. Good. And ...

  19. 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 ...

  20. 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 ...

  1. Implementation of BNCT treatment planning procedures

    International Nuclear Information System (INIS)

    Estimation of radiation doses delivered during boron neutron capture therapy (BNCT) requires combining data on spatial distribution of both the thermal neutron fluence and the 10B concentration, as well as the relative biological effectiveness of various radiation dose components in the tumor and normal tissues. Using the treatment planning system created at Idaho National Engineering and Environmental Laboratory and the procedures we had developed for clinical trials, we were able to optimize the treatment position, safely deliver the prescribed BNCT doses, and carry out retrospective analyses and reviews. In this paper we describe the BNCT treatment planning process and its implementation in the ongoing dose escalation trials at Brookhaven National Laboratory. (author)

  2. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... to check the usual sites that a pancreatic cancer can spread. That would include the liver, other sites in the abdominal cavity, and the ... common bile duct. That drains bile from the liver into the intestine. And then if we move ... where the cancer was earlier this morning. At this point, we' ...

  3. 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 ...

  4. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... fourth most common but it is the fourth leading cause of cancer death, principally because it is ... we have on our faculty some of the leading experts in the country in the fields of ...

  5. 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 ...

  6. 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 ...

  7. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... around it that are at risk of harboring invisible cancer cells. And so that's why the Whipple ... just come towards me… if you turn your hand around, maybe, and just kind of stay below ...

  8. 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 ...

  9. 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 ...

  10. 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 ...

  11. 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 ...

  12. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... scan of the chest, abdomen, and pelvic area, looking for any spread of the cancerous growth. These ... up here a little bit, basically we're looking at the stomach here, we're looking at ...

  13. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... looking for any spread of the cancerous growth. These are very, very sensitive studies, but they don' ... the abdomen, so we're dividing some of these tissues that sit between the colon and the ...

  14. 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 ...

  15. 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 ...

  16. 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 ...

  17. 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

  18. 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 ...

  19. 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, ...

  20. 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 ...

  1. 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 ...

  2. 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 ...

  3. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... OR-Live makes it easy for you to learn more. Just click on the "Request Information" button ... like to see a little bit more and learn a little bit more about this procedure and ...

  4. 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 ...

  5. 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 ...

  6. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... to those of you who are viewing this today. I would like to also acknowledge my gratitude to this particular patient for his willingness to volunteer today to have this procedure taped. He did so ...

  7. 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 ...

  8. 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 ...

  9. 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, ...

  10. Whipple Procedure for Pancreatic Cancer

    Medline Plus

    Full Text Available ... smaller incision. 00:07:54 This is the colon here. The lining of the abdominal cavity is smooth and healthy. There's no indication of any spread of cancer we've been able to identify at any ...

  11. 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 §...

  12. 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...

  13. Nuclear medicine procedures in lung cancer

    International Nuclear Information System (INIS)

    Although radiography, computed tomography and magnetic resonance imaging are still the methods of choice for the study of lung cancer, they have certain limitations in the determination of the nature of suspicious lung nodules, the evaluation of mediastinal involvement, the assessment of the viability of previously treated lesions and the diagnosis of tumour relapse. There is a wide range of current oncological requirements related to lung cancer: detection of malignant lesions at the earliest stage and in the most effective way; the definition of the biological characteristics of a lesion (proliferation, aggressiveness, differentiation, etc.); the need to define the operability of the patient (function of residual lung and staging); and the need to evaluate the behaviour of the tumour (response to therapy, early detection of recurrences, metastatic spread). Most of the efforts of the nuclear medicine community have been focussed on diagnosis, staging, restaging and therapy monitoring of lung cancer. Many radiopharmaceuticals have been employed for this, including gallium, monoclonal antibodies, somatostatin analogues, lipophilic cations and positron emission tracers. There is ample evidence that nuclear medicine techniques may provide complementary information with respect to anatomical imaging, for example in the assessment of preoperative function by means of ventilation and perfusion scintigraphy, or in tumour localisation by means of specific tumour-seeking agents. However, clinical data suggest that, when properly used, nuclear medicine procedures in some cases may be not only complementary to radiology but essential for the clinical management of lung cancer. An example of such a procedure is fluorodeoxyglucose positron emission tomography (FDG PET) the introduction of which has greatly contributed to confirmation of the clinical value of nuclear medicine in this field. FDG PET has proved of great help in lung cancer management and its cost-effectiveness in

  14. Tracheobronchial reconstructive procedures for lung cancer

    International Nuclear Information System (INIS)

    Tracheobronchial reconstructive procedures have been done for lung cancer in 26 patients. Twenty-four of the 26 cases were advanced cases in stage 3. Six of the 26 cases were irradiated preoperatively. The survival rate for 26 patients at three years was 43.4% and that for 20 patients without preoperative irradiation at three years was 58.0%. Three of the six preoperative irradiated cases died within two months after operation due to anastomotic dehiscences it appears that the use of preoperative irradiation resulted in increase in complications. (author)

  15. 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

  16. 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).

  17. 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.

  18. 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.

  19. 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

  20. VMAT planning study in rectal cancer patients

    International Nuclear Information System (INIS)

    To compare the dosimetric differences among fixed field intensity-modulated radiation therapy (IMRT), single-arc volumetric-modulated arc therapy (SA-VMAT) and double-arc volumetric-modulated arc therapy (DA-VMAT) plans in rectal cancer. Fifteen patients with rectal cancer previously treated with IMRT in our institution were selected for this study. For each patient, three plans were generated with the planning CT scan: one using a fixed beam IMRT, and two plans using the VMAT technique: SA-VMAT and DA-VMAT. Dose prescription to the PTV was 50 Gy in 2 Gy per fraction. Dose volume histograms (DVH) for the target volume and the organs at risk (small bowel, bladder, femoral heads and healthy tissue) were compared for these different techniques. Monitor units (MU) and delivery treatment time were also reported. DA-VMAT achieved the highest minimum planning target volume (PTV) dose and the lowest maximal dose, resulting in the most homogeneous PTV dose distribution. DA-VMAT also yielded the best CI, although the difference was not statistically significant. Between SA-VMAT and IMRT, the target dose coverage was largely comparable; however, SA-VMAT was able to achieve a better V95 and V107. VMAT showed to be inferior to IMRT in terms of organ at risk sparing, especially for the small bowel. Compared with IMRT, DA-VMAT increased the V15 of small bowel nearly 55 cc. The MU and treatment delivery time were significantly reduced by the use of VMAT techniques. VMAT is a new radiation technique that combines the ability to achieve highly conformal dose distributions with highly efficient treatment delivery. Considering the inferior role of normal tissue sparing, especially for small bowel, VMAT need further investigation in rectal cancer treatment

  1. 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)

  2. PET/CT-guided interventional procedures: rationale, justification, initial study, and research plan

    International Nuclear Information System (INIS)

    Positron-emission tomography (PET) and PET/CT (computed tomography) are becoming increasingly important for diagnosis and treatment of cancer. Clinically relevant changes can sometimes be seen on PET that are not seen on other imaging modalities. However, PET is not suitable for guiding biopsy as the images are not obtained in real-time. Therefore, our research group has begun developing a concept for PET/CT-guided interventional procedures. This paper presents the rationale for this concept, outlines our research plan, and includes an initial study to evaluate the relative sensitivity of CT and PET/CT in detecting suspicious lesions. (orig.)

  3. Preparedness strategy and procedures. Annual report 1996. Plans for 1997

    International Nuclear Information System (INIS)

    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)

  4. Individually-tailored procedures of breast cancer therapy

    International Nuclear Information System (INIS)

    On the basis of clinical evaluation of 1007 case histories of breast cancer supplied from the Kazakh Republican Oncological Dispensary, Research Institute of Oncology and Radiation and Municipal Oncological Dispensary (Alma-Ata, 1960-1977), individually-tailored methods of therapy were developed. The procedures are based on such criteria as age, stage, localization, anatomical and histological characteristics of tumor

  5. Automated synthesis of image processing procedures using AI planning techniques

    Science.gov (United States)

    Chien, Steve; Mortensen, Helen

    1994-01-01

    This paper describes the Multimission VICAR (Video Image Communication and Retrieval) Planner (MVP) (Chien 1994) system, which uses artificial intelligence planning techniques (Iwasaki & Friedland, 1985, Pemberthy & Weld, 1992, Stefik, 1981) to automatically construct executable complex image processing procedures (using models of the smaller constituent image processing subprograms) in response to image processing requests made to the JPL Multimission Image Processing Laboratory (MIPL). The MVP system allows the user to specify the image processing requirements in terms of the various types of correction required. Given this information, MVP derives unspecified required processing steps and determines appropriate image processing programs and parameters to achieve the specified image processing goals. This information is output as an executable image processing program which can then be executed to fill the processing request.

  6. 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.

  7. 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...

  8. 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

  9. 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...

  10. Test plan/procedure for the SPM-1 shipping container system. Revision 0

    International Nuclear Information System (INIS)

    The 49 CFR 173.465 Type A packaging tests will verify that SPM-1 will provide adequate protection and pass as a Type A package. Test will determine that the handle of the Pig will not penetrate through the plywood spacer and rupture the shipping container. Test plan/procedure provides planning, pre-test, setup, testing, and post-testing guidelines and procedures for conducting the open-quotes Free Drop Testclose quotes procedure for the SPM-1 package

  11. 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...

  12. 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

  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. ENTERPRISE RESOURCE PLANNING: COMPARISON IMPLEMANTATION PROCEDURES OF TWO COMPANIES

    OpenAIRE

    Mehmet SAHIN; Didem PASAOGLU HAMSIOGLU

    2008-01-01

    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 a...

  15. 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.

  16. 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.)

  17. 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.

  18. Health Care Procedure Considerations and Individualized Health Care Plans

    Science.gov (United States)

    Heller, Kathryn Wolff; Avant, Mary Jane Thompson

    2011-01-01

    Teachers need to maintain a safe, healthy environment for all their students in order to promote learning. However, there are additional considerations when students require health care procedures, such as tube feeding or clean intermittent catheterization. Teachers must effectively monitor their students and understand their roles and…

  19. 75 FR 53171 - Prohibited Transaction Exemption Procedures; Employee Benefit Plans

    Science.gov (United States)

    2010-08-30

    ... the electronic posting of notices of proposed and final prohibited transaction exemptions as published... transaction with the plan). See, for example, PTE 2008-01, 73 FR 3274 (Jan. 17, 2008) and PTE 2009-06, 74 FR...'' (as defined in section 407(d)(2) of ERISA). Most of the transactions prohibited by section 406...

  20. 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.

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

    International Nuclear Information System (INIS)

    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). Five days prior to BT, the pre-planning procedure was performed in 18 cervix cancer patients: tandem-ring applicator was inserted under PCA, pelvic MRI obtained and applicator removed. Procedure tolerability was assessed. High risk clinical target volume (HR CTV) and organs at risk were delineated on the pre-planning MRI, virtual needles placed at optimal positions, and dose planning performed. At BT, insertion was carried out in subarachnoidal anaesthesia according to pre-planned geometry. Pre-planned and actual treatment parameters were compared. Pre-planning procedure was well tolerated. Median difference between the pre-planned and actual needle insertion depth and position were 2 (0–10) mm and 4 (0–30) degrees, respectively. The differences between the pre-planned and actual geometric and dosimetric parameters were statistically non-significant. All actual needles were positioned inside the HR CTV and outside the organs at risk (OAR). Our pre-planning approach is well tolerated and effective. Pre-planned geometry and dose distribution can be reproduced at BT

  2. 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.

  3. 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

  4. Socioeconomic inequalities in cancer survival in England after the NHS cancer plan

    Science.gov (United States)

    Rachet, B; Ellis, L; Maringe, C; Chu, T; Nur, U; Quaresma, M; Shah, A; Walters, S; Woods, L; Forman, D; Coleman, M P

    2010-01-01

    Background: Socioeconomic inequalities in survival were observed for many cancers in England during 1981–1999. The NHS Cancer Plan (2000) aimed to improve survival and reduce these inequalities. This study examines trends in the deprivation gap in cancer survival after implementation of the Plan. Materials and method: We examined relative survival among adults diagnosed with 1 of 21 common cancers in England during 1996–2006, followed up to 31 December 2007. Three periods were defined: 1996–2000 (before the Cancer Plan), 2001–2003 (initialisation) and 2004–2006 (implementation). We estimated the difference in survival between the most deprived and most affluent groups (deprivation gap) at 1 and 3 years after diagnosis, and the change in the deprivation gap both within and between these periods. Results: Survival improved for most cancers, but inequalities in survival were still wide for many cancers in 2006. Only the deprivation gap in 1-year survival narrowed slightly over time. A majority of the socioeconomic disparities in survival occurred soon after a cancer diagnosis, regardless of the cancer prognosis. Conclusion: The recently observed reduction in the deprivation gap was minor and limited to 1-year survival, suggesting that, so far, the Cancer Plan has little effect on those inequalities. Our findings highlight that earlier diagnosis and rapid access to optimal treatment should be ensured for all socioeconomic groups. PMID:20588275

  5. 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...

  6. Evidence-Based Interventions and Screening Recommendations for Colorectal Cancer in Comprehensive Cancer Control Plans: A Content Analysis

    OpenAIRE

    Townsend, Julie S.; Richardson, Lisa C.; Steele, C. Brooke; White, Dana E

    2009-01-01

    Introduction Colorectal cancer is the third most commonly diagnosed cancer and third leading cause of cancer death in the United States. The extent to which Comprehensive Cancer Control (CCC) programs in states, tribal governments and organizations, territories, and Pacific Island jurisdictions address evidence-based recommendations and interventions for colorectal cancer in their CCC plans is largely unknown. Methods We downloaded CCC plans posted on the Cancer Control PLANET Web site for re...

  7. 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...

  8. Computer-assisted planning and dosimetry for radiation treatment of head and neck cancer in Cameroon

    International Nuclear Information System (INIS)

    This evaluation was part of a multicenter, multinational study sponsored by the International Agency for Atomic Energy (Vienna) to investigate a simple, reliable computer-assisted planning and dosimetry system for radiation treatment of head and neck cancers in developing countries. Over a 13-month period (April 1992-April 1993), 120 patients with histologically-proven head or neck cancer were included in the evaluation. In each patient, planning and dosimetry were done both manually and using the computer-assisted system. The manual and computerized systems were compared on the basis of accuracy of determination of the outer contour, target volume, and critical organs; volume inequality resolution; structure heterogeneity correction; selection of the number, angle, and size of beams; treatment time calculation; availability of dosimetry predictions; and duration and cost of the procedure. Results demonstrated that the computer-assisted procedure was superior over the manual procedure, despite less than optimal software. The accuracy provided by the completely computerized procedure is indispensable for Level II radiation therapy, which is particularly useful in tumors of the sensitive, complex structures in the head and neck. (authors). 7 refs., 3 tabs

  9. 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

  10. 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 group of patients with cancer. PMID:26831922

  11. Enhancing photogrammetric 3d city models with procedural modeling techniques for urban planning support

    International Nuclear Information System (INIS)

    This paper presents a workflow to increase the level of detail of reality-based 3D urban models. It combines the established workflows from photogrammetry and procedural modeling in order to exploit distinct advantages of both approaches. The combination has advantages over purely automatic acquisition in terms of visual quality, accuracy and model semantics. Compared to manual modeling, procedural techniques can be much more time effective while maintaining the qualitative properties of the modeled environment. In addition, our method includes processes for procedurally adding additional features such as road and rail networks. The resulting models meet the increasing needs in urban environments for planning, inventory, and analysis

  12. 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...

  13. [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…

  14. 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. ...

  15. 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.)

  16. 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)

  17. 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.…

  18. Generic Planning Target Margin for Rectal Cancer Treatment Setup Variation

    International Nuclear Information System (INIS)

    Purpose: To calculate the generic planning target margin (GPTM) for patients receiving radiation therapy (RT) for rectal cancer placed in a prone position with a customized cradle for small-bowel exclusion. Methods and Materials: A total of 25 consecutive rectal cancer patients were treated for 25 or 28 fractions in a prone position using a cradle to maximize small bowel exclusion. Treatment planning computed tomography (CT) scans were used to create orthogonally digitally reconstructed radiographs (DRRs) for portal image registration, which were compared with daily portal images from an electronic portal-imaging device (EPID). Translation values needed to align the DRRs and EPIDs were recorded for the superior to inferior (SI), right to left (RL), and anterior to posterior (AP) directions, and used to calculate the GPTM using the four-parameter model. Age, weight, and body mass index were tested compared with the setup variation using a Pearson correlation and a t test for significance. Gender versus setup variation was compared with a t test. Results: A total of 1,723 EPID images were reviewed. The GPTM was 10 mm superior, 8 mm inferior, 7 mm RL and 10 mm AP. Age and gender were unrelated to setup variation. Weight was significantly associated with systematic AP variation (p < 0.05). BMI was significantly associated with systematic SI (p < 0.05) and AP (p < 0.01) variation and random RL variation (p < 0.05). Conclusions: The GPTM for rectal cancer is asymmetric with a maximum of 10 mm in the superior, anterior and posterior dimensions. Body mass index may effect setup variation. Research using advanced treatment planning should include these margins in the planning target volume definition.

  19. Phenomenological modelling of second cancer incidence for radiation treatment planning

    International Nuclear Information System (INIS)

    It is still an unanswered question whether a relatively low dose of radiation to a large volume or a higher dose to a small volume produces the higher cancer incidence. This is of interest in view of modalities like IMRT or rotation therapy where high conformity to the target volume is achieved at the cost of a large volume of normal tissue exposed to radiation. Knowledge of the shape of the dose response for radiation-induced cancer is essential to answer the question of what risk of second cancer incidence is implied by which treatment modality. This study therefore models the dose response for radiation-induced second cancer after radiation therapy of which the exact mechanisms are still unknown. A second cancer risk estimation tool for treatment planning is presented which has the potential to be used for comparison of different treatment modalities, and risk is estimated on a voxel basis for different organs in two case studies. The presented phenomenological model summarises the impact of microscopic biological processes into effective parameters of mutation and cell sterilisation. In contrast to other models, the effective radiosensitivities of mutated and non-mutated cells are allowed to differ. Based on the number of mutated cells present after irradiation, the model is then linked to macroscopic incidence by summarising model parameters and modifying factors into natural cancer incidence and the dose response in the lower-dose region. It was found that all principal dose-response functions discussed in the literature can be derived from the model. However, from the investigation and due to scarcity of adequate data, rather vague statements about likelihood of dose-response functions can be made than a definite decision for one response. Based on the predicted model parameters, the linear response can probably be rejected using the dynamics described, but both a flattening response and a decrease appear likely, depending strongly on the effective cell

  20. Phenomenological modelling of second cancer incidence for radiation treatment planning

    Energy Technology Data Exchange (ETDEWEB)

    Pfaffenberger, Asja; Oelfke, Uwe [Deutsches Krebsforschungszentrum, Heidelberg (Germany). Abt. fuer Medizinische Physik in der Strahlentherapie; Schneider, Uwe [Triemli Hospital and Vetsuisse Faculty, Zurich Univ. (Switzerland). Dept. of Radiation Oncology and Nuclear Medicine; Poppe, Bjoern [Oldenburg Univ. (Germany). Arbeitsgruppe Medizinische Strahlenphysik

    2009-07-01

    It is still an unanswered question whether a relatively low dose of radiation to a large volume or a higher dose to a small volume produces the higher cancer incidence. This is of interest in view of modalities like IMRT or rotation therapy where high conformity to the target volume is achieved at the cost of a large volume of normal tissue exposed to radiation. Knowledge of the shape of the dose response for radiation-induced cancer is essential to answer the question of what risk of second cancer incidence is implied by which treatment modality. This study therefore models the dose response for radiation-induced second cancer after radiation therapy of which the exact mechanisms are still unknown. A second cancer risk estimation tool for treatment planning is presented which has the potential to be used for comparison of different treatment modalities, and risk is estimated on a voxel basis for different organs in two case studies. The presented phenomenological model summarises the impact of microscopic biological processes into effective parameters of mutation and cell sterilisation. In contrast to other models, the effective radiosensitivities of mutated and non-mutated cells are allowed to differ. Based on the number of mutated cells present after irradiation, the model is then linked to macroscopic incidence by summarising model parameters and modifying factors into natural cancer incidence and the dose response in the lower-dose region. It was found that all principal dose-response functions discussed in the literature can be derived from the model. However, from the investigation and due to scarcity of adequate data, rather vague statements about likelihood of dose-response functions can be made than a definite decision for one response. Based on the predicted model parameters, the linear response can probably be rejected using the dynamics described, but both a flattening response and a decrease appear likely, depending strongly on the effective cell

  1. 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

  2. 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.

  3. Adverse effect of a distended rectum in intensity-modulated radiotherapy (IMRT) treatment planning of prostate cancer

    International Nuclear Information System (INIS)

    Background and purpose: The retrospective planning study for intensity-modulated radiotherapy (IMRT) of prostate cancer evaluated whether proximal rectum and supra-anal rectum/anal canal should be delineated as separated organs-at-risk (OARs) to achieve optimal dose distributions to the anorectal region. Patients and methods: For 10 patients with localized prostate cancer IMRT plans were generated with the rectum and anal canal as separated OARs (Rec-sep) and as one single OAR (Rec-tot). Two different treatment planning systems (TPS) were utilized. Influence on dose distributions to target and OARs was analyzed. Results: Results from both TPS showed significantly increased doses to the distal rectum/anal canal for plans Rec-tot compared with Rec-sep in case of a distended rectum in the planning CT study: doses were increased by up to mean 31% (P=0.02) and 18% (P=0.03), respectively, in both TPS. For the patient with the largest rectum, the maximum dose increase was 61%. No significant differences in doses to target, bladder, femoral head and proximal rectum were seen. Conclusions: For patients with a distended rectum in the planning CT, delineation of separated OARs for proximal rectum and distal rectum/anal canal resulted in superior dose distributions to the anorectal region and therefore, we recommend this as standard procedure for IMRT planning of prostate cancer

  4. 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 ...

  5. 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...

  6. 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.

  7. 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.)

  8. 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

  9. 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...

  10. 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

  11. 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.

  12. The interplay of ultrasound and computed tomography in the planning and execution of interventional procedures

    International Nuclear Information System (INIS)

    Even in large academic and private settings, where subspecialists abound and diagnostic and interventional radiologists are divided, both physically and philosophically, the interventionalist has emerged from the fluoroscopic suite to participate in the imaging workup of patients referred for precutaneous procedures. This expanded imaging role for the interventionalist is a natural outgrowth of several developments in radiology training. Computed tomography and ultrasound no longer are obscure techniques, understood only by an elite group of academic radiologists in large centers with access to equipment. All residents receive extensive education in these modalities, as imaging is a major part of general radiology. In addition, fellowship programs have been expanded to emphasize organ system training as opposed to ''modality'' training alone. Armed with imaging skills, the interventionalist is able to evaluate the cross-sectional diagnostic images better and to address specific findings and issues with respect to the planned procedure. These specific issues, elucidated by cross-sectional imaging, impact on the planning of interventional procedures addressed in this chapter

  13. Radiation dose and cancer risk among pediatric patients undergoing interventional neuroradiology procedures

    OpenAIRE

    Thierry-Chef, Isabelle; Simon, Steven L.; Miller, Donald L.

    2006-01-01

    Background During interventional neuroradiology procedures, patients can be exposed to moderate to high levels of radiation. Special considerations are required to protect children, who are generally more sensitive to the short- and long-term detrimental effects of radiation exposure. Estimates of dose to the skin of children from certain interventional procedures have been published elsewhere, but we are not aware of data on dose to the brain or on the long-term risk of cancer from brain rad...

  14. 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.

  15. 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)

  16. Utility of Pamphlets in Promoting Knowledge and Positive Attitudes about Two Early Cancer Detection Procedures.

    Science.gov (United States)

    Marty, Phillip J.; McDermott, Robert J.

    Informational pamphlets about breast self-examination (BSE) and testicular self-examination (TSE) are widely distributed in health care settings, but the pamphlets' effectiveness in promoting knowledge and positive attitudes about these early cancer detection procedures is largely unknown. A study compared pamphlets with alternative methods of…

  17. 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)

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

    International Nuclear Information System (INIS)

    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.

  19. 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.

  20. 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

  1. 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

  2. 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

  3. 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

  4. Planning and consultation procedures for low-level radioactive waste disposal

    International Nuclear Information System (INIS)

    This Report is the result of a year-long study funded by UK Nirex Ltd. between 1986 and 1987. The central purpose was to learn from overseas experience of planning and public consultation procedures associated with the establishment of low-level radioactive waste (LLW) disposal sites. The most recent information on LLW developments in the United States, Canada, France, Holland, Switzerland, Sweden, and West Germany was sought, particularly in regard to: (1) the efficacy of public consultation and negotiation procedures, focusing in particular on the perceived problems, successes and areas for improvement; (2) the key aspects bearing on the public acceptability of LLW proposals; and (3) the form and effect of any compensation mechanisms in operation. The greatest success overseas appears to be linked to some combination of the following elements: authority and clarity in the exposition of the direction of radioactive waste management policy, backed up by authoritative and independent analysis; the early involvement of local authority (county council/regional authority) organisations in the site selection process; careful attention to the potential contribution of authoritative independent advisory groups on both technical and procedural/site selection matters; the development and nurturing of local liaison committees to establish good communications at the local level; careful consideration of means of devolving some power to local authority level for safety reassurance, for example, in relation to site inspections and safety monitoring; the development of an incremental, openly negotiated approach to compensation. (author)

  5. 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

  6. A technique using 99mTc-mebrofenin SPECT for radiotherapy treatment planning for liver cancers or metastases

    International Nuclear Information System (INIS)

    Radiotherapy or stereotactic body radiosurgery (SBRT) requires a sufficient functional liver volume to tolerate the treatment. The current study extended the work of de Graaf et al. (2010) [3] on the use of 99mTc-mebrofenin imaging for presurgery planning to radiotherapy planning for liver cancer or metastases. Patient was immobilized and imaged in an identical position on a single-photon emission computed tomography/computed tomography (SPECT-CT) system and a radiotherapy simulation CT system. 99mTc-mebrofenin SPECT was registered to the planning CT through image registration of noncontrast CT from SPECT-CT system to the radiotherapy planning CT. The voxels with higher uptake of 99mTc-mebrofenin were transferred to the planning CT as an avoidance structure in optimizing a 2-arc RapidArc plan for SBRT delivery. Excellent dose coverage to the target and sparing of the healthy remnant liver volume was achieved. This report illustrated a procedure for the use of 99mTc-mebrofenin SPECT for optimizing radiotherapy for liver cancers and metastases

  7. 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)

  8. 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

  9. 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.

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

    International Nuclear Information System (INIS)

    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.

  11. 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.

  12. Classifying breast cancer surgery: a novel, complexity-based system for oncological, oncoplastic and reconstructive procedures, and proof of principle by analysis of 1225 operations in 1166 patients

    Directory of Open Access Journals (Sweden)

    Wallwiener Diethelm

    2009-04-01

    Full Text Available Abstract Background One of the basic prerequisites for generating evidence-based data is the availability of classification systems. Attempts to date to classify breast cancer operations have focussed on specific problems, e.g. the avoidance of secondary corrective surgery for surgical defects, rather than taking a generic approach. Methods Starting from an existing, simpler empirical scheme based on the complexity of breast surgical procedures, which was used in-house primarily in operative report-writing, a novel classification of ablative and breast-conserving procedures initially needed to be developed and elaborated systematically. To obtain proof of principle, a prospectively planned analysis of patient records for all major breast cancer-related operations performed at our breast centre in 2005 and 2006 was conducted using the new classification. Data were analysed using basic descriptive statistics such as frequency tables. Results A novel two-type, six-tier classification system comprising 12 main categories, 13 subcategories and 39 sub-subcategories of oncological, oncoplastic and reconstructive breast cancer-related surgery was successfully developed. Our system permitted unequivocal classification, without exception, of all 1225 procedures performed in 1166 breast cancer patients in 2005 and 2006. Conclusion Breast cancer-related surgical procedures can be generically classified according to their surgical complexity. Analysis of all major procedures performed at our breast centre during the study period provides proof of principle for this novel classification system. We envisage various applications for this classification, including uses in randomised clinical trials, guideline development, specialist surgical training, continuing professional development as well as quality of care and public health research.

  13. A Comprehensive Comparison of IMRT and VMAT Plan Quality for Prostate Cancer Treatment

    International Nuclear Information System (INIS)

    Purpose: We performed a comprehensive comparative study of the plan quality between volumetric-modulated arc therapy (VMAT) and intensity-modulated radiation therapy (IMRT) for the treatment of prostate cancer. Methods and Materials: Eleven patients with prostate cancer treated at our institution were randomly selected for this study. For each patient, a VMAT plan and a series of IMRT plans using an increasing number of beams (8, 12, 16, 20, and 24 beams) were examined. All plans were generated using our in-house–developed automatic inverse planning (AIP) algorithm. An existing eight-beam clinical IMRT plan, which was used to treat the patient, was used as the reference plan. For each patient, all AIP-generated plans were optimized to achieve the same level of planning target volume (PTV) coverage as the reference plan. Plan quality was evaluated by measuring mean dose to and dose–volume statistics of the organs at risk, especially the rectum, from each type of plan. Results: For the same PTV coverage, the AIP-generated VMAT plans had significantly better plan quality in terms of rectum sparing than the eight-beam clinical and AIP-generated IMRT plans (p < 0.0001). However, the differences between the IMRT and VMAT plans in all the dosimetric indices decreased as the number of beams used in IMRT increased. IMRT plan quality was similar or superior to that of VMAT when the number of beams in IMRT was increased to a certain number, which ranged from 12 to 24 for the set of patients studied. The superior VMAT plan quality resulted in approximately 30% more monitor units than the eight-beam IMRT plans, but the delivery time was still less than 3 min. Conclusions: Considering the superior plan quality as well as the delivery efficiency of VMAT compared with that of IMRT, VMAT may be the preferred modality for treating prostate cancer.

  14. 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.

  15. 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 ...

  16. 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.

  17. Proposal evaluation tool of standards and procedures for breast cancer in the province of Cienfuegos

    International Nuclear Information System (INIS)

    Breast cancer is one of the most frequent malignancies Although Cuba and be a program with rules and procedures established a high number of women will die from cause. Objectives, design an instrument to assess compliance with the rules and procedures of breast cancer in Cienfuegos Province. Methodological design, a study was conducted descriptive, during the time period from January 2007 to January 2008, whose study group consisted of 55 women diagnosed with breast cancer at the 'Hospital Universitario Dr. Gustavo Lima Aldereguia' of Cienfuegos, the research was divided into three stages: general characterization, design of an assessment tool, criterion validation by external evaluators. Methods were used theoretical, empirical and mathematical statistics. Results, the stadiums most representative were II and III, there are delays in the performance definitive surgery, radical surgical treatments prevail, delays in the initiation of chemotherapy. Findings, there difficulties in adherence and compliance and therapeutic procedures established in the province of Cienfuegos, by which an instrument was designed for evaluation. (Author)

  18. Hospital discharge diagnostic and procedure codes for upper gastro-intestinal cancer: how accurate are they?

    Directory of Open Access Journals (Sweden)

    Stavrou Efty

    2012-09-01

    Full Text Available Abstract Background Population-level health administrative datasets such as hospital discharge data are used increasingly to evaluate health services and outcomes of care. However information about the accuracy of Australian discharge data in identifying cancer, associated procedures and comorbidity is limited. The Admitted Patients Data Collection (APDC is a census of inpatient hospital discharges in the state of New South Wales (NSW. Our aim was to assess the accuracy of the APDC in identifying upper gastro-intestinal (upper GI cancer cases, procedures for associated curative resection and comorbidities at the time of admission compared to data abstracted from medical records (the ‘gold standard’. Methods We reviewed the medical records of 240 patients with an incident upper GI cancer diagnosis derived from a clinical database in one NSW area health service from July 2006 to June 2007. Extracted case record data was matched to APDC discharge data to determine sensitivity, positive predictive value (PPV and agreement between the two data sources (κ-coefficient. Results The accuracy of the APDC diagnostic codes in identifying site-specific incident cancer ranged from 80-95% sensitivity. This was comparable to the accuracy of APDC procedure codes in identifying curative resection for upper GI cancer. PPV ranged from 42-80% for cancer diagnosis and 56-93% for curative surgery. Agreement between the data sources was >0.72 for most cancer diagnoses and curative resections. However, APDC discharge data was less accurate in reporting common comorbidities - for each condition, sensitivity ranged from 9-70%, whilst agreement ranged from κ = 0.64 for diabetes down to κ  Conclusions Identifying incident cases of upper GI cancer and curative resection from hospital administrative data is satisfactory but under-ascertained. Linkage of multiple population-health datasets is advisable to maximise case ascertainment and minimise false

  19. 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...

  20. 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

  1. Report of a study on IMRT planning strategies for ethmoid sinus cancer

    International Nuclear Information System (INIS)

    Aim: This communication reviews the planning strategies and dose statistics of nine IMRT plans generated for a complex head and neck case. Patient and method: An ethmoid sinus cancer case was sent as an IMRT planning task to all participants of the ESTRO course on 'IMRT and Other Conformal Techniques in Practice', held in Amsterdam in June 2001. Results: Nine IMRT plans were generated for the case, the majority of the plans generated with commercial planning systems. The number of beam incidences ranged between four and eleven, while five of the nine beam setups were coplanar. The planning target volume dose homogeneity was inversely correlated with the degree of sparing of the surrounding organs at risk. Conclusion: IMRT strategies for complex head and neck cases, such as ethmoid sinus cancer, can be striklingly different in various aspects, such as beam setup, total number of segments, PTV dose coverage and dose statistics for organs at risks. (orig.)

  2. Radiation dose and cancer risk among pediatric patients undergoing interventional neuroradiology procedures

    International Nuclear Information System (INIS)

    During interventional neuroradiology procedures, patients can be exposed to moderate to high levels of radiation. Special considerations are required to protect children, who are generally more sensitive to the short- and long-term detrimental effects of radiation exposure. Estimates of dose to the skin of children from certain interventional procedures have been published elsewhere, but we are not aware of data on dose to the brain or on the long-term risk of cancer from brain radiation. Our goals were to estimate radiation doses to the brain in 50 pediatric patients who had undergone cerebral embolization and to assess their lifetime risks of developing radiation-related brain cancer. Entrance-peak skin dose and various assumptions on conditions of exposure were used as input for dosimetric calculations to estimate the spatial pattern of dose within the brain and the average dose to the whole brain for each child. The average dose and the age of the child at time of exposure were used to estimate the lifetime risk of developing radiation-related brain cancer. Among the 50 patients, average radiation doses to the brain were estimated to vary from 100 mGy to 1,300 mGy if exposed to non-collimated fields and from 20 mGy to 160 mGy for collimated, moving fields. The lifetime risk of developing brain cancer was estimated to be increased by 2% to 80% as a result of the exposure. Given the very small lifetime background risk of brain tumor, the excess number of cases will be small even though the relative increase might be as high as 80%. ALARA principles of collimation and dose optimization are the most effective means to minimize the risk of future radiation-related cancer. (orig.)

  3. PET/CT planning during chemoradiotherapy for esophageal cancer

    International Nuclear Information System (INIS)

    To evaluate the usefulness of positron emission tomography/computed tomography (PET/CT) for field modification during radiotherapy in esophageal cancer. We conducted a retrospective study on 33 patients that underwent chemoradiotherapy (CRT). Pathologic findings were squamous cell carcinoma in 32 patients and adenocarcinoma in 1 patient. All patients underwent PET/CT scans before and during CRT (after receiving 40 Gy and before a 20 Gy boost dose). Response evaluation was determined by PET/CT using metabolic tumor volume (MTV), total glycolytic activity (TGA), MTV ratio (rMTV) and TGA ratio (rTGA), or determined by CT. rMTV and rTGA were reduction ratio of MTV and TGA between before and during CRT, respectively. Significant decreases in MTV (MTV2.5: mean 70.09%, p 2.5: mean 79.08%, p2.5 was 0.299 (range, 0 to 0.98) and median rTGA2.5 was 0.209 (range, 0 to 0.92). During CRT, PET/CT detected newly developed distant metastasis in 1 patient, and this resulted in a treatment strategy change. At a median 4 months (range, 0 to 12 months) after completion of CRT, 8 patients (24.2%) achieved clinically complete response, 11 (33.3%) partial response, 5 (15.2%) stable disease, and 9 (27.3%) disease progression. SUVmax (p = 0.029), rMTV50% (p = 0.016), rMTV75% (p = 0.023) on intra-treatment PET were found to correlate with complete clinical response. PET/CT during CRT can provide additional information useful for radiotherapy planning and offer the potential for tumor response evaluation during CRT. rMTV50% during CRT was found to be a useful predictor of clinical response.

  4. Rectum separation in patients with cervical cancer for treatment planning in primary chemo-radiation

    International Nuclear Information System (INIS)

    To proof feasibility of hydrogel application in patients with advanced cervical cancer undergoing chemo-radiation in order to reduce rectal toxicity from external beam radiation as well as brachytherapy. Under transrectal sonographic guidance five patients with proven cervical cancer underwent hydro gel (20 cc) instillation into the tip of rectovaginal septum adherent to posterior part of the visible cervical tumor. Five days after this procedure all patients underwent T2 weighted transversal and sagittal MRI for brachytherapy planning. MRI protocol included T2 weighted fast spin echo (FSE) imaging in sagittal, coronal and para-axial orientation using an 1.5 Tesla MRI. Separation of anterior rectal wall and cervix was documented. Hydrogel application was uneventful in all patients and no toxicity was reported. Separation ranged from 7 to 26 mm in width (median 10 mm). The length of the separation varied between 18 and 38 mm (median 32 mm). In all patients displacement was seen in the posterior vaginal fornix, and/or at the deepest part of uterine cervix depending on the extension of the cul-de-sac in correlation to the posterior wall of the uterus. In patients with bulky tumor and/or deep (vaginal) extend of peritoneal cavity tumour was seen mainly cranial from the rectovaginal space and therefore above the hydrogeI application. Only in the extra-peritoneal (lower) part of the cervix a good separation could be achieved between the rectum and cervix. Hydrgel instillation in patients with cervial cancer undergoing chemoradiation is safe and feasible. Because of the loose tissue of the cul-de-sac and its intra- and extraperitoneal part, hydrogel instillation of 20 cc did not result in a sufficient separation of the cervix from anterior wall

  5. Are women in Kuwait aware of breast cancer and its diagnostic procedures?

    Science.gov (United States)

    Saeed, Raed Saeed; Bakir, Yousif Yacoub; Ali, Layla Mohammed

    2014-01-01

    The aim of this study was to examine the knowledge and awareness of women in Kuwait with regard to risk factors, symptoms and diagnostic procedures of breast cancer. A total of 521 questionnaires were distributed among women in Kuwait. Results showed that 72% of respondents linked breast cancer factors to family history, while 69.7% scored abnormal breast enlargement as the most detectable symptom of the disease. Some 84% of participants had heard about self-examination, but knowledge about mammograms was limited to 48.6% and only 22.2% were familiar with diagnostic procedures. Some 22.9% of respondents identified the age over 40 years as the reasonable age to start mammogram screening. Risk factor awareness was independent on age groups (p>0.05), but both high education and family history increased the likelihood of postivie answers; the majority knew about a few factors such as aging, pregnancy after age 30, breast feeding for short time, menopause after age of 50, early puberty, and poor personal hygiene. In conclusion, 43.1% of participants had an overall good knowledge of breast cancer with regards to symptoms, risk factors and breast examination. Very highly significant associations (pbreast should be recommended to eliminate the confusion of wrong perceptions about malignant mammary disease. PMID:25124616

  6. 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…

  7. 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.

  8. 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.

  9. 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.

  10. NCI Approves Funding Plan for NCI Community Oncology Research Program (NCORP) | Division of Cancer Prevention

    Science.gov (United States)

    On June 24, 2014, the Scientific Program Leaders (SPL) of the National Cancer Institute (NCI) approved the funding plan for the NCI Community Oncology Research Program (NCORP), a national network of investigators, cancer care providers, academic institutions, and other organizations. NCORP will conduct multi-site cancer clinical trials and studies in diverse populations in community-based healthcare systems across the United States. The program will receive $93 million a year for five years. |

  11. 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

  12. 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

  13. Improved Beam Angle Arrangement in Intensity Modulated Proton Therapy Treatment Planning for Localized Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Cao, Wenhua; Lim, Gino J. [Department of Industrial Engineering, University of Houston, Houston, TX 77204 (United States); Li, Yupeng [Applied Research, Varian Medical Systems, Palo Alto, CA 94304 (United States); Zhu, X. Ronald; Zhang, Xiaodong, E-mail: xizhang@mdanderson.org [Department of Radiation Physics, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030 (United States)

    2015-03-30

    Purpose: This study investigates potential gains of an improved beam angle arrangement compared to a conventional fixed gantry setup in intensity modulated proton therapy (IMPT) treatment for localized prostate cancer patients based on a proof of principle study. Materials and Methods: Three patients with localized prostate cancer retrospectively selected from our institution were studied. For each patient, IMPT plans were designed using two, three and four beam angles, respectively, obtained from a beam angle optimization algorithm. Those plans were then compared with ones using two lateral parallel-opposed beams according to the conventional planning protocol for localized prostate cancer adopted at our institution. Results: IMPT plans with two optimized angles achieved significant improvements in rectum sparing and moderate improvements in bladder sparing against those with two lateral angles. Plans with three optimized angles further improved rectum sparing significantly over those two-angle plans, whereas four-angle plans found no advantage over three-angle plans. A possible three-beam class solution for localized prostate patients was suggested and demonstrated with preserved dosimetric benefits because individually optimized three-angle solutions were found sharing a very similar pattern. Conclusions: This study has demonstrated the potential of using an improved beam angle arrangement to better exploit the theoretical dosimetric benefits of proton therapy and provided insights of selecting quality beam angles for localized prostate cancer treatment.

  14. Improved Beam Angle Arrangement in Intensity Modulated Proton Therapy Treatment Planning for Localized Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Wenhua Cao

    2015-03-01

    Full Text Available Purpose: This study investigates potential gains of an improved beam angle arrangement compared to a conventional fixed gantry setup in intensity modulated proton therapy (IMPT treatment for localized prostate cancer patients based on a proof of principle study. Materials and Methods: Three patients with localized prostate cancer retrospectively selected from our institution were studied. For each patient, IMPT plans were designed using two, three and four beam angles, respectively, obtained from a beam angle optimization algorithm. Those plans were then compared with ones using two lateral parallel-opposed beams according to the conventional planning protocol for localized prostate cancer adopted at our institution. Results: IMPT plans with two optimized angles achieved significant improvements in rectum sparing and moderate improvements in bladder sparing against those with two lateral angles. Plans with three optimized angles further improved rectum sparing significantly over those two-angle plans, whereas four-angle plans found no advantage over three-angle plans. A possible three-beam class solution for localized prostate patients was suggested and demonstrated with preserved dosimetric benefits because individually optimized three-angle solutions were found sharing a very similar pattern. Conclusions: This study has demonstrated the potential of using an improved beam angle arrangement to better exploit the theoretical dosimetric benefits of proton therapy and provided insights of selecting quality beam angles for localized prostate cancer treatment.

  15. Improved Beam Angle Arrangement in Intensity Modulated Proton Therapy Treatment Planning for Localized Prostate Cancer

    International Nuclear Information System (INIS)

    Purpose: This study investigates potential gains of an improved beam angle arrangement compared to a conventional fixed gantry setup in intensity modulated proton therapy (IMPT) treatment for localized prostate cancer patients based on a proof of principle study. Materials and Methods: Three patients with localized prostate cancer retrospectively selected from our institution were studied. For each patient, IMPT plans were designed using two, three and four beam angles, respectively, obtained from a beam angle optimization algorithm. Those plans were then compared with ones using two lateral parallel-opposed beams according to the conventional planning protocol for localized prostate cancer adopted at our institution. Results: IMPT plans with two optimized angles achieved significant improvements in rectum sparing and moderate improvements in bladder sparing against those with two lateral angles. Plans with three optimized angles further improved rectum sparing significantly over those two-angle plans, whereas four-angle plans found no advantage over three-angle plans. A possible three-beam class solution for localized prostate patients was suggested and demonstrated with preserved dosimetric benefits because individually optimized three-angle solutions were found sharing a very similar pattern. Conclusions: This study has demonstrated the potential of using an improved beam angle arrangement to better exploit the theoretical dosimetric benefits of proton therapy and provided insights of selecting quality beam angles for localized prostate cancer treatment

  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. Impact of tissue heterogeneity corrections in stereotactic body radiation therapy treatment plans for lung cancer

    OpenAIRE

    Herman Tania De; Gabrish Heather; Herman Terence; Vlachaki Maria; Ahmad Salahuddin

    2010-01-01

    This study aims at evaluating the impact of tissue heterogeneity corrections on dosimetry of stereotactic body radiation therapy treatment plans. Four-dimensional computed tomography data from 15 low stage non-small cell lung cancer patients was used. Treatment planning and dose calculations were done using pencil beam convolution algorithm of Varian Eclipse system with Modified Batho Power Law for tissue heterogeneity. Patient plans were generated with 6 MV co-planar non-opposing four to six...

  18. 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

  19. Is the Whipple procedure a better palliative option for pancreatic cancer?

    Science.gov (United States)

    Vanhooser, R; Organ, C H

    1991-05-01

    In recent years, improved results with the Whipple operation have been reported because of improved case selection, thorough intraoperative assessment, aggressive nutritional management, and technical superiority. Ninety-four cases of pancreatic cancer using the Whipple procedure at the University of Oklahoma Health Sciences Center between 1980 and 1986 were reviewed. The median survival time for patients reviewed was 4.5 months; 1- and 2-year survival rates were 16% and 6%, respectively. No survivals at 5 years were observed. Those who underwent resection (Group A) survived 12.9 months with 1- and 2-year survival rates of 54% and 27%. Those undergoing bypass procedures (Group B) had a median survival time of 6 months, with 1- and 2-year survival rates of 16% and 4%. No statistical difference in survival distribution was observed between Groups A and B. The median survival time of patients receiving a staging laparotomy with no therapeutic intervention (Group C) was 2.3 months. Group D patients either refused abdominal exploration or demonstrated signs of inoperability. Surgical mortality in Groups A and B was 8% and 10%, respectively. We suggest that clinical Stage 1 and carefully selected Stage 2 cases of pancreatic cancer should be treated by pancreatoduodenectomy. Stage 3 and 4 patients warrant simultaneous duodenal-biliary by-passes. PMID:1714964

  20. 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

  1. 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

  2. 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

  3. Evaluation on lung cancer patients' adaptive planning of TomoTherapy utilising radiobiological measures and Planned Adaptive module.

    Science.gov (United States)

    Su, Fan-Chi; Shi, Chengyu; Mavroidis, Panayiotis; Rassiah-Szegedi, Prema; Papanikolaou, Niko

    2009-01-01

    Adaptive radiation therapy is a promising concept that allows individualised, dynamic treatment planning based on feedback of measurements. The TomoTherapy Planned Adaptive application, integrated to the helical TomoTherapy planning system, enables calculation of actual dose delivered to the patient for each treatment fraction according to the pretreatment megavoltage computed tomography (MVCT) scan and image registration. As a result, new fractionation treatment plans are available if correction is necessary. In order to evaluate therealclinicaleffect,biologicaldoseis preferred to physical dose. A biological parameter, biologically effective uniform dose ([Formula: see text]), has the advantages of not only reporting delivered dose but also facilitating the analysis of dose-response relations, which link radiation dose to the clinical effect. Therefore, in this study, four lung patients' adaptive plans were evaluated using the [Formula: see text] in addition to physical doses estimated from the TomoTherapy Planned Adaptive module. Higher complication-free tumour control probability (P(+))(of about 8%) was observed in patients treated with larger dose-per-fraction by using the [Formula: see text] in addition to the physical dose. Moreover, a significant increase of 13.2% in the P(+) for the adaptive TomoTherapy plan in one of the lung cancer patients was also observed, which indicates the clinical benefit of adaptive TomoTherapy. PMID:20376282

  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. 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.

  6. 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

  7. 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 ...

  8. 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 ...

  9. 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...

  10. 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

  11. 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.

  12. 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.

  13. 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.

  14. 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

  15. On the relationship between the uncertain role concepts of Third World planners and the substantive versus the procedural argument in planning theory

    OpenAIRE

    W E J Tips

    1986-01-01

    Some of the discussions in two distinct areas of planning theory concern, namely the substantive versus procedural theory debate and the uncertain role concepts of planners, are related to each other. These concerns are considered from a practical viewpoint and some empirical data are used to raise important issues for planning practice. The viability of planning theory in Third World countries as either substantive issues alone or procedural issues alone is questioned. For educational purpos...

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

    Science.gov (United States)

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

    2015-07-01

    We compare the dosimetrical differences between plans generated for helical tomotherapy by using the 2D or 3D the margining technique for the treatment of prostate cancer. Ten prostate cancer patients were included in this study. For 2D plans, the planning target volume (PTV) was created by adding 5 mm (lateral/anterior-posterior) to the clinical target volume (CTV). For 3D plans, a 5-mm margin was added not only lateral/anterior-posterior, but also superior-inferior, to the 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 the 2D and the 3D PTV indices were not significant except for the 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 differences in any organs at risk (OARs) between the 2D and the 3D plans. Overall, the average dose for the 2D plan was slightly lower than that for the 3D plan dose. Compared to the 2D plan, the 3D plan increased the average treatment time by 1.5 minutes; however, this difference was not statistically significant (p = 0.082). We confirmed that the 2D and the 3D margin plans were not significantly different with regard to various dosimetric indices such as the PITV, CI, and HI for PTV and the OARs with tomotherapy.

  17. 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.

  18. 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.)

  19. Use of health plan data to estimate cost and outcomes of a breast cancer population

    International Nuclear Information System (INIS)

    Purpose/Objective: To compare insurance billing data with tumor registry data for estimating date of diagnosis and date of recurrence. To collect and estimate cost of treatment from billing data as a step towards performing cost-effective or cost-utility analysis. To correlate first year treatment cost first year with overall cost to enable the former to serve as a proxy for the latter for patients migrating out of insurance plans. Materials and Methods: Billing data for patients(pts.) diagnosed with breast cancer between 1990-1992 was obtained from Paramount Health Plans, a NCQA accredited health plan in Northwest Ohio. Tumor registry and hospital records were surveyed for the clinical data. Total cost of care received by pts., cost of care associated with treatment of breast cancer, and cost of care billed as breast cancer care was collected for each 12 month period from the date of diagnosis. Costs were measured from a payers, i.e. health plans, perspective. Net present value (NPV) costs discounted at a rate of 3% to the year of diagnosis are reported. Pts. were considered in the plan for the entire duration of the study if they were in the plan from the time of diagnosis to the end of the analysis, (12(96)). Students t-test was used to determined statistical differences between groups analyzed. Results: Paramount Health Plan was a small health plan with approximately 10,000-13,000 female enrolees during the study period. Breast cancer was diagnosed in 21 women during 1990-1992 with 18 pts. diagnosed while in the insurance plan and 3 diagnosed prior to entry into the plan. (12(18)) pts. were in the plan for the entire duration of the study. The mean deviation for the date of diagnosis as recorded from tumor registry data, compared to the first date that a diagnosis of breast cancer appears on the billing record is 18 days (range:0-158). Four pts. experienced a recurrence. A determination of a recurrence from insurance records was only possible in (1(4)) pts. who

  20. 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 ...

  1. 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...

  2. 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...

  3. 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.

  4. Improved robotic stereotactic body radiation therapy plan quality and planning efficacy for organ-confined prostate cancer utilizing overlap-volume histogram-driven planning methodology

    International Nuclear Information System (INIS)

    Background and purpose: This study is to determine if the overlap-volume histogram (OVH)-driven planning methodology can be adapted to robotic SBRT (CyberKnife Robotic Radiosurgery System) to further minimize the bladder and rectal doses achieved in plans manually-created by clinical planners. Methods and materials: A database containing clinically-delivered, robotic SBRT plans (7.25 Gy/fraction in 36.25 Gy) of 425 patients with localized prostate cancer was used as a cohort to establish an organ’s distance-to-dose model. The OVH-driven planning methodology was refined by adding the PTV volume factor to counter the target’s dose fall-off effect and incorporated into Multiplan to automate SBRT planning. For validation, automated plans (APs) for 12 new patients were generated, and their achieved dose/volume values were compared to the corresponding manually-created, clinically-delivered plans (CPs). A two-sided, Wilcoxon rank-sum test was used for statistical comparison with a significance level of p < 0.05. Results: PTV’s V(36.25 Gy) was comparable: 95.6% in CPs comparing to 95.1% in APs (p = 0.2). On average, the refined approach lowered V(18.12 Gy) to the bladder and rectum by 8.2% (p < 0.05) and 6.4% (p = 0.14). A physician confirmed APs were clinically acceptable. Conclusions: The improvements in APs could further reduce toxicities observed in SBRT for organ-confined prostate cancer

  5. Adaptive plan selection vs. re-optimisation in radiotherapy for bladder cancer: A dose accumulation comparison

    International Nuclear Information System (INIS)

    Purpose: Patients with urinary bladder cancer are obvious candidates for adaptive radiotherapy (ART) due to large inter-fractional variation in bladder volumes. In this study we have compared the normal tissue sparing potential of two ART strategies: daily plan selection (PlanSelect) and daily plan re-optimisation (ReOpt). Materials and methods: Seven patients with bladder cancer were included in the study. For the PlanSelect strategy, a patient-specific library of three plans was generated, and the most suitable plan based on the pre-treatment cone beam CT (CBCT) was selected. For the daily ReOpt strategy, plans were re-optimised based on the CBCT from each daily fraction. Bladder contours were propagated to the CBCT scan using deformable image registration (DIR). Accumulated dose distributions for the ART strategies as well as the non-adaptive RT were calculated. Results: A considerable sparing of normal tissue was achieved with both ART approaches, with ReOpt being the superior technique. Compared to non-adaptive RT, the volume receiving more than 57 Gy (corresponding to 95% of the prescribed dose) was reduced to 66% (range 48–100%) for PlanSelect and to 41% (range 33–50%) for ReOpt. Conclusion: This study demonstrated a considerable normal tissue sparing potential of ART for bladder irradiation, with clearly superior results by daily adaptive re-optimisation

  6. PET/CT planning during chemoradiotherapy for esophageal cancer

    OpenAIRE

    Seol, Ki Ho; Jeong Eun LEE

    2014-01-01

    Purpose To evaluate the usefulness of positron emission tomography/computed tomography (PET/CT) for field modification during radiotherapy in esophageal cancer. Materials and Methods We conducted a retrospective study on 33 patients that underwent chemoradiotherapy (CRT). Pathologic findings were squamous cell carcinoma in 32 patients and adenocarcinoma in 1 patient. All patients underwent PET/CT scans before and during CRT (after receiving 40 Gy and before a 20 Gy boost dose). Response evalu...

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

    International Nuclear Information System (INIS)

    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

  8. 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

  9. 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

  10. 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

  11. Sentinel Lymph Node Navigation Surgery for Early Gastric Cancer: Is It a Safe Procedure in Countries with Non-Endemic Gastric Cancer Levels? A Preliminary Experience

    Science.gov (United States)

    Dos Santos, Elizabeth Gomes; Victer, Felipe Carvalho; Neves, Marcelo Soares; Pinto, Márcia Ferreira; Carvalho, Carlos Eduardo De Souza

    2016-01-01

    Purpose Early diagnosis of gastric cancer is still the exception in Western countries. In the East, as in Japan and Korea, this disease is an endemic disorder. More conservative surgical procedures are frequently performed in early gastric cancer cases in these countries where sentinel lymph node navigation surgery is becoming a safe option for some patients. This study aims to evaluate preliminary outcomes of patients with early gastric cancer who underwent sentinel node navigation surgeries in Brazil, a country with non-endemic gastric cancer levels. Materials and Methods From September 2008 to March 2014, 14 out of 205 gastric cancer patients underwent sentinel lymph node navigation surgeries, which were performed using intraoperative, endoscopic, and peritumoral injection of patent blue dye. Results Antrectomies with Billroth I gastroduodenostomies were performed in seven patients with distal tumors. The other seven patients underwent wedge resections. Sentinel basin resections were performed in four patients, and lymphadenectomies were extended to stations 7, 8, and 9 in the other 10. Two patients received false-negative results from sentinel node biopsies, and one of those patients had micrometastasis. There was one postoperative death from liver failure in a cirrhotic patient. Another cirrhotic patient died after two years without recurrence of gastric cancer, also from liver failure. All other patients were followed-up for 13 to 79 months with no evidence of recurrence. Conclusions Sentinel lymph node navigation surgery appears to be a safe procedure in a country with non-endemic levels of gastric cancer. PMID:27104022

  12. MRI or CT for pretreatment staging and radiotherapy planning for radiochemotherapy in distal rectal cancer. Radiologists point

    International Nuclear Information System (INIS)

    Full text: Introduction: In the recent years, the therapeutic approach to rectal cancer changed dramatically. Implementation of a common mesorectal excision and preoperative radiotherapy has become a standard procedure. Noninvasive imaging methods have become basic and leading methods in the process of pre-therapy staging and rectal cancer radiotherapy planning. What you will learn : Following the recommendations of the 2013 ESGAR EURECCA 2012 we will present: a comparative data about the place and role of MRI and CT in the algorithm for low rectal carcinoma staging ; a standard MRI protocol for low rectum carcinoma staging as well as the questions concerning the image interpretation that the radiologist needs to answer. Discussion : Based on the European rules and consensus in the standard protocols implementation of in conducting MRI in rectal cancer, we have the opportunity for preoperative staging of the tumor and hence for proper treatment. The high spatial and tissue resolution of MRI allows carcinoma’s visualization at the depth infiltration of the wall of rectum, distance from mesorectal fascia, involvement of anorectal sphincter, pelvic floor and adjacent bodies, involvement of the venous plexus and the metastatic pararectal lymph nodes presence. Additional performed lung, abdomen and pelvis CT (MDCT) has limited chance for tumor staging, but it serves for distant metastases detection. Conclusion: MRI is the main method for T and N staging and re-staging of low carcinoma of the rectum. MDCT is used for determination of the N stages of the disease

  13. Technical proposal for including health in the procedures for assessing the environmental impact of policies, plans, programmes, projects and activities

    Directory of Open Access Journals (Sweden)

    Almudena García Nieto

    2015-05-01

    Full Text Available Health was an element of general licensing procedures until Spain joined the EU in 1986, when the health report became diluted. The purpose of this article is to provide an overview of this topic’s current regulatory framework and to try to briefly describe health priorities and the channels for feasibly integrating the health variable in the environmental assessment of plans, programmes and projects from the public and private sectors. The current existence of the Environmental Assessment Act and the Public Health Act may help to achieve this.When preparing a strategic environmental study and an environmental impact study, the health impact assessment should be considered an essential step in these environmental procedures and have the same legal treatment as the “compulsory and determinant reports” of said procedures.Thus, it is concluded that the regulatory development of the aspects relating to the assessment of the health impact of the plans, programmes and projects envisaged in the Environmental Assessment Act is essential, the health impact assessment being the tool for doing so.

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

    International Nuclear Information System (INIS)

    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

  15. 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.

  16. 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...

  17. 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. PMID:25315184

  18. The Adjoint Method for The Optimization of Brachytherapy and Radiotherapy Patient Treatment Planning Procedures Using Monte Carlo Calculations

    International Nuclear Information System (INIS)

    The goal of this project is to investigate the use of the adjoint method, commonly used in the reactor physics community, for the optimization of radiation therapy patient treatment plans. Two different types of radiation therapy are being examined, interstitial brachytherapy and radiotherapy. In brachytherapy radioactive sources are surgically implanted within the diseased organ such as the prostate to treat the cancerous tissue. With radiotherapy, the x-ray source is usually located at a distance of about 1-meter from the patient and focused on the treatment area. For brachytherapy the optimization phase of the treatment plan consists of determining the optimal placement of the radioactive sources, which delivers the prescribed dose to the disease tissue while simultaneously sparing (reducing) the dose to sensitive tissue and organs. For external beam radiation therapy the optimization phase of the treatment plan consists of determining the optimal direction and intensity of beam, which provides complete coverage of the tumor region with the prescribed dose while simultaneously avoiding sensitive tissue areas. For both therapy methods, the optimal treatment plan is one in which the diseased tissue has been treated with the prescribed dose and dose to the sensitive tissue and organs has been kept to a minimum

  19. Axomparison for treatment planning of tomotherapy and proton therapy in prostate cancer

    International Nuclear Information System (INIS)

    The prostate cancer is the most common malignant tumor in males. Prostate cancer is the most common malignant tumor that occurs in the male in Korea in 2007 to an annual average of 5,292 cases and 3.3% of the total cancer incidence seventh occurred. Our study compared property for tomotherapy and proton therapy in radiotherapy of prostate cancer patients. We analyzed DVH(Dose Volume Histogram) and dose distribution for prostate, bladder and rectum for radiation treatment planning of prostate cancer with 11 patients in Ilsan K cancer hospital from June to November 2011. There was no differences between tomotherapy and proton therapy in the purpose of prostate cancer therapy for PTV. The adjacent organs of bladder and rectum of average dose-volume were 2 port proton therapy that it was low dose treatment comparing with tomotherapy and 5 port proton therapy. H·I of proton therapy was less than H·I of tomotherapy. Also, 5 port was less than 2 port in H·I of proton therapy. However, 2 port proton therapy has more advantage over 5 port proton therapy that the bladder and rectum of average dose-volume and control time of equipment in radiotherapy of prostate cancer

  20. Planning the procedure for dismantling the TRIGA Reactor at the Medical University of Hannover

    International Nuclear Information System (INIS)

    The aim of this contribution is to provide an overview of the procedure for dismantling the TRIGA reactor at the Medical University of Hannover (MHH). In particular, the dismantling concept and techniques, the amount and the handling of radioactive material, the measurements for release, radiation protection for persons and the environment are presented. (author)

  1. 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

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

    International Nuclear Information System (INIS)

    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

  3. 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

  4. 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…

  5. 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...

  6. 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

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

    International Nuclear Information System (INIS)

    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.

  8. 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.

  9. 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

  10. Impact of tissue heterogeneity corrections in stereotactic body radiation therapy treatment plans for lung cancer

    International Nuclear Information System (INIS)

    This study aims at evaluating the impact of tissue heterogeneity corrections on dosimetry of stereotactic body radiation therapy treatment plans. Four-dimensional computed tomography data from 15 low stage non-small cell lung cancer patients was used. Treatment planning and dose calculations were done using pencil beam convolution algorithm of Varian Eclipse system with Modified Batho Power Law for tissue heterogeneity. Patient plans were generated with 6 MV co-planar non-opposing four to six field beams optimized with tissue heterogeneity corrections to deliver a prescribed dose of 60 Gy in three fractions to at least 95% of the planning target volume, keeping spinal cord dose < 10 Gy. The same plans were then regenerated without heterogeneity correction by recalculating previously optimized treatment plans keeping identical beam arrangements, field fluences and monitor units. Compared with heterogeneity corrected plans, the non-corrected plans had lower average minimum, mean, and maximum tumor doses by 13%, 8% and 6% respectively. The results indicate that tissue heterogeneity is an important determinant of dosimetric optimization of SBRT plans. (author)

  11. Impact of tissue heterogeneity corrections in stereotactic body radiation therapy treatment plans for lung cancer

    Directory of Open Access Journals (Sweden)

    Herman Tania De

    2010-01-01

    Full Text Available This study aims at evaluating the impact of tissue heterogeneity corrections on dosimetry of stereotactic body radiation therapy treatment plans. Four-dimensional computed tomography data from 15 low stage non-small cell lung cancer patients was used. Treatment planning and dose calculations were done using pencil beam convolution algorithm of Varian Eclipse system with Modified Batho Power Law for tissue heterogeneity. Patient plans were generated with 6 MV co-planar non-opposing four to six field beams optimized with tissue heterogeneity corrections to deliver a prescribed dose of 60 Gy in three fractions to at least 95% of the planning target volume, keeping spinal cord dose <10 Gy. The same plans were then regenerated without heterogeneity correction by recalculating previously optimized treatment plans keeping identical beam arrangements, field fluences and monitor units. Compared with heterogeneity corrected plans, the non-corrected plans had lower average minimum, mean, and maximum tumor doses by 13%, 8%, and 6% respectively. The results indicate that tissue heterogeneity is an important determinant of dosimetric optimization of SBRT plans.

  12. 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.

  13. Consenting of the vulnerable: the informed consent procedure in advanced cancer patients in Mexico

    Directory of Open Access Journals (Sweden)

    Verástegui Emma L

    2006-12-01

    Full Text Available Abstract Background A topic of great concern in bioethics is the medical research conducted in poor countries sponsored by wealthy nations. Western drug companies increasingly view Latin America as a proper place for clinical research trials. The region combines a large population, modern medical facilities, and low per capita incomes. Participants from developing countries may have little or non alternative means of treatment other than that offered through clinical trials. Therefore, the provision of a valid informed consent is important. Methods To gain insight about some aspects of the informed consent procedure in a major cancer centre in Mexico, we conducted a three-step evaluation process: 1 a ten point multiple choice survey questionnaires, was used to explore some aspects of the patients' experiences during the informed consent process, 2 researchers' knowledge about specific aspects of the informed consent was evaluated in this study using survey questionnaires; and 3 the comprehensibility, readability and number of pages of the consent forms were analysed. The socioeconomic and educational level of the patients, were also considered. Results were reported using a numerical scale. Results Thirty five patients, 20 doctors, and 10 individuals working at the hospital agreed to participate in the study. Eighty three percent of the patients in the study were classified as living in poverty; education level was poor or non existent, and 31% of the patients were illiterate. The consent forms were difficult to understand according to 49% of the patients, most doctors agreed that the forms were not comprehensible to the patients. The average length of the IC documents analysed was 14 pages, and the readability average score was equivalent to 8TH Grade. Conclusion The results presented in this work describe some relevant characteristics of the population seen at public health care institutions in Mexico. Poverty, limited or no education, and the

  14. Agro-energy supply chain planning: a procedure to evaluate economic, energy and environmental sustainability

    OpenAIRE

    Fabrizio Ginaldi; Francesco Danuso; Franco Rosa; Alvaro Rocca; Oxana Bashanova; Emiliano Sossai

    2012-01-01

    The increasing demand for energy and expected shortage in the medium term, solicit innovative energy strategies to fulfill the increasing gap between demand-supply. For this purpose it is important to evaluate the potential supply of the energy crops and finding the areas of EU where it is most convenient. This paper proposes an agro-energy supply chain approach to planning the biofuel supply chain at a regional level. The proposed methodology is the result of an interdisciplinary team work a...

  15. 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

  16. 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...

  17. 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

  18. Nonrigid Image Registration for Head and Neck Cancer Radiotherapy Treatment Planning With PET/CT

    International Nuclear Information System (INIS)

    Purpose: Head and neck radiotherapy planning with positron emission tomography/computed tomography (PET/CT) requires the images to be reliably registered with treatment planning CT. Acquiring PET/CT in treatment position is problematic, and in practice for some patients it may be beneficial to use diagnostic PET/CT for radiotherapy planning. Therefore, the aim of this study was first to quantify the image registration accuracy of PET/CT to radiotherapy CT and, second, to assess whether PET/CT acquired in diagnostic position can be registered to planning CT. Methods and Materials: Positron emission tomography/CT acquired in diagnostic and treatment position for five patients with head and neck cancer was registered to radiotherapy planning CT using both rigid and nonrigid image registration. The root mean squared error for each method was calculated from a set of anatomic landmarks marked by four independent observers. Results: Nonrigid and rigid registration errors for treatment position PET/CT to planning CT were 2.77 ± 0.80 mm and 4.96 ± 2.38 mm, respectively, p = 0.001. Applying the nonrigid registration to diagnostic position PET/CT produced a more accurate match to the planning CT than rigid registration of treatment position PET/CT (3.20 ± 1.22 mm and 4.96 ± 2.38 mm, respectively, p = 0.012). Conclusions: Nonrigid registration provides a more accurate registration of head and neck PET/CT to treatment planning CT than rigid registration. In addition, nonrigid registration of PET/CT acquired with patients in a standardized, diagnostic position can provide images registered to planning CT with greater accuracy than a rigid registration of PET/CT images acquired in treatment position. This may allow greater flexibility in the timing of PET/CT for head and neck cancer patients due to undergo radiotherapy

  19. 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.

  20. 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.

  1. 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.

  2. 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.

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

    International Nuclear Information System (INIS)

    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. Cumulative radiation exposure and cancer risk of patients with ischemic heart diseases from diagnostic and therapeutic imaging procedures

    International Nuclear Information System (INIS)

    Objectives: To present a detailed analysis of the cumulative radiation exposure and cancer risk of patients with ischemic heart diseases (IHD) from diagnostic and therapeutic imaging. Methods: For 1219 IHD patients, personal and examination data were retrieved from the information systems of a university hospital. For each patient, cumulative organ doses and the corresponding effective dose (E¯) resulting from all imaging procedures performed within 3 months before and 12 months after the date of the diagnosis were calculated. The cumulative lifetime attributable risk (LAR¯) of the patients to be diseased by radiation-related cancer was estimated using sex-, age-, and organ-specific risk models. Results: Among the 3870 procedures performed in the IHD patients, the most frequent were radiographic examinations (52.4%) followed by coronary catheter angiographies and percutaneous cardiac interventions (41.3%), CT scans (3.9%), and perfusion SPECT (2.3%). 87% of patient exposure resulted from heart catheter procedures. E¯ and LAR¯ were significantly higher in males than females (average, 13.3 vs. 10.3 mSv and 0.09 vs. 0.07%, respectively). Contrary to the effective dose, the cancer risk decreased markedly for both sexes with increasing age. Conclusions: Although IHD patients were partially exposed to considerable amounts of radiation, estimated LAR¯s were small as compared to their baseline risk to develop cancer in the remaining life

  6. Post-mastectomy radiotherapy in Denmark: From 2D to 3D treatment planning guidelines of The Danish Breast Cancer Cooperative Group

    DEFF Research Database (Denmark)

    Thomsen, Mette Skovhus; Berg, Martin; Nielsen, Hanne M.;

    2008-01-01

    , it was investigated whether it was possible to find a treatment technique alternative to the one recommended by the Danish Breast Cancer Cooperative Group (DBCG). A dosimetric comparison of a combined photon/electron 3-field technique (3F) and a partial wide tangent technique (PWT) was carried out on individual......This paper describes the procedure of changing from 2D to 3D treatment planning guidelines for post-mastectomy radiotherapy in Denmark. The aim of introducing 3D planning for post-mastectomy radiotherapy was to optimize the target coverage and minimize the dose to the normal tissues. Initially...... to 3F. It was concluded that PWT was an appropriate choice of technique for future radiation treatment of post-mastectomy patients. A working group was formed and guidelines for 3D planning were developed during a series of workshops where radiation oncologists and physicists from all radiotherapy...

  7. 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

  8. Adaptive brachytherapy of cervical cancer, comparison of conventional point A and CT based individual treatment planning

    International Nuclear Information System (INIS)

    Background. Locally advanced cervical cancer is commonly treated with external radiation therapy combined with local brachytherapy. The brachytherapy is traditionally given based on standard dose planning with prescription of dose to point A. Dosimetric aspects when changing from former standard treatment to individualized treatment plans based on computed tomography (CT) images are here investigated. Material and methods. Brachytherapy data from 19 patients with a total of 72 individual treatment fractions were retrospectively reviewed. Standard library plans were analyzed with respect to doses to organs at risk (OARs), and the result was compared to corresponding delivered individualized plans. The theoretical potential of further optimization based on prescription to target volumes was investigated. The treatments were performed with a Fletcher applicator. Results. For standard treatment planning, the tolerance dose limits were exceeded in the bladder, rectum and sigmoid in 26%, 4% and 15% of the plans, respectively. This was observed most often for the smallest target volumes. The individualized planning of the delivered treatment gave the possibility of controlling the dose to critical organs to below certain limits. The dose was still prescribed to point A. An increase in target dose coverage was achieved when additional individual optimization was performed, while still keeping the dose to the OARs below predefined limits. Relatively low average target coverage, especially for the largest volumes was however seen. Conclusion. The individualized delivered treatment plans ensured that doses to OARs were within acceptable limits. This was not the case in 42% of the corresponding standard plans. Further optimized treatment plans were found to give an overall better dose coverage. In lack of MR capacity, it may be favorable to use CT for planning due to possible protection of OARs. The CT based target volumes were, however, not equivalent to the volumes described

  9. 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

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

    International Nuclear Information System (INIS)

    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

  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. RapidArc volumetric modulated therapy planning for prostate cancer patients

    DEFF Research Database (Denmark)

    Kjaer-Kristoffersen, Flemming; Ohlhues, Lars; Medin, Joakim;

    2009-01-01

    clinical practice in May 2008 for treatment of prostate cancer patients. We report here our experiences with performing treatment planning using the Eclipse RapidArc optimization software for this patient group. MATERIAL AND METHODS: A stand-alone installation of Eclipse 8.5 with RapidArc optimization...... capability was performed at Rigshospitalet. Patient data for 8 prostate cancer patients were imported, most of whom were previously treated at Rigshospitalet using IMRT. Three of the patients were treated at Rigshospitalet using the RapidArc technique. Treatment plans were optimized using objectives as given......PURPOSE: Recently, Varian Medical Systems have announced the introduction of a new treatment technique, RapidArc, in which dose is delivered over a single gantry rotation with dynamically variable MLC positions, dose rate and gantry speed. At Rigshospitalet, the RapidArc technique was brought into...

  13. 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.

  14. 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

  15. 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.

  16. 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

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

    International Nuclear Information System (INIS)

    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

  18. DEA radial measurement for environmental assessment and planning: Desirable procedures to evaluate fossil fuel power plants

    International Nuclear Information System (INIS)

    Energy policy depends on a proper use of methodology in guiding a large energy issue such as the global warming and climate change. DEA is one of such methodologies that are often used for preparing environmental policy, which is closely linked to various energy issues. Unfortunately, the use of DEA applied to environmental policy is insufficient, often misguiding policy makers and other individuals who are involved in energy issues. This study provides three guidelines for a use of DEA in preparing environmental assessment. First, it is important to prepare both primal and dual formulations to confirm whether information regarding all production factors (i.e., inputs, desirable and undesirable outputs) is fully utilized in DEA assessment. Second, DEA has model variations in radial and non-radial measurements. It is necessary for us to examine environmental issues by different models in order to avoid a methodological bias existing in those empirical studies. Finally, DEA environmental assessment needs to incorporate the concept of natural and managerial disposability. The natural disposability indicates that a firm negatively adapts a regulation change on undesirable outputs. In contrast, the managerial disposability indicates that a firm positively adapts the regulation change because the firm considers the regulation change as a new business opportunity. - Highlights: ► This study proposes three disable procedures. ► The disposability is separated into natural and managerial disposability. ► All extensions have large applicability in energy policy.

  19. 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

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

    International Nuclear Information System (INIS)

    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.

  1. [Procedures and perceptions of professionals and groups acting in the Brazilian health plan market].

    Science.gov (United States)

    Ribeiro, José Mendes; Lobato, Lenaura de Vasconcelos Costa; Vaitsman, Jeni; Farias, Luís Otávio; Vasconcellos, Maurício; Hollanda, Eliane; Teixeira, Carla Pacheco

    2008-01-01

    This study analyzes the mechanisms used in Brazil by health plan and insurance operators, hospitals and physicians for organizing the access to health care services and their strategies towards cost reduction and decision-making. The study is based on the literature about regulation of the health services, with special focus on micro-management and managed care. From an intentional sample of health care organizations selected according to the number of beneficiaries, organizational modality and geographic criteria we selected probabilistic samples of doctors and hospital services. Data were collected through questionnaires applied to key informants from health care operators and affiliated doctors and hospitals. Results suggest that the relationships between health care organizations, physicians and hospitals follow basically patterns inherited from the former social security system, mainly with fixed pricing and open account payments. More complex financing mechanisms, risk sharing and efficiency strategies are of minor interest. Mechanisms for risk reduction and encouragement of adequate use of technologies are weak. Cost control is mainly based on co-payment and barriers to access to the services. We conclude that in Brazil managed care is still in its beginning. PMID:18813650

  2. Deformable planning CT to cone-beam CT image registration in head-and-neck cancer

    International Nuclear Information System (INIS)

    Purpose: The purpose of this work was to implement and validate a deformable CT to cone-beam computed tomography (CBCT) image registration method in head-and-neck cancer to eventually facilitate automatic target delineation on CBCT. Methods: Twelve head-and-neck cancer patients underwent a planning CT and weekly CBCT during the 5-7 week treatment period. The 12 planning CT images (moving images) of these patients were registered to their weekly CBCT images (fixed images) via the symmetric force Demons algorithm and using a multiresolution scheme. Histogram matching was used to compensate for the intensity difference between the two types of images. Using nine known anatomic points as registration targets, the accuracy of the registration was evaluated using the target registration error (TRE). In addition, region-of-interest (ROI) contours drawn on the planning CT were morphed to the CBCT images and the volume overlap index (VOI) between registered contours and manually delineated contours was evaluated. Results: The mean TRE value of the nine target points was less than 3.0 mm, the slice thickness of the planning CT. Of the 369 target points evaluated for registration accuracy, the average TRE value was 2.6±0.6 mm. The mean TRE for bony tissue targets was 2.4±0.2 mm, while the mean TRE for soft tissue targets was 2.8±0.2 mm. The average VOI between the registered and manually delineated ROI contours was 76.2±4.6%, which is consistent with that reported in previous studies. Conclusions: The authors have implemented and validated a deformable image registration method to register planning CT images to weekly CBCT images in head-and-neck cancer cases. The accuracy of the TRE values suggests that they can be used as a promising tool for automatic target delineation on CBCT.

  3. 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

  4. 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

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

    International Nuclear Information System (INIS)

    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 cm3 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

  6. 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

  7. High dose-rate (HDR) conformal interstitial brachytherapy for locally recurrent rectal cancer. Real-time computed tomography (CT) fluoroscopy guidance and image-based treatment planning

    International Nuclear Information System (INIS)

    The aim of the study is to develop high dose-rate (HDR) conformal interstitial brachytherapy by means of combined real-time computed tomography (CT) fluoroscopy guidance with CT-based treatment planning for locally recurrent rectal carcinoma. The procedures of brachytherapy needle insertion were guided with a helical CT scanner providing real-time fluoroscopy reconstruction. A video monitor placed adjacent to the CT gantry simultaneously allowed the operator to see the process of needle insertion. CT images were transferred by an on-line system to the treatment-planning computer which reconstructed the implant needles and organ contours. The doses in planning target volume were normalized and geometrically optimized. The patients received a dose of 5 Gy per fraction on a daily hyperfractionation schedule at a total dose of 30-50 Gy with or without external radiation therapy. Nine patients were treated for this procedure. Thirteen to 36 needles (average 19.1) were successfully placed at the planning target volume in each patient. The average time for CT fluoroscopy was 370.1 seconds in each procedure. No accident was occurred during needle insertion, but one patient developed fibular nerve palsy after needle removal but gradually recovered. The CT-based treatment planning was faster and more accurate than projection reconstruction with conventional radiograms. Analysis of a dose volume histogram demonstrated conformal dose distribution of the target, while avoiding dose to normal structures with this method. Real-time CT fluoroscopy ensures safety and increases the accuracy of needle placement. Conformal high dose-rate (HDR) interstitial brachytherapy with CT-based treatment planning is an attractive method for locally recurrent rectal cancer. (author)

  8. Decision making, procedural compliance, and outcomes definition in U.S. forest service planning processes

    International Nuclear Information System (INIS)

    The National Environmental Policy Act (NEPA) dictates a process of analyzing and disclosing the likely impacts of proposed agency actions on the human environment. This study addresses two key questions related to NEPA implementation in the U.S. Forest Service: 1) how do Interdisciplinary (ID) team leaders and decision makers conceptualize the outcomes of NEPA processes? And 2), how does NEPA relate to agency decision making? We address these questions through two separate online surveys that posed questions about recently completed NEPA processes - the first with the ID team leaders tasked with carrying out the processes, and the second with the line officers responsible for making the processes' final decisions. Outcomes of NEPA processes include impacts on public relations, on employee morale and team functioning, on the achievement of agency goals, and on the achievement of NEPA's procedural requirements (disclosure) and substantive intent (minimizing negative environmental impacts). Although both tended to view public relations outcomes as important, decision makers' perceptions of favorable outcomes were more closely linked to the achievement of agency goals and process efficiency than was the case for ID team leaders. While ID team leaders' responses suggest that they see decision making closely integrated with the NEPA process, decision makers more commonly decoupled decision making from the NEPA process. These findings suggest a philosophical difference between ID team leaders and decision makers that may pose challenges for both the implementation and the evaluation of agency NEPA. We discuss the pros and cons of integrating NEPA with decision making or separating the two. We conclude that detaching NEPA from decision making poses greater risks than integrating them.

  9. 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 ...

  10. 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)

  11. 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)

  12. 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.

  13. 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.

  14. 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

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

    Science.gov (United States)

    2016-02-15

    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

  16. 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)

  17. 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 ...

  18. Evaluation of delivered dose for a clinical daily adaptive plan selection strategy for bladder cancer radiotherapy

    International Nuclear Information System (INIS)

    Purpose: To account for variable bladder size during bladder cancer radiotherapy, a daily plan selection strategy was implemented. The aim of this study was to calculate the actually delivered dose using an adaptive strategy, compared to a non-adaptive approach. Material and methods: Ten patients were treated to the bladder and lymph nodes with an adaptive full bladder strategy. Interpolated delineations of bladder and tumor on a full and empty bladder CT scan resulted in five PTVs for which VMAT plans were created. Daily cone beam CT (CBCT) scans were used for plan selection. Bowel, rectum and target volumes were delineated on these CBCTs, and delivered dose for these was calculated using both the adaptive plan, and a non-adaptive plan. Results: Target coverage for lymph nodes improved using an adaptive strategy. The full bladder strategy spared the healthy part of the bladder from a high dose. Average bowel cavity V30Gy and V40Gy significantly reduced with 60 and 69 ml, respectively (p < 0.01). Other parameters for bowel and rectum remained unchanged. Conclusions: Daily plan selection compared to a non-adaptive strategy yielded similar bladder coverage and improved coverage for lymph nodes, with a significant reduction in bowel cavity V30Gy and V40Gy only, while other sparing was limited

  19. Agro-energy supply chain planning: a procedure to evaluate economic, energy and environmental sustainability

    Directory of Open Access Journals (Sweden)

    Fabrizio Ginaldi

    2012-07-01

    Full Text Available The increasing demand for energy and expected shortage in the medium term, solicit innovative energy strategies to fulfill the increasing gap between demand-supply. For this purpose it is important to evaluate the potential supply of the energy crops and finding the areas of EU where it is most convenient. This paper proposes an agro-energy supply chain approach to planning the biofuel supply chain at a regional level. The proposed methodology is the result of an interdisciplinary team work and is aimed to evaluate the potential supply of land for the energy production and the efficiency of the processing plants considering simultaneously economic, energy and environmental targets. The crop simulation, on the basis of this approach, takes into account environmental and agricultural variables (soil, climate, crop, agronomic technique that affect yields, energy and economic costs of the agricultural phase. The use of the Dijkstra’s algorithm allows minimizing the biomass transport path from farm to collecting points and the processing plant, to reduce both the transport cost and the energy consumption. Finally, a global sustainability index (ACSI, Agro-energy Chain Sustainability Index is computed combining economic, energy and environmental aspects to evaluate the sustainability of the Agroenergy supply chain (AESC on the territory. The empirical part consists in a pilot study applied to the whole plain of Friuli Venezia Giulia (FVG a region situated in the North-Eastern part of Italy covering about 161,300 ha. The simulation has been applied to the maize cultivation using three different technologies (different levels of irrigation and nitrogen fertilization: low, medium and high input. The higher input technologies allow to achieve higher crop yields, but affect negatively both the economic and energy balances. Low input levels provides, on the average, the most favourable energy and economic balances. ACSI indicates that low inputs levels

  20. 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

  1. Understanding Cervical Cancer Screening Intentions Among Latinas Using An Expanded Theory of Planned Behavior Model

    Science.gov (United States)

    Roncancio, Angelica M.; Ward, Kristy K.; Fernandez, Maria E.

    2016-01-01

    We examined the utility of an expanded Theory of Planned Behavior (TPB) model in predicting cervical cancer screening intentions among Latinas. The model included acculturation and past cervical cancer screening behavior along with attitude, subjective norms, and perceived behavioral control. This cross-sectional study included a sample of 206 Latinas who responded to a self-administered survey. Structural equation modeling was employed to test the expanded TPB model. Acculturation (p= .025) and past screening behavior (p= .001) along with attitude (p= .019), subjective norms (p= .028), and perceived behavioral control (p= .014) predicted the intention to be screened for cervical cancer. Our findings suggest that the TPB is a useful model for understanding cervical cancer screening intentions among Latinas when both past behavior and culture are included. This highlights the importance of culture on behavior and indicates a need to develop culturally sensitive, theory-based interventions to encourage screening and reduce cervical cancer-related health disparities in Latinas. PMID:23930898

  2. Planning and consultation procedures for low-level radioactive waste disposal: a comparative analysis of overseas experience

    International Nuclear Information System (INIS)

    The results are presented of a study the purpose of which was to learn from experience in countries other than the UK, of planning and public consultation procedures associated with the establishment of low-level radioactive waste (LLW) disposal sites. Information on LLW developments in the United States, Canada, France, Holland, Switzerland, Sweden, and West Germany was sought. Particular regard was given to the efficacy of public consultation and negotiation procedures; the key aspects bearing on the public acceptability of LLW proposals; and the form and effect of any compensation mechanisms in operation. The main findings include: (i) Public acceptability of radioactive waste proposals depends upon a combination of basic understanding, trust, consultation and negotiation. (ii) There is no overall correct approach. (iii) The greatest success overseas appears to be linked to some combination of the following elements: authority and clarity in the exposition of radioactive waste management policy; the early involvement of local authority organisations in site selection; careful attention to the potential contribution of authoritative independent advisory groups; the development and nurturing of local liaison committees to establish good communications at the local level; careful consideration of means of devolving some power to local authority level for safety reassurance; and the development of an incremental, openly negotiated approach to compensation. (author)

  3. 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.

  4. 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)

  5. 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

  6. Role of spiral computed Tomography in the diagnosis and treatment planning of patients with colorectal cancer and peritoneal carcinomatosis

    International Nuclear Information System (INIS)

    The results of CT of the abdomen and pelvis in 21 patients with colorectal cancer with peritoneal carcinomatosis were analysed. The study was compared with data obtained at surgical exploration. Location and size of peritoneal implants were evaluated according to peritoneal cancer index. The study shows a lack of sensitivity of single slice spiral CT for peritoneal carcinomatosis detection in patients with colorectal cancer and limited value of the method in planning of surgical treatment

  7. Effect of heterogeneity correction on dosimetric parameters of radiotherapy planning for thoracic esophageal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Nakayama, Masao, E-mail: naka2008@med.kobe-u.ac.jp [Division of Radiation Oncology, Kobe University Graduate School of Medicine, Kobe, Hyogo (Japan); Yoshida, Kenji; Nishimura, Hideki; Miyawaki, Daisuke; Uehara, Kazuyuki; Okamoto, Yoshiaki [Division of Radiation Oncology, Kobe University Graduate School of Medicine, Kobe, Hyogo (Japan); Okayama, Takanobu [Radiology Department, Kobe University Hospital, Kobe, Hyogo (Japan); Sasaki, Ryohei [Division of Radiation Oncology, Kobe University Graduate School of Medicine, Kobe, Hyogo (Japan)

    2014-04-01

    The present study aimed to investigate the effect of heterogeneity correction (HC) on dosimetric parameters in 3-dimensional conformal radiotherapy planning for patients with thoracic esophageal cancer. We retrospectively analyzed 20 patients. Two treatment plans were generated for each patient using a superposition algorithm on the Xio radiotherapy planning system. The first plan was calculated without HC. The second was a new plan calculated with HC, using identical beam geometries and maintaining the same number of monitor units as the first. With regard to the planning target volume (PTV), the overall mean differences in the prescription dose, maximum dose, mean dose, and dose that covers 95% of the PTV between the first and second plans were 1.10 Gy (1.8%), 1.35 Gy (2.2%), 1.10 Gy (1.9%), and 0.56 Gy (1.0%), respectively. With regard to parameters related to the organs at risk (OARs), the mean differences in the absolute percentages of lung volume receiving greater than 5, 10, 20, and 30 Gy (lung V{sub 5}, V{sub 10}, V{sub 20}, and V{sub 30}) between the first and second plans were 7.1%, 2.7%, 0.4%, and 0.5%, respectively. These results suggest that HC might have a more pronounced effect on the percentages of lung volume receiving lower doses (e.g., V{sub 5} and V{sub 10}) than on the dosimetric parameters related to the PTV and other OARs.

  8. A comparison of different three-dimensional treatment planning techniques for localized radiotherapy of prostate cancer

    International Nuclear Information System (INIS)

    Purpose: Four different three-dimensional planning techniques for localized radiotherapy of prostate cancer were compared with regard to dose homogeneity within the target volume and dose to organs at risk, dependent upon tumor stage. Patients and Methods: Six patients with stage T1, 7 patients with stage T2 and 4 patients with stage T3 were included in this study. Four different 3D treatment plans (rotation, 4-field, 5-field and 6-field technique) were calculated for each patient. Dose was calculated with the reference point at the isocenter (100%). The planning target volume was encompassed within the 95% isodose surface. All the techniques used different shaped portal for each beam. Dose volume histograms were created and compared for the planning target volume and the organs at risk (33%, 50%, 66% volume level) in all techniques. Results: The 4 different three-dimensional planning techniques revealed no differences concerning dose homogeneity within the planning target volume. The dose volume distribution at organs at risk show differences between the calculated techniques. In our study the best protection for bladder and rectum in stage T1 and T2 was achieved by the 6-field technique. A significant difference was achieved between 6-field and 4-field technique only in the 50% volume of the bladder (p=0.034), between the 6-field and rotation technique (all volume levels) and between 5-field and rotation technique (all volume levels). In stage T1, T2 6-field and 4-field technique in 50% (p-0.033) and 66% (p=0.011) of the rectum volume. In stage T3 a significant difference was not observed between the 4 techniques. The best protection of head of the femur was achieved by the rotation technique. Conclusion: In the localized radiotherapy of prostate cancer in stage T1 or T2 the best protection for bladder and rectum was achieved by a 3D-planned conformal 6-field technique. If the seminal vesicles have been included in the target volume and in the case of large

  9. 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.

  10. SU-E-T-266: Proton PBS Plan Design and Robustness Evaluation for Head and Neck Cancers

    International Nuclear Information System (INIS)

    Purpose: To describe a newly designed proton pencil beam scanning (PBS) planning technique for radiotherapy of patients with bilateral oropharyngeal cancer, and to assess plan robustness. Methods: We treated 10 patients with proton PBS plans using 2 posterior oblique field (2F PBS) comprised of 80% single-field uniform dose (SFUD) and 20% intensity-modulated proton therapy (IMPT). All patients underwent weekly CT scans for verification. Using dosimetric indicators for both targets and organs at risk (OARs), we quantitatively compared initial plans and verification plans using student t-tests. We created a second proton PBS plan for each patient using 2 posterior oblique plus 1 anterior field comprised of 100% SFUD (3F PBS). We assessed plan robustness for both proton plan groups, as well as a photon volumetric modulated arc therapy (VMAT) plan group by comparing initial and verification plans. Results: The 2F PBS plans were not robust in target coverage. D98% for clinical target volume (CTV) degraded from 100% to 96% on average, with maximum change Δ D98% of −24%. Two patients were moved to photon VMAT treatment due to insufficient CTV coverage on verification plans. Plan robustness was especially weak in the low-anterior neck. The 3F PBS plans, however, demonstrated robust target coverage, which was comparable to the VMAT photon plan group. Doses to oral cavity were lower in the Proton PBS plans compared to photon VMAT plans due to no lower exit dose to the oral cavity. Conclusion: Proton PBS plans using 2 posterior oblique fields were not robust for CTV coverage, due to variable positioning of redundant soft tissue in the posterior neck. We designed 3-field proton PBS plans using an anterior field to avoid long heterogeneous paths in the low neck. These 3-field proton PBS plans had significantly improved plan robustness, and the robustness is comparable to VMAT photon plans

  11. 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

  12. 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

  13. 4D FDG-PET based treatment planning for IGRT in the treatment of lung cancer

    Directory of Open Access Journals (Sweden)

    AlexanderChi

    2014-08-01

    Full Text Available 18F fluorodeoxyglucose positron emission tomography (FDG-PET has changed the staging of, and the treatment response assessment for lung cancer over the past decades dramatically. The improved accuracy in tumor identification with FDG-PET has led to its increased utilization in target volume delineation for radiotherapy treatment planning in the treatment of lung cancer. Despite the increased ability to distinguish tumor and normal tissue with the help of PET/CT registration, how to best delineate the PET avid tumor volume continues to be controversial as the PET intensity can be influenced by multiple machine and patient related factors. One major factor influencing the PET intensity and image resolution in the thorax is respiratory motion. This problem may be minimized by 4D FDG-PET based treatment planning, which can further improve the resolution of tumor extent, and the delineation of the internal target volume. Here, we offer our perspectives on the utilization of 4D FDG-PET based treatment planning for thoracic image-guided radiotherapy.

  14. Radionuclide methods in the planning of therapy of cancer of the uterus

    International Nuclear Information System (INIS)

    Indirect low radionuclide lymphography with sup(133m)In-coind and serial renoscintigraphy with sup(131m)I-hippuran were done to 103 patients with cancer of the uterus. A high diagnostic value of radionuclide methods was shown. In a comparative analysis of radiolymphography and direct roentgenocontrast lymphography with the results of a morphological study of the lymph nodes the informative value was 70.7% for the radionuclide and 75% for the X-ray studies of the lymphatic system. A higher sensitivity of serial renoscintigraphy as compared to excretory urography (34.2% and 27.6% respectively) was shown in the diagnosis of pathology of the urinary system. Taking into account the absence of counterindications to and the simplicity of radionuclide studies it is recommended that they should be included in the complex of diagnostic procedures for patients with cancer of the uterus

  15. 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

  16. 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.

  17. 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; Andersen, John Sahl

    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....... participation. When looking at integrated care from the perspective of patients, the development of a more holistic and personalized approach is needed....... 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. 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....

  19. 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.

  20. 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.

  1. Individualized margins in 3D conformal radiotherapy planning for lung cancer: analysis of physiological movements and their dosimetric impacts.

    Science.gov (United States)

    Germain, François; Beaulieu, Luc; Fortin, André

    2008-01-01

    In conformal radiotherapy planning for lung cancer, respiratory movements are not taken into account when a single computed tomography (CT) scan is performed. This study examines tumor movements to design individualized margins to account for these movements and evaluates their dosimetric impacts on planning volume. Fifteen patients undergoing CT-based planning for radical radiotherapy for localized lung cancer formed the study cohort. A reference plan was constructed based on reference gross, clinical, and planning target volumes (rGTV, rCTV, and rPTV, respectively). The reference plans were compared with individualized plans using individualized margins obtained by using 5 serial CT scans to generate individualized target volumes (iGTV, iCTV, and iPTV). Three-dimensional conformal radiation therapy was used for plan generation using 6- and 23-MV photon beams. Ten plans for each patient were generated and dose-volume histograms (DVHs) were calculated. Comparisons of volumetric and dosimetric parameters were performed using paired Student t-tests. Relative to the rGTV, the total volume occupied by the superimposed GTVs increased progressively with each additional CT scans. With the use of all 5 scans, the average increase in GTV was 52.1%. For the plans with closest dosimetric coverage, target volume was smaller (iPTV/rPTV ratio 0.808) but lung irradiation was only slightly decreased. Reduction in the proportion of lung tissue that received 20 Gy or more outside the PTV (V20) was observed both for 6-MV plans (-0.73%) and 23-MV plans (-0.65%), with p = 0.02 and p = 0.04, respectively. In conformal RT planning for the treatment of lung cancer, the use of serial CT scans to evaluate respiratory motion and to generate individualized margins to account for these motions produced only a limited lung sparing advantage. PMID:18262123

  2. Individualized Margins in 3D Conformal Radiotherapy Planning for Lung Cancer: Analysis of Physiological Movements and Their Dosimetric Impacts

    International Nuclear Information System (INIS)

    In conformal radiotherapy planning for lung cancer, respiratory movements are not taken into account when a single computed tomography (CT) scan is performed. This study examines tumor movements to design individualized margins to account for these movements and evaluates their dosimetric impacts on planning volume. Fifteen patients undergoing CT-based planning for radical radiotherapy for localized lung cancer formed the study cohort. A reference plan was constructed based on reference gross, clinical, and planning target volumes (rGTV, rCTV, and rPTV, respectively). The reference plans were compared with individualized plans using individualized margins obtained by using 5 serial CT scans to generate individualized target volumes (iGTV, iCTV, and iPTV). Three-dimensional conformal radiation therapy was used for plan generation using 6- and 23-MV photon beams. Ten plans for each patient were generated and dose-volume histograms (DVHs) were calculated. Comparisons of volumetric and dosimetric parameters were performed using paired Student t-tests. Relative to the rGTV, the total volume occupied by the superimposed GTVs increased progressively with each additional CT scans. With the use of all 5 scans, the average increase in GTV was 52.1%. For the plans with closest dosimetric coverage, target volume was smaller (iPTV/rPTV ratio 0.808) but lung irradiation was only slightly decreased. Reduction in the proportion of lung tissue that received 20 Gy or more outside the PTV (V20) was observed both for 6-MV plans (-0.73%) and 23-MV plans (-0.65%), with p = 0.02 and p = 0.04, respectively. In conformal RT planning for the treatment of lung cancer, the use of serial CT scans to evaluate respiratory motion and to generate individualized margins to account for these motions produced only a limited lung sparing advantage

  3. 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

  4. 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

  5. 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...

  6. Retrospective estimate of the quality of intensity-modulated radiotherapy plans for lung cancer

    Science.gov (United States)

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

    2015-07-01

    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 by using the conformity index (CI), coverage index (CVI), and homogeneity index (HI) of the planning target volume (PTV), the OAR-PTV distance and the OAR-PTV overlap volume, and the V10 Gy , V20 Gy , and equivalent uniform dose (EUD) of the OARs. The CI, CVI, and HI of the PTV were 0.54-0.89 (0.77 ± 0.08), 0.90-1.00 (0.98 ± 0.02), and 0.11-0.41, (0.15 ± 0.05), respectively. The mean EUDs (V10 Gy , V20 Gy ) 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), respectively. EUDs tended to decrease as the OAR-PTV distance increased and the OAR-PTV overlap volume decreased. Because the plans in this study were from a single department, relatively few people were involved in treatment planning. Differences in treatment results for a given patient would be much more pronounced if many departments were involved.

  7. 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

  8. Site selection under the underground geologic store plan. Procedures of selecting underground geologic stores as disputed by society, science, and politics. Site selection rules

    International Nuclear Information System (INIS)

    The new Nuclear Power Act and the Nuclear Power Ordinance of 2005 are used in Switzerland to select a site of an underground geologic store for radioactive waste in a substantive planning procedure. The ''Underground Geologic Store Substantive Plan'' is to ensure the possibility to build underground geologic stores in an independent, transparent and fair procedure. The Federal Office for Energy (BFE) is the agency responsible for this procedure. The ''Underground Geologic Store'' Substantive Plan comprises these principles: - The long term protection of people and the environment enjoys priority. Aspects of regional planning, economics and society are of secondary importance. - Site selection is based on the waste volumes arising from the five nuclear power plants currently existing in Switzerland. The Substantive Plan is no precedent for or against future nuclear power plants. - A transparent and fair procedure is an indispensable prerequisite for achieving the objectives of a Substantive Plan, i.e., finding accepted sites for underground geologic stores. The Underground Geologic Stores Substantive Plan is arranged in two parts, a conceptual part defining the rules of the selection process, and an implementation part documenting the selection process step by step and, in the end, naming specific sites of underground geologic stores in Switzerland. The objective is to be able to commission underground geologic stores in 25 or 35 years' time. In principle, 2 sites are envisaged, one for low and intermediate level waste, and one for high level waste. The Swiss Federal Council approved the conceptual part on April 2, 2008. This marks the beginning of the implementation phase and the site selection process proper. (orig.)

  9. 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

  10. 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

  11. 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)

  12. 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

  13. An adaptive radiotherapy planning strategy for bladder cancer using deformation vector fields

    International Nuclear Information System (INIS)

    Purpose: Adaptive radiotherapy (ART) has considerable potential in treatment of bladder cancer due to large inter-fractional changes in shape and size of the target. The aim of this study was to compare our clinically applied method for plan library creation that involves manual bladder delineations (Clin-ART) with a method using the deformation vector fields (DVFs) resulting from intensity-based deformable image registrations (DVF-based ART). Materials and methods: The study included thirteen patients with urinary bladder cancer who had daily cone beam CTs (CBCTs) acquired for set-up. In both ART strategies investigated, three plan selection volumes were generated using the CBCTs from the first four fractions; in Clin-ART boolean combinations of delineated bladders were used, while the DVF-based strategy applied combinations of the mean and standard deviation of patient-specific DVFs. The volume ratios (VRs) of the course-averaged PTV for the two ART strategies relative the non-adaptive PTV were calculated. Results: Both Clin-ART and DVF-based ART considerably reduced the course-averaged PTV, compared to non-adaptive RT. The VR for DVF-based ART was lower than for Clin-ART (0.65 vs. 0.73; p < 0.01). Conclusions: DVF-based ART for bladder irradiation has a considerable normal tissue sparing potential surpassing our already highly conformal clinically applied ART strategy

  14. Predictors of breast radiotherapy plan modifications: Quality assurance rounds in a large cancer centre

    International Nuclear Information System (INIS)

    Background and purpose: This study describes the process and outcomes of breast radiotherapy (RT) quality assurance (QA) rounds, seeking to identify variables associated with plan modifications. Materials and methods: Real-time data were prospectively collected over 2 years. Descriptive statistics determined the proportion of cases requiring no (A), minor (B), or major (C) modifications, which were then subjected to univariate and multivariate analyses. Results: A total of 2223 breast cancer QA cases were reviewed; 47 cases (2.1%) underwent a minor, and 52 cases (2.3%) required a major modification. Common changes included boost, volume, seroma, and bolus. On univariate analysis, regional nodal irradiation (RNI), tumour size, and axillary node dissection were significantly associated with major modifications. Upon multivariate analysis, the only independent predictor was RNI (OR 2.12, p = 0.0075). For patients with no RNI, <2 cm tumours, no axillary lymph node dissection, and no boosts (n = 420); the likelihood of category C was only 1.4%. Conclusions: It is feasible to conduct QA review for all breast cancer cases prior to commencing RT. Patients undergoing RNI had a higher likelihood of plan modifications; a group with low risk of modification was identified, which could direct future re-structuring of QA rounds

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

    DEFF Research Database (Denmark)

    Hansen, Henrik Villibald; Loft, Annika; Berthelsen, Anne Kiil;

    2015-01-01

    /CT. METHODS: 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......PURPOSE: 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...

  16. 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

  17. Quality control in health care: an experiment in radiotherapy planning for breast cancer patients after mastectomy

    International Nuclear Information System (INIS)

    Purpose: The importance of evaluating and improving quality in clinical practice is now generally acknowledged. In this study we estimated different sources of variation in radiotherapy planning for breast cancer patients after mastectomy and sought to test the applicability of a reproducibility and repeatability (R and R) study in a clinical context. Methods: Eleven radiation oncologists planned radiotherapy three times for three different kinds of breast cancer patients without knowing they were handling the same patient three times. Variation was divided into different components: physicians as operators, patients as parts, and repeated measurements as trials. Variation due to difference across trials (repeatability), that across the physicians (reproducibility), and that across the patients (variability) were estimated, as well as interactions between physicians and patients. Calculation was based on the sum of squares, and analysis was supported by various graphical presentations such as range charts and box plots. Results: Some parts of the planning process were characterized by higher and different kinds of variation than the others. Interphysician variation (i.e., reproducibility) was not high but there were some clearly outlying physicians. The highest variation was in repeatability (intraphysician variation). The major part of the variation was, however, that from patient to patient: 33% of the total in Parameter 1 and 85% of the total in Parameter 2. Conclusions: R and R studies are applicable and are needed to evaluate and improve quality in clinical practice. This kind of analysis provides opportunities to establish which kinds of patients require particularly careful attention, which points in the process are most critical for variation, which are the most difficult aspects for each physician and call for more careful description in documents, and which physicians need further training

  18. 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

  19. Fast Helical Tomotherapy in a head and neck cancer planning study: is time priceless?

    International Nuclear Information System (INIS)

    The last few years, in radiotherapy there has been a growing focus on speed of treatment delivery (largely driven by economical and commercial interests). This study investigates the influence of treatment time on plan quality for helical tomotherapy (HT), using delivery times with Volumetric Modulated Arc Therapy (VMAT; Rapid Arc [RA]) as reference. In a previous study, double arc RA (Eclipse) and standard HT plans (TomoHD™) were created for five oropharyngeal cancer patients and reported according to ICRU 83 guidelines. By modifying the beam width from 2.5 to 5.0 cm, elevating the pitch and lowering the modulation factor, “TomoFast” (TF) plans were generated with treatment times equal to RA plans. To quantify the impact of TF’s craniocaudal gradient, similar plans were generated on TomoEdgeTM (TomoEdgeFast;TEF). The homogeneity index (HI), conformity index (CI), mean dose, Dnear-max (D2) and Dnear-min (D98) of the PTVs were analyzed as well as the mean dose, specific critical doses and volumes of 26 organs at risk (OARs). Data were analyzed using repeated measures ANOVA. With a mean treatment time of 3.05 min (RA), 2.89 min (TF) and 2.95 min (TEF), PTVtherapeutic coverage was more homogeneous with TF (HI.07;SE.01) and TEF (HI.08;SE.01) compared to RA (HI.10;SE.01), while PTVprophylactic was most homogeneous with RA. Mean doses to parotid glands were comparable for RA, TF, TEF: 25.62, 25.34, 23.09 Gy for contralateral and 32.02, 31.96, 30.01 Gy for ipsilateral glands, respectively. OARs’ mean doses varied between different approaches not favoring a particular technique. TF’s higher dose to OARs at the cranial-caudal edges of the PTVs and its higher integral dose, both due to the extended cranial-caudal gradient, seems to be solved by the new TomoEdge™ software. However, all these faster techniques lose part of standard TomoHD’s OAR sparing capacity It is possible to treat oropharyngeal cancer patients using HT (TF/TEF) within time-frames observed

  20. 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

  1. 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

  2. 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

  3. 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.

  4. 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

  5. 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.

  6. Impact of aerobic exercise capacity and procedure-related factors in lung cancer surgery

    OpenAIRE

    Licker, Marc; Schnyder, J-M; Frey, J-G; Diaper, J; Cartier, V; Inan, Cigdem; Robert, John; Bridevaux, Pierre-Olivier; Tschopp, Jean-Marie

    2011-01-01

    Over the past decades, major progress in patient selection, surgical techniques and anaesthetic management have largely contributed to improved outcome in lung cancer surgery. The purpose of this study was to identify predictors of post-operative cardiopulmonary morbidity in patients with a forced expiratory volume in 1 s 17 mL·kg⁻¹·min⁻¹, those with a peak V'(O₂)

  7. 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

  8. 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.)

  9. 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

  10. 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)

  11. 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.

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

    International Nuclear Information System (INIS)

    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

  13. 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

  14. 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...

  15. 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)

  16. Therapeutic and diagnostic procedures in preinvasive disease of the cervix and cervical cancer in pregnant women

    International Nuclear Information System (INIS)

    154 pregnant women with displasis and cervical carcinoma of the uterus treated in the Institute in years 1953-1990 underwent investigation. Authors noticed that only 50 pathologies were diagnosed in 1st trimester of pregnancy and 85% constituted precancerous and early forms of carcinoma of the uterine cervix. Authors presented the model of management and care of pregnancy, labour and puerperium in these patients. Due to this procedure we obtained 90% comparability of preliminary and final diagnosis. (author)

  17. Comparison of three radiotherapy technics in three-dimensional dosimetric planning for non-small cell lung cancer

    International Nuclear Information System (INIS)

    Objective: To assess and delineate the dosimetric shortcomings of conventional radiotherapy planning, as compared with the three-dimensional treatment planning system, and to obtain a better technique in the treatment of lung cancers. Methods: Thirteen patients with stage III A-III B non-small cell lung cancer were chosen in the present study. Using the Cadplan 6.0.8 treatment planning system, three different methods of radiotherapy planning: conventional planning, conventional and conformal planning, and conformal planning were designed for each patient. The total radiation dose was 66 Gy and DVHs were used to assess the dosimetric distribution in the gross tumor volume and the surrounding organs at risk. Results: No significant dosimetric disparity in the target volume was found among the three designs, according to anticipated therapeutic requirements. The conformity indices were 0.13, 0.24 and 0.35 for these three radiotherapy designs. The mean lung volumes which received radiation dose of ≥20 Gy were 32%, 26% and 25%. The mean maximum dose at the spinal cord were 42 Gy, 49 Gy and 33 Gy. The mean esophageal volume which received radiation of ≥50 Gy were 32%, 34% and 22%, and the mean radiation dose to the heart were 18 Gy, 15 Gy and 12 Gy, respectively. Conclusions: Conventional radiotherapy planning is able to meet the demands of dosimetric requirements for radiation treatment of lung cancers. The three dimensional conformal radiation therapy planning system is able to provide superior delivery of high dose to the target volume without inflicting too high a risk to the surrounding normal tissues and organs

  18. Linking Hospital Discharge Summaries from Oncology Departments in Order to Achieve Epidemiological Cancer Monitoring for Strategic Planning

    Directory of Open Access Journals (Sweden)

    Rodrigues J-M

    2001-09-01

    Full Text Available In anticipation of the creation of a cancer institute (ICL in Saint-Etienne, France, 3 hospitals tested a procedure which permanently links hospital discharge summaries to DRG’s (PMSI. To this end used the asymmetric hashing and encrypting software developed by one of the authors which had been evaluated from 1996 to 1999 by selecting discharge summaries from each institution containing at least one malignant tumour ICD code. Thus, we were able to compile an anonymous 16,000 patient register. 5 tumour locations were found in almost half the patients: breast (16.7 %, bowel (9.6 %, lung and bronchi (9.1 %, prostate gland (6.8 %, and skin (5.5 %. We estimate that the future ICL will take care of 2,500 cancer patients annually. We compared the number of new patients hospitalized each year (1,500 to the incidence reported by the manual cancer registers (FRANCIM. We conclude that this linking procedure is both feasible and acceptable when its precise health goal is clearly defined. Following this initial step, we are extending the procedure to involve other health care institutions (both public and private in the Saint Etienne area and to the main regional cancer network (ONCORA. Beginning in 2001 the French ministry of health has approved this DRGs linking procedure throughout France.

  19. Effect of CT contrast on volumetric arc therapy planning (RapidArc and helical tomotherapy) for head and neck cancer

    International Nuclear Information System (INIS)

    The objectives of the study were to evaluate the effect of intravenous contrast in the dosimetry of helical tomotherapy and RapidArc treatment for head and neck cancer and determine if it is acceptable during the computed tomography (CT) simulation to acquire only CT with contrast for treatment planning of head and neck cancer. Overall, 5 patients with head and neck cancer (4 men and 1 woman) treated on helical tomotherapy were analyzed retrospectively. For each patient, 2 consecutive CT scans were performed. The first CT set was scanned before the contrast injection and secondary study set was scanned 45 seconds after contrast. The 2 CTs were autoregistered using the same Digital Imaging and Communications in Medicine coordinates. Tomotherapy and RapidArc plans were generated on 1 CT data set and subsequently copied to the second CT set. Dose calculation was performed, and dose difference was analyzed to evaluate the influence of intravenous contrast media. The dose matrix used for comparison included mean, minimum and maximum doses of planning target volume (PTV), PTV dose coverage, and V45 Gy, V30 Gy, and V20 Gy organ doses. Treatment planning on contrasted images generally showed a lower dose to both organs and target than plans on noncontrasted images. The doses for the points of interest placed in the organs and target rarely changed more than 2% in any patient. In conclusion, treatment planning using a contrasted image had insignificant effect on the dose to the organs and targets. In our opinion, only CT with contrast needs to be acquired during the CT simulation for head and neck cancer. Dose calculations performed on contrasted images can potentially underestimate the delivery dose slightly. However, the errors of planning on a contrasted image should not affect the result in clinically significant way

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

    OpenAIRE

    Shyam Pokharel

    2013-01-01

    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...

  1. 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

  2. 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

  3. Multicriteria optimization enables less experienced planners to efficiently produce high quality treatment plans in head and neck cancer radiotherapy

    International Nuclear Information System (INIS)

    To demonstrate that novice dosimetry planners efficiently create clinically acceptable IMRT plans for head and neck cancer (HNC) patients using a commercially available multicriteria optimization (MCO) system. Twenty HNC patients were enrolled in this in-silico comparative planning study. Per patient, novice planners with less experience in dosimetry planning created an IMRT plan using an MCO system (RayStation). Furthermore, a conventionally planned clinical IMRT plan was available (Pinnacle3). All conventional IMRT and MCO-plans were blind-rated by two expert radiation-oncologists in HNC, using a 5-point scale (1–5 with 5 the highest score) assessment form comprising 10 questions. Additionally, plan quality was reported in terms of planning time, dosimetric and normal tissue complication probability (NTCP) comparisons. Inter-rater reliability was derived using the intra-class correlation coefficient (ICC). In total, the radiation-oncologists rated 800 items on plan quality. The overall plan score indicated no differences between both planning techniques (conventional IMRT: 3.8 ± 1.2 vs. MCO: 3.6 ± 1.1, p = 0.29). The inter-rater reliability of all ratings was 0.65 (95% CI: 0.57–0.71), indicating substantial agreement between the radiation-oncologists. In 93% of cases, the scoring difference of the conventional IMRT and MCO-plans was one point or less. Furthermore, MCO-plans led to slightly higher dose uniformity in the therapeutic planning target volume, to a lower integral body dose (13.9 ± 4.5 Gy vs. 12.9 ± 4.0 Gy, p < 0.001), and to reduced dose to the contra-lateral parotid gland (28.1 ± 11.8 Gy vs. 23.0 ± 11.2 Gy, p < 0.002). Consequently, NTCP estimates for xerostomia reduced by 8.4 ± 7.4% (p < 0.003). The hands-on time of the conventional IMRT planning was approximately 205 min. The time to create an MCO-plan was on average 43 ± 12 min. MCO planning enables novice treatment planners to create high quality IMRT plans for HNC patients. Plans were

  4. 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...

  5. 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...

  6. 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.

  7. Validation of natural language processing to extract breast cancer pathology procedures and results

    Directory of Open Access Journals (Sweden)

    Arika E Wieneke

    2015-01-01

    Full Text Available Background: Pathology reports typically require manual review to abstract research data. We developed a natural language processing (NLP system to automatically interpret free-text breast pathology reports with limited assistance from manual abstraction. Methods: We used an iterative approach of machine learning algorithms and constructed groups of related findings to identify breast-related procedures and results from free-text pathology reports. We evaluated the NLP system using an all-or-nothing approach to determine which reports could be processed entirely using NLP and which reports needed manual review beyond NLP. We divided 3234 reports for development (2910, 90%, and evaluation (324, 10% purposes using manually reviewed pathology data as our gold standard. Results: NLP correctly coded 12.7% of the evaluation set, flagged 49.1% of reports for manual review, incorrectly coded 30.8%, and correctly omitted 7.4% from the evaluation set due to irrelevancy (i.e. not breast-related. Common procedures and results were identified correctly (e.g. invasive ductal with 95.5% precision and 94.0% sensitivity, but entire reports were flagged for manual review because of rare findings and substantial variation in pathology report text. Conclusions: The NLP system we developed did not perform sufficiently for abstracting entire breast pathology reports. The all-or-nothing approach resulted in too broad of a scope of work and limited our flexibility to identify breast pathology procedures and results. Our NLP system was also limited by the lack of the gold standard data on rare findings and wide variation in pathology text. Focusing on individual, common elements and improving pathology text report standardization may improve performance.

  8. Minimally invasive procedures for the management of vertebral bone pain due to cancer

    DEFF Research Database (Denmark)

    Mercadante, Sebastiano; Klepstad, Pål; Kurita, Geana Paula;

    2016-01-01

    systematic review of the existing data regarding minimally invasive techniques for the pain management of vertebral bone metastases was performed by experts of the European Palliative Care Research Network. RESULTS: Only five papers were taken into consideration after performing rigorous screening according...... evidence favors the use of these procedures in a small select cohort of patients with severe and disabling back pain refractory to medical therapy....... to inclusion and exclusion criteria (low number of patients, retrospective series, proceedings). DISCUSSION: According to the present data a recommendation should be made to perform kiphoplasty in patients with vertebral tumors or metastases. However, the strength of this recommendation was based on...

  9. 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 & ...

  10. 45 CFR 286.160 - What are the applicable time frames and procedures for submitting a Tribal Family Assistance Plan?

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 2 2010-10-01 2010-10-01 false What are the applicable time frames and procedures... and Processing § 286.160 What are the applicable time frames and procedures for submitting a Tribal... Secretary according to the following time frames: Implementation date: Letter of intent due to ACF and...

  11. VMAT and step-and-shoot IMRT in head and neck cancer. A comparative plan analysis

    International Nuclear Information System (INIS)

    Rotational IMRT is a new technique, whose value still has to be assessed. We evaluated its adequacy for the treatment of head and neck (H and N) cancer compared to the well-established step-and-shoot IMRT. A total of 15 patients, who were treated with either IMRT (13 patients) or VMAT (2 patients) in the H and N region, were chosen. For each patient, a treatment plan with the respective other technique was calculated. To compare the resulting dose distributions, the dose-volume histograms (DVHs) were evaluated. To quantify the differences, a new quality index (QI) was introduced, as a measure of the planning target volume (PTV) coverage and homogeneity. A conformity function (CF) was defined to estimate normal tissue sparing. The QI for VMAT amounts to 36.3, whereas for IMRT the mean value is 66.5, indicating better PTV coverage as well as less overdosage for the rotational technique. While the sparing of organs at risk (OAR) was similar for both techniques, the CF shows a significantly better sparing of healthy tissue for all doses with VMAT treatment. VMAT results in dose distributions for H and N patients that are at least comparable with treatments performed with step-and-shoot IMRT. Two new tools to quantify the quality of dose distributions are presented and have proven to be useful.

  12. 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...

  13. 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

  14. Comparison of dose-volume histograms of IMRT treatment plans for ethmoid sinus cancer computed by advanced treatment planning systems including Monte Carlo

    International Nuclear Information System (INIS)

    Background and purpose: To recompute clinical intensity-modulated treatment plans for ethmoid sinus cancer and to compare quantitatively the dose-volume histograms (DVHs) of the planning target volume (PTV) and the optic organs at risk. Material and methods: Ten step-and-shoot intensity-modulated treatment plans were enrolled in this study. Large natural and surgical air cavities challenged the calculation systems. Each optimized treatment plan was recalculated by two superposition convolution (TMS and Pinnacle) and a Monte Carlo system (MCDE). To compare the resulting DVHs, a one-way ANOVA for repeated measurements was performed and multiple pairwise comparisons were made. Results: The tails of the PTV-DVHs were significantly higher for the Monte Carlo system. The DVHs of the critical organs displayed some statistically but not always clinically significant differences. For the individual patients, the three planning systems sometimes reproduced clinically discrepant DVHs that were not significantly different when averaged over all patients. Conclusions: Dose to air cavities contains computational uncertainty. As this dose is clinically irrelevant and optimizing it is meaningless, we recommended extracting the air from the PTV when constructing the PTV-DVH. The planning systems considered reproduce DVHs that are significantly different, especially in the tail region of PTV-DVHs

  15. 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

  16. 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.

  17. 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.

  18. 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.)

  19. 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.)

  20. 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

  1. 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.

  2. 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.

  3. 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

  4. Dosimetric comparison of different multileaf collimator leaves in treatment planning of intensity-modulated radiotherapy for cervical cancer

    International Nuclear Information System (INIS)

    To study the effect of multileaf collimator (MLC) leaf widths (standard MLC [sMLC] width of 10 mm and micro-MLC [mMLC] width of 4 mm) on intensity-modulated radiotherapy (IMRT) for cervical cancer. Between January 2010 and August 2010, a retrospective analysis was conducted on 12 patients with cervical cancer. The treatment plans for all patients were generated with the same machine setup parameters and optimization methods in a treatment planning system (TPS) based on 2 commercial Elekta MLC devices. The dose distribution for the planning tumor volume (PTV), the dose sparing for organs at risk (OARs), the monitor units (MUs), and the number of IMRT segments were evaluated. For the delivery efficiency, the MUs were significantly higher in the sMLC-IMRT plan than in the mMLC-IMRT plan (802 ± 56.9 vs 702 ± 56.7; p 0.05). For the planning quality, the conformity index (CI) between the 2 paired IMRT plans with the mMLC and the sMLC did not differ significantly (average: 0.817 ± 0.024 vs 0.810 ± 0.028; p > 0.05). The differences of the homogeneity index (HI) between the 2 paired plans were statistically significant (average: 1.122 ± 0.010 vs 1.132 ± 0.014; p 10, V20, V30, and V40, percentage of contoured OAR volumes receiving 10, 20, 30, and 40 Gy, respectively, and the mean dose (Dmean) received. The IMRT plans with the mMLC protected the OARs better than the plans with the sMLC. There were significant differences (p 30 and V40 of the rectum and V10, V20, V40, and Dmean of the bladder. IMRT plans with the mMLC showed advantages over the plans with the sMLC in dose homogeneity for targets, dose sparing of OARs, and fewer MUs in cervical cancer

  5. 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.

  6. 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

  7. 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...

  8. 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

  9. 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.

  10. Randomised comparison of procedures for obtaining informed consent in clinical trials of treatment for cancer.

    Science.gov (United States)

    Simes, R J; Tattersall, M H; Coates, A S; Raghavan, D; Solomon, H J; Smartt, H

    1986-10-25

    Methods of obtaining informed consent have evolved differently in Western countries without substantive information on the impact of these different practices on the patients. A randomised study was performed to compare two commonly adopted methods of seeking consent to randomised treatment: an individual approach at the discretion of each doctor and a uniform policy of total disclosure of all relevant information. The impact of both consent procedures on the patient's understanding and anxiety levels and on the doctor-patient relationship was assessed by means of a questionnaire given soon after the consent interview. Fifty seven patients were assigned at random to two groups: to 29 patients an individual approach to seeking consent was adopted and to 28 patients all relevant information was given. Seven patients refused consent to randomised treatment, with slightly more refusals by patients in the total disclosure group (5 v 2, p = 0.25). The main effects of total disclosure of all information compared with an individual approach to seeking consent were: a better understanding of treatment and side effects and of research aspects of the treatments; less willingness to agree to randomised treatment; and increased anxiety. No significant differences were found in patients' perceptions of the doctor-patient relationship. A repeat questionnaire given three to four weeks later no longer showed significant differences between the two groups. PMID:3094776

  11. 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

  12. An umbrella protocol for standardized data collection (SDC) in rectal cancer: A prospective uniform naming and procedure convention to support personalized medicine

    International Nuclear Information System (INIS)

    Predictive models allow treating physicians to deliver tailored treatment moving from prescription by consensus to prescription by numbers. The main features of an umbrella protocol for standardizing data and procedures to create a consistent dataset useful to obtain a trustful analysis for a Decision Support System for rectal cancer are reported

  13. Hook Wire Localization Procedure and Early Detection of Breast Cancer - Our Experience

    Science.gov (United States)

    Dimitrovska, Maja Jakimovska; Mitreska, Nadica; Lazareska, Menka; Jovanovska, Elizabeta Stojovska; Dodevski, Ace; Stojkoski, Aleksandar

    2015-01-01

    AIM: The purpose of this study is to describe our experience with needle localization technique in diagnosing small breast cancers. MATERIAL AND METHODS: This retrospective study included a hundred and twenty patients’ with impalpable breast lesions and they underwent wire localization. All patients had mammography, ultrasound exam and pathohystological results. We use Mammomat Inspiration Siemens digital unit for diagnosing mammography, machine - Lorad Affinity with fenestrated compressive pad for wire localization and ultrasound machine Acuson X300 with linear array probe 10 MhZ. We use two types of wire: Bard hook wire and Kopans breast lesion localization needle, Cook. Comparative radiologic and pathologic data were collected and analyzed. RESULTS: In 120 asymptomatic women, 68 malignancies and 52 benign findings were detected with mammography and ultrasound. The mean age for patients with malignancy was 58.6 years. According BI-RADS classification for mammography the distribution is our group was: BI-RADS 3 was presented in 6 (8.82%) patients, BI-RADS 4 was presented in 56 (82.35%) patients and BI-RADS 5 was present in 6 (8.82%) of the patients. Most wire localizations were performed under mammographic guidance in 58 from 68 patients with malignant lesions (85.29%) and with ultrasound in 10 (14.7%). According the mammographic findings patients with mass on mammograms were 29 (42.65%), mass with calcifications 9 (13.23%), calcifications 20 (29.41%) and architectural distortions or asymmetry 10 (14.71%). CONCLUSION: Wire localization is a well established technique for the management of impalpable breast lesions.

  14. 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

  15. 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.

  16. 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 (pbrachytherapy.

  17. 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.

  18. 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

  19. 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

  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. Inversely planned intensity modulated radiotheraphy for irradiation of a woman with breast cancer and funnel chest

    International Nuclear Information System (INIS)

    Background: A 44-year old woman with breast cancer was transferred to our institution for irradiation. Due to a pronounced funnel chest no satisfying dose distribution was obtained by conventional techniques. Thus an intensity-modulated radiotherapy (IMRT) based on inverse optimisation was carried out. IMRT was compared to conventional techniques regarding dose distribution and feasibility. Patient and Methods: Tumor site was in the right middle lower quadrant. Target volume included the right breast and the parasternal lymph nodes. Target dose was 50.4 Gy. Based on inverse optimisation irradiation was carried out in 'step-and-short'-technique with twelve intensity modulated beams with six intensity steps. Additionally, treatment plans were calculated using conventional techniques (technique A with two tangential wedged 6-MV photon beams, technique B with additional oblique 15-MeV electron portal). We analysed conformality and homogeneity of target volume and dose distribution within normal tissue. Results: Dose conformality was substantially improved by IMRT. Dose homogeneity was slightly decreased compared to technique A. Lung volume irradiated with a dose higher than 20 Gy was reduced from 56.8% with technique A and 40.1% with technique B, respectively to 22.1% with IMRT. Treatment was tolerated well by the patient without relevant side effects. Mean treatment time was 19.5 min. Conclusion: The inversely planned IMRT using multiple beam directions is suitable for breast irradiation following breast conserving surgery. In the present case of a woman with funnel chest lung dose was substantially reduced without reduction of target dose. In which way the complex treatment technique leads to a clinically detectable advantage is examined at present, in the context of a study. (orig.)

  2. Mastectomy -- The Surgical Procedure

    Medline Plus

    Full Text Available ... Study Breast Cancer and the Environment Early Life Exposures and Breast Cancer Risk Factors That Do Not ... Following Your Treatment Plan Supportive Care and Symptom Management Managing Pain Related to Treatment Survival and Risk ...

  3. 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.)

  4. 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

  5. Clinical procedure for colon carcinoma tissue sampling directly affects the cancer marker-capacity of VEGF family members

    International Nuclear Information System (INIS)

    mRNA levels of members of the Vascular Endothelial Growth Factor family (VEGF-A, -B, -C, -D, Placental Growth Factor/PlGF) have been investigated as tissue-based markers of colon cancer. These studies, which used specimens obtained by surgical resection or colonoscopic biopsy, yielded contradictory results. We studied the effect of the sampling method on the marker accuracy of VEGF family members. Comparative RT-qPCR analysis was performed on healthy colon and colon carcinoma samples obtained by biopsy (n = 38) or resection (n = 39) to measure mRNA expression levels of individual VEGF family members. mRNA levels of genes encoding the eicosanoid enzymes cyclooxygenase 2 (COX2) and 5-lipoxygenase (5-LOX) and of genes encoding the hypoxia markers glucose transporter 1 (GLUT-1) and carbonic anhydrase IX (CAIX) were included as markers for cellular stress and hypoxia. Expression levels of COX2, 5-LOX, GLUT-1 and CAIX revealed the occurrence in healthy colon resection samples of hypoxic cellular stress and a concurrent increment of basal expression levels of VEGF family members. This increment abolished differential expression of VEGF-B and VEGF-C in matched carcinoma resection samples and created a surgery-induced underexpression of VEGF-D. VEGF-A and PlGF showed strong overexpression in carcinoma samples regardless of the sampling method. Sampling-induced hypoxia in resection samples but not in biopsy samples affects the marker-reliability of VEGF family members. Therefore, biopsy samples provide a more accurate report on VEGF family mRNA levels. Furthermore, this limited expression analysis proposes VEGF-A and PlGF as reliable, sampling procedure insensitive mRNA-markers for molecular diagnosis of colon cancer

  6. 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)

  7. The relationship between the bladder volume and optimal treatment planning in definitive radiotherapy for localized prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Nakamura, Naoki; Sekiguchi, Kenji; Akahane, Keiko [Dept. of Radiation Oncology, St. Luke' s International Hospital, Tokyo (Japan)], e-mail: nnakamur-tky@umin.ac.jp; Shikama, Naoto [Dept. of Radiation Oncology, Saitama Medical Univ., Hidaka (Japan); Takahashi, Osamu [Div. of General Internal Medicine, Dept. of Medicine, St. Luke' s International Hospital, Tokyo (Japan); Hama, Yukihiro [Dept. of Radiology, Edogawa Hospital, Tokyo (Japan); Nakagawa, Keiichi [Dept. of Radiology, Tokyo Univ. School of Medicine, Tokyo (Japan)

    2012-07-15

    Background and purpose: There is no current consensus regarding the optimal bladder volumes in definitive radiotherapy for localized prostate cancer. The aim of this study was to clarify the relationship between the bladder volume and optimal treatment planning in radiotherapy for localized prostate cancer. Material and methods: Two hundred and forty-three patients underwent definitive radiotherapy with helical tomotherapy for intermediate- and high-risk localized prostate cancer. The prescribed dose defined as 95 % of the planning target volume (PTV) receiving 100 % of the prescription dose was 76 Gy in 38 fractions. The clinical target volume (CTV) was defined as the prostate with a 5-mm margin and 2 cm of the proximal seminal vesicle. The PTV was defined as the CTV with a 5-mm margin. Treatment plans were optimized to satisfy the dose constraints defined by in-house protocols for PTV and organs at risk (rectum wall, bladder wall, sigmoid colon and small intestine). If all dose constraints were satisfied, the plan was defined as an optimal plan (OP). Results: An OP was achieved with 203 patients (84%). Mean bladder volume ({+-} 1 SD) was 266 ml ({+-} 130 ml) among those with an OP and 214 ml ({+-}130 ml) among those without an OP (p = 0.02). Logistic regression analysis also showed that bladder volumes below 150 ml decreased the possibility of achieving an OP. However, the percentage of patients with an OP showed a plateau effect at bladder volumes above 150 ml. Conclusions. Bladder volume is a significant factor affecting OP rates. However, our results suggest that bladder volumes exceeding 150 ml may not help meet planning dose constraints.

  8. 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

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

    International Nuclear Information System (INIS)

    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

  10. 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.

  11. 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

  12. 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.

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

    Science.gov (United States)

    Cubukcu, Kemal Mert; Cubukcu, Ebru

    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…

  14. A procedure for the detection of linkage with high density SNP arrays in a large pedigree with colorectal cancer

    International Nuclear Information System (INIS)

    The apparent dominant model of colorectal cancer (CRC) inheritance in several large families, without mutations in known CRC susceptibility genes, suggests the presence of so far unidentified genes with strong or moderate effect on the development of CRC. Linkage analysis could lead to identification of susceptibility genes in such families. In comparison to classical linkage analysis with multi-allelic markers, single nucleotide polymorphism (SNP) arrays have increased information content and can be processed with higher throughput. Therefore, SNP arrays can be excellent tools for linkage analysis. However, the vast number of SNPs on the SNP arrays, combined with large informative pedigrees (e.g. >35–40 bits), presents us with a computational complexity that is challenging for existing statistical packages or even exceeds their capacity. We therefore setup a procedure for linkage analysis in large pedigrees and validated the method by genotyping using SNP arrays of a colorectal cancer family with a known MLH1 germ line mutation. Quality control of the genotype data was performed in Alohomora, Mega2 and SimWalk2, with removal of uninformative SNPs, Mendelian inconsistencies and Mendelian consistent errors, respectively. Linkage disequilibrium was measured by SNPLINK and Merlin. Parametric linkage analysis using two flanking markers was performed using MENDEL. For multipoint parametric linkage analysis and haplotype analysis, SimWalk2 was used. On chromosome 3, in the MLH1-region, a LOD score of 1.9 was found by parametric linkage analysis using two flanking markers. On chromosome 11 a small region with LOD 1.1 was also detected. Upon linkage disequilibrium removal, multipoint linkage analysis yielded a LOD score of 2.1 in the MLH1 region, whereas the LOD score dropped to negative values in the region on chromosome 11. Subsequent haplotype analysis in the MLH1 region perfectly matched the mutation status of the family members. We developed a workflow for linkage

  15. Mastectomy -- The Surgical Procedure

    Medline Plus

    Full Text Available ... Following Your Treatment Plan Supportive Care and Symptom Management Managing Pain Related to Treatment Survival and Risk of Having Cancer Return after Treatment (Recurrence) Return ...

  16. Mastectomy -- The Surgical Procedure

    Medline Plus

    Full Text Available ... Following Your Treatment Plan Supportive Care and Symptom Management Managing Pain Related to Treatment Survival and Risk of Having Cancer Return after Treatment (Recurrence) Breast ...

  17. Linking Hospital Discharge Summaries from Oncology Departments in Order to Achieve Epidemiological Cancer Monitoring for Strategic Planning

    OpenAIRE

    Rodrigues J-M; De Laroche G; Martin C.; Quantin C; Trombert-Paviot B

    2001-01-01

    In anticipation of the creation of a cancer institute (ICL) in Saint-Etienne, France, 3 hospitals tested a procedure which permanently links hospital discharge summaries to DRG’s (PMSI). To this end used the asymmetric hashing and encrypting software developed by one of the authors which had been evaluated from 1996 to 1999 by selecting discharge summaries from each institution containing at least one malignant tumour ICD code. Thus, we were able to compile an anonymous 16,000 patient regist...

  18. 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.

  19. 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.

  20. Prospective descriptive study of the toxicity of CAPOX plan in systemic treatment of colorectal cancer

    International Nuclear Information System (INIS)

    In recent years, the incorporation of new cytostatic drugs to treat colorectal cancer (CRC) and adjuvant objective is to treat the disease or disseminated contributed to decrease the reoccurrence and increased overall patient survive and thus the advent of various toxicity profiles according to the scheme used. To describe the clinical and para clinical toxicity of one of the schemes more chemotherapy used for the treatment of RCC at the National Cancer Institute (INCA). METHODOLOGY: Longitudinal prospective study. An analysis was made after consideration of the direction of INCA medical records of 27 patients with CRC assisted at the service of such chemotherapy Institution in the June / 2008 - Dec / 2009. He had the free and informed consent of the patients to participate in the study, disguising personal data to protect your privacy. They are proceeded to complete the notebook data collection in order to determine the toxicity of CAPOX plan. Results: 27 patients, 11 females and 16 males were included with a 58 median age. In terms of tumor topography, 10 were right colon level 10 to level the left colon and 7 rectum level. 55.5% were stage III, stage IV 29.6% and 14.8% stage II. The 27 patients included CAPOX plan received the standard dose with a median cycles of 7. The clinical toxicities more frequent were: sensory neuropathy (66.6%), diarrhea (48.1%), hand-foot syndrome (44.4%), nausea (37%), Vomiting (29.6%), mucositis (11.1%) observed less frequently: conjunctival irritation, hyperpigmentation skin, pharynx larynx dysesthesia, alopecia, and fatigue stress angina. Concerning the haematological toxicity It emphasizes that all patients had a decrease in platelet count during treatment with 44.4% of grade 1 thrombocytopenia, was 62.9% of anemia, leucopenia and 33.3% to 37.0% of neutropenia. Single one patient had mild elevation of serum creatinine. Liver enzyme toxicity occurred in 37% TGO level - GGT, 29.6% in the TGP; 29.6% in the FA and 66.6% of patients

  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) 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...... 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. 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.

  3. 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.

  4. 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...

  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. Maximizing Benefits for Effective Cancer Survivorship Programming: Defining a Dissemination and Implementation Plan

    OpenAIRE

    Wolin, Kathleen Y.; Colditz, Graham A.; Proctor, Enola K.

    2011-01-01

    The latest in implementation science is used to outline a process that cancer organizations can use in designing, implementing, prioritizing, and evaluating cancer survivor programs to improve patient outcomes, using smoking cessation as a primary example.

  7. The use of quantitative methods in planning national cancer control programmes*: A WHO Meeting1

    OpenAIRE

    1986-01-01

    There is a strong need to allocate in a rational and cost-effective way the available resources for cancer control in countries. Continuation of current priorities in resource allocation can only lead to unnecessarily high incidence, morbidity and mortality from cancer. Two cancer control models for cost-effectiveness, which were developed by WHO to help Member States set priorities in national cancer control programmes, have been tested and found useful. This article discusses cost-effective...

  8. Understanding Cancer Prognosis

    Medline Plus

    Full Text Available ... Image & Sexuality Day to Day Life Survivorship For Family & Friends Questions to Ask About Cancer Advanced Cancer Choices For Care Talking About Advanced Cancer Coping With Your Feelings Planning for Advanced Cancer Advanced Cancer & Caregivers Managing Cancer ...

  9. 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.

  10. 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...

  11. 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...

  12. 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

  13. 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.

  14. Improved Planning Time and Plan Quality Through Multicriteria Optimization for Intensity-Modulated Radiotherapy

    International Nuclear Information System (INIS)

    Purpose: To test whether multicriteria optimization (MCO) can reduce treatment planning time and improve plan quality in intensity-modulated radiotherapy (IMRT). Methods and Materials: Ten IMRT patients (5 with glioblastoma and 5 with locally advanced pancreatic cancers) were logged during the standard treatment planning procedure currently in use at Massachusetts General Hospital (MGH). Planning durations and other relevant planning information were recorded. In parallel, the patients were planned using an MCO planning system, and similar planning time data were collected. The patients were treated with the standard plan, but each MCO plan was also approved by the physicians. Plans were then blindly reviewed 3 weeks after planning by the treating physician. Results: In all cases, the treatment planning time was vastly shorter for the MCO planning (average MCO treatment planning time was 12 min; average standard planning time was 135 min). The physician involvement time in the planning process increased from an average of 4.8 min for the standard process to 8.6 min for the MCO process. In all cases, the MCO plan was blindly identified as the superior plan. Conclusions: This provides the first concrete evidence that MCO-based planning is superior in terms of both planning efficiency and dose distribution quality compared with the current trial and error–based IMRT planning approach.

  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. 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

  17. 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

  18. 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)

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

    International Nuclear Information System (INIS)

    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 objectives for minimum dose on the boost target and the elective volumes with research probabilistic objectives: the latter allow for explicit handling of systematic and random geometric uncertainties, enabling confidence level based probabilistic treatment planning. Monte-Carlo evaluations of geometrical errors were performed, with endpoints D98%, D2% and Dmean, calculated at a confidence level of 90%. The dose distribution was expanded outside the patient to prevent large bilateral elective treatment volumes ending up in air for probabilistic shifts. Results: TPP resulted in more regular isodoses and in reduced dose, on average, to organs at risk (OAR), up to more than 6 Gy, while maintaining target coverage and keeping the maximum dose to limiting structures within requirements. In particular, when the surrounding OARs overlap with the planning target volume (PTV) but not with the clinical target volume (CTV), better results were achieved. Conclusion: The TPP approach was evaluated in HNC patients, and proven to be an efficient tool for managing uncertainties

  20. Diagnostic and staging impact of radiotherapy planning FDG-PET-CT in non-small-cell lung cancer

    International Nuclear Information System (INIS)

    Background and purpose: To evaluate whether FDG-PET performed for radiotherapy (RT) planning can detect disease progression, compared with staging PET. Materials and methods: Twenty-six patients with newly-diagnosed non-small-cell lung cancer underwent planning PET-CT for curative RT within 8 weeks (mean: 33 ± 14 days) of staging PET-CT. Progressive disease (PD) was defined as >25% increase in tumour size (transaxial) or volume, as delineated by SUV threshold of 2.5, or new sites (SUV > 2.5). Results: The planning PET detected PD in 16 patients (61%), compared to four patients (15%) by CT component of PET-CT. The mean scan interval was longer in patients with progression: 40 ± 12 days, compared to 22 ± 11 days without progression. Planning PET detected PD in 13/17 (76%), 12/14 (86%) and 7/7 patients if the interval was ⩾4, 5 and 6 weeks, respectively, compared with 3/9 patients if interval <4 weeks. Planning PET detected PD in primary metabolic volume in seven patients, 20 new nodal sites in 12 new nodal stations and nine patients, five extra-nodal sites in five patients. This resulted in upstaging in nine patients (35%): stage IIIA in three, IIIB in three and IV in three. Conclusions: RT-planning FDG-PET can provide incremental diagnostic information and may impact on staging in a significant number of patients.

  1. Multicriteria optimization informed VMAT planning

    International Nuclear Information System (INIS)

    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

  2. Multicriteria optimization informed VMAT planning.

    Science.gov (United States)

    Chen, Huixiao; Craft, David L; Gierga, David P

    2014-01-01

    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-IMRT or

  3. 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

  4. 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.

  5. 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

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. Interobserver variation in rectal and bladder doses in orthogonal film-based treatment planning of cancer of the uterine cervix

    Directory of Open Access Journals (Sweden)

    Raghukumar P

    2008-01-01

    Full Text Available Orthogonal film-based treatment planning is the most commonly adopted standard practice of treatment planning for cancer of the uterine cervix using high dose rate brachytherapy (HDR. This study aims at examining the variation in rectal and bladder doses when the same set of orthogonal films was given to different observers. Five physicists were given 35 pairs of orthogonal films obtained from patients who had undergone HDR brachytherapy. They were given the same instructions and asked to plan the case assuming the tumor was centrally placed, using the treatment-planning system, PLATO BPS V13.2. A statistically significant difference was observed in the average rectal (F = 3.407, P = 0.01 and bladder (F = 3.284, P = 0.013 doses and the volumes enclosed by the 100% isodose curve ( P < 0.01 obtained by each observer. These variations may be attributed to the differences in the reconstruction of applicators, the selection of source positions in ovoids and the intrauterine (IU tube, and the differences in the selection of points especially for the rectum, from lateral radiographs. These variations in planning seen within a department can be avoided if a particular source pattern is followed in the intrauterine tube, unless a specific situation demands a change. Variations in the selection of rectal points can be ruled out if the posterior vaginal surface is clearly seen.

  11. 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

  12. 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.

  13. 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

  14. The evaluation of parasternal lymph node on CT images for radiotherapy planning in breast cancer

    International Nuclear Information System (INIS)

    The parasternal lymph nodes (PSNs) are supposed after recently published literatures to located within 10 mm from internal mammary artery and vein. As these vessels are not infrequently identified on recently advanced CT images, the author intended first to locate the PSN in adult female without chest wall deformity, and secondly to observe the postmastectomy chest wall thickness, considering for the further information in radiotherapy planning of the breast cancer. The material consisted of 50 Japanese females; the age distribution was from 31 to 81 years old (average 60.0). In all cases the CT scans were performed with intravenous administration of contrast material. The measurement of the distance was carried out from midsternal line to most laterally visualized internal mammary vessel at the level of 1st to 4th intercostal spaces (ICS), getting the results as follows. Right 1st ICS; 30.0 mm ± 3.1 S.D. range [24 - 36 mm]. Left 1st ICS; 30.0 ± 3.3 [25 - 42]. Right 2nd ICS; 28.2 ± 2.9 [22 - 34]. Left 2nd ICS; 27.3 ± 2.9 [21 - 32]. Right 3rd ICS; 27.9 ± 3.0 [20 - 35]. Left 3rd ICS; 27.5 ± 2.7 [20 - 34]. Right 4th ICS; 28.3 ± 3.5 [22 - 38]. Left 4th ICS; 27.5 ± 3.5 [23 - 39]. The thickness of the anterior chest wall in 17 postmastectomy patients was measured from midsternal line to 3 cm laterally at the level of 2nd ICS. The time intervals between operation and CT scans were from 5 months to 10 years (average 3 years and 10 months). The mean thickness on the operated side was 10.4 mm, while the nonoperated side on an average 27.7 mm. However, in 8 patients on whom the interval between mastectomy and CT examination was within 2 years, the thickness of operated side was not over 10 mm. (J.P.N.)

  15. Automated Volumetric Modulated Arc Therapy Treatment Planning for Stage III Lung Cancer: How Does It Compare With Intensity-Modulated Radio Therapy?

    International Nuclear Information System (INIS)

    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 8 patients with stage III lung cancer were randomly selected. For group 1, the dosimetrists spent their best effort in designing IMRT plans to compete with the automated inverse planning system (mdaccAutoPlan); for group 2, 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 was the best and 3 was 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 1, 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 1 had 10% higher planning tumor volume (PTV) conformality and 24% lower esophagus V70 (the volume receiving 70 Gy or more) than the manual IMRT plans; they also resulted in more than 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 2, 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 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

  16. Automated Volumetric Modulated Arc Therapy Treatment Planning for Stage III Lung Cancer: How Does It Compare With Intensity-Modulated Radio Therapy?

    Energy Technology Data Exchange (ETDEWEB)

    Quan, Enzhuo M. [Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Chang, Joe Y.; Liao Zhongxing [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Xia Tingyi [Department of Radiation Oncology, Beijing 301 Hospital, Beijing (China); Yuan Zhiyong [Department of Radiation Oncology, Tianjin Medical University Cancer Hospital and Institute, Tianjin (China); Liu Hui [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Department of Radiation Oncology, Zhongshan University Hospital, Guangzhou (China); Li, Xiaoqiang; Wages, Cody A.; Mohan, Radhe [Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Zhang Xiaodong, E-mail: xizhang@mdanderson.org [Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2012-09-01

    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 8 patients with stage III lung cancer were randomly selected. For group 1, the dosimetrists spent their best effort in designing IMRT plans to compete with the automated inverse planning system (mdaccAutoPlan); for group 2, 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 was the best and 3 was 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 1, 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 1 had 10% higher planning tumor volume (PTV) conformality and 24% lower esophagus V70 (the volume receiving 70 Gy or more) than the manual IMRT plans; they also resulted in more than 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 2, 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 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

  17. 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

  18. 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.

  19. Mine and land ownership in operation planning procedures. On the framing of issues of conflicting civil rights under administrative law

    International Nuclear Information System (INIS)

    On the framing of issues of conflicting civil rights under administrative law. The available arsenal of legal instruments for solving conflicts between proprietary titles to land surfaces and mines is more extensive and differentiated and, if properly deployed, more effective than one might at first expect. The control mechanisms become effective either immediately through laws or through administrative or private acts and are based on public or on private law. They range from the sphere of mining rights, operation planning law, the law on the prevention of damage to private persons over to the regulations under mining law on the payment of damages. The constitutionality of the mining regulations examined here is beyond dispute. They comply with the constitutional requirement to frame the issue concerned and afford protection while at the same time providing the required measure of openness and flexibility for conforming to the peculiarities of the mining business and permitting the necessary sensitivity of administrative control for managing this multipolar legal relationship. At the statutory level the regulatory purpose of the mining law in force is thus fulfilled. (orig./HSCH)

  20. 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 < 0.01) while the TPB constructs together explained 43% of the variance in physical activity intention (p < 0.01). Unique 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

  1. 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.

  2. 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

  3. Correlation of Point B and Lymph Node Dose in 3D-Planned High-Dose-Rate Cervical Cancer Brachytherapy

    International Nuclear Information System (INIS)

    Purpose: To compare high dose rate (HDR) point B to pelvic lymph node dose using three-dimensional-planned brachytherapy for cervical cancer. Methods and Materials: Patients with FIGO Stage IB-IIIB cervical cancer received 70 tandem HDR applications using CT-based treatment planning. The obturator, external, and internal iliac lymph nodes (LN) were contoured. Per fraction (PF) and combined fraction (CF) right (R), left (L), and bilateral (Bil) nodal doses were analyzed. Point B dose was compared with LN dose-volume histogram (DVH) parameters by paired t test and Pearson correlation coefficients. Results: Mean PF and CF doses to point B were R 1.40 Gy ± 0.14 (CF: 7 Gy), L 1.43 ± 0.15 (CF: 7.15 Gy), and Bil 1.41 ± 0.15 (CF: 7.05 Gy). The correlation coefficients between point B and the D100, D90, D50, D2cc, D1cc, and D0.1cc LN were all less than 0.7. Only the D2cc to the obturator and the D0.1cc to the external iliac nodes were not significantly different from the point B dose. Significant differences between R and L nodal DVHs were seen, likely related to tandem deviation from irregular tumor anatomy. Conclusions: With HDR brachytherapy for cervical cancer, per fraction nodal dose approximates a dose equivalent to teletherapy. Point B is a poor surrogate for dose to specific nodal groups. Three-dimensional defined nodal contours during brachytherapy provide a more accurate reflection of delivered dose and should be part of comprehensive planning of the total dose to the pelvic nodes, particularly when there is evidence of pathologic involvement.

  4. 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.

  5. Enhancing Cancer Screening in Primary Care: Rationale, Design, Analysis Plan, and Recruitment Results

    OpenAIRE

    Murray, David M.; Katz, Mira L.; Post, Doug M.; Pennell, Michael L.; Young, Gregory S.; Tatum, Cathy M.; Paskett, Electra D.

    2013-01-01

    Colorectal cancer (CRC) is the third leading type of cancer and the third leading cause of cancer death in the United States. National policy-making organizations recognize and support a variety of CRC screening strategies among average-risk adults aged 50 and older based on strong evidence showing that screening decreases mortality from CRC and can also reduce the incidence of the disease. The goal of this study was to test a multi-level stepped intervention to increase CRC screening rates. ...

  6. 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 ...

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

    International Nuclear Information System (INIS)

    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, eligible for high dose (neo-adjuvant) (chemo)radiotherapy, were included. All patients underwent a planning FDG-PET/CT-scan. Radiotherapy target volumes (TVs) were delineated on CT and patients were treated according to the CT-based treatment plans. The PET images remained blinded. After treatment, TVs were adjusted based on PET/CT, when appropriate. Follow up included CT-thorax/abdomen every 6 months. If LRR was suspected, a PET/CT was conducted and the site of recurrence was compared to the original TVs. If the LRR was located outside the CT-based clinical TV (CTV) and inside the PET/CT-based CTV, we considered this LRR possibly preventable. Results: Based on PET/CT, the gross tumour volume (GTV) was larger in 23% and smaller in 27% of the cases. In 32 patients (36%), >5% of the PET/CT-based GTV would be missed if the treatment planning was based on CT. The median follow up was 29 months. LRRs were seen in 10 patients (11%). There were 3 in-field recurrences, 4 regional recurrences outside both CT-based and PET/CT-based CTV and 3 recurrences at the anastomosis without changes in TV by PET/CT; none of these recurrences were considered preventable by PET/CT. Conclusion: No LRR was found after CT-based radiotherapy that could have been prevented by PET/CT. The value of PET/CT for radiotherapy seems limited

  8. Impact of planning target volume margins and rectal distention on biochemical failure in image-guided radiotherapy of prostate cancer

    International Nuclear Information System (INIS)

    Background and purpose: A previous study in our department demonstrated the negative impact on freedom from biochemical failure (FFBF) of using too narrow planning target volume (PTV) margins during prostate image-guided radiotherapy (IGRT). Here, we investigated the impact of appropriate PTV margins and rectal distention on FFBF. Methods and materials: A total of 50 T1-T3N0M0 prostate cancer patients were treated with daily IGRT by implanted markers. In the first 25 patients, PTV margins were 3 mm laterolateral, 5 mm anterioposterior and 4 mm craniocaudal. The subsequent 25 patients were treated with isotropic margins of 6 mm. The rectal cross-sectional area (CSA) was determined on the planning CT. Median follow-up was 61 months. Results: The overall 5-year FFBF was 83%. A 6 mm PTV margin was related to increased 5-year FFBF on univariate analysis (96% vs 74% with the tighter PTV margins, p = 0.04). The 5-year FFBF of patients with a rectal distention on the planning CT was worse compared to those with limited rectal filling (75% for CSA ⩾ 9 cm2 vs 89% for CSA < 9 cm2, p = 0.02), which remained significant on multivariate analysis (p = 0.04). Conclusion: This retrospective study illustrated the positive impact of PTV margin adaptation and addressed the importance of avoiding rectal distention at time of the planning CT

  9. Poster — Thur Eve — 69: Computational Study of DVH-guided Cancer Treatment Planning Optimization Methods

    International Nuclear Information System (INIS)

    Purpose: To compare methods to incorporate the Dose Volume Histogram (DVH) curves into the treatment planning optimization. Method: The performance of three methods, namely, the conventional Mixed Integer Programming (MIP) model, a convex moment-based constrained optimization approach, and an unconstrained convex moment-based penalty approach, is compared using anonymized data of a prostate cancer patient. Three plans we generated using the corresponding optimization models. Four Organs at Risk (OARs) and one Tumor were involved in the treatment planning. The OARs and Tumor were discretized into total of 50,221 voxels. The number of beamlets was 943. We used commercially available optimization software Gurobi and Matlab to solve the models. Plan comparison was done by recording the model runtime followed by visual inspection of the resulting dose volume histograms. Conclusion: We demonstrate the effectiveness of the moment-based approaches to replicate the set of prescribed DVH curves. The unconstrained convex moment-based penalty approach is concluded to have the greatest potential to reduce the computational effort and holds a promise of substantial computational speed up

  10. The Role of MR Imaging for the Surgical Treatment Planning of Breast Cancer: Comparison with US and the Whole-Excised Breast Histopathologic Correlation

    International Nuclear Information System (INIS)

    We wanted to evaluate the effectiveness of breast magnetic resonance (MR) imaging as a preoperative evaluation modality, as compared with ultrasonography (US) imaging, and we wanted to determine the correlation of MRI and US with using the whole-excised breast histopathology as the standard reference. (Check this and adjust it as needed.) From October 2004 to March 2008, among the 245 patients with breast cancer, 82 patients underwent modified radical mastectomy (MRM). Seven patients were excluded due to receiving neoadjuvant chemotherapy before MRI (n=4) or mammotome excision (n=2) or non-visualization of the mass on US and MR imaging (n=1). The remaining 76 breasts in 75 women (one bilateral) were examined preoperatively with MR imaging and US. On US, 42 cases showed unifocal cancer, 16 showed multifocal cancer and 18 showed multicentric breast cancers. On MRI, 39 cases showed unifocal cancer, 11 showed multifocal cancer and 26 showed multicentric breast cancers. We assessed the US findings to identify the patients who were eligible for breast conservative surgery, and then we evaluated the cancers that were treated with conversion to MRM based on the MR imaging. Histopathologic analysis revealed 45 unifocal, 10 multifocal and 22 multicentric breast cancers. Fifty five of the 76 breasts were indicated for MRM based on the US findings due to multicentric cancers (n=18), unifocal or multifocal lesions near the nipple (n=31), or unifocal or multifocal lesions showing extension towards the nipple (n=6). The remaining 21 breasts were classified as suitable for BCS on US, but 5 patients who desired MRM were excluded. Sixteen breasts were altered to MRM based on the additional findings that were suspicious for malignancy on the MR imaging. Among them, 14 (88%) breasts were adequately converted on the surgical plan to MRM based on the histopathologic verification. The remaining 2 breasts had been overestimated. Breast MRI has a significant effect for the preoperative

  11. Not just bricks and mortar: planning hospital cancer services for Aboriginal people

    Directory of Open Access Journals (Sweden)

    Durey Angela

    2011-03-01

    Full Text Available Abstract Background Aboriginal people in Australia experience higher mortality from cancer compared with non-Aboriginal Australians, despite an overall lower incidence. A notable contributor to this disparity is that many Aboriginal people do not take up or continue with cancer treatment which almost always occurs within major hospitals. Thirty in-depth interviews with urban, rural and remote Aboriginal people affected by cancer were conducted between March 2006 and September 2007. Interviews explored participants' beliefs about cancer and experiences of cancer care and were audio-recorded, transcribed verbatim and coded independently by two researchers. NVivo7 software was used to assist data management and analysis. Information from interviews relevant to hospital services including and building design was extracted. Findings Relationships and respect emerged as crucial considerations of participants although many aspects of the hospital environment were seen as influencing the delivery of care. Five themes describing concerns about the hospital environment emerged: (i being alone and lost in a big, alien and inflexible system; (ii failure of open communication, delays and inefficiency in the system; (iii practicalities: costs, transportation, community and family responsibilities; (iv the need for Aboriginal support persons; and (v connection to the community. Conclusions Design considerations and were identified but more important than the building itself was the critical need to build trust in health services. Promotion of cultural safety, support for Aboriginal family structures and respecting the importance of place and community to Aboriginal patients are crucial in improving cancer outcomes.

  12. Cervical cancer in Iquitos, Peru: local realities to guide prevention planning

    Directory of Open Access Journals (Sweden)

    Hunter Jennifer L.

    2004-01-01

    Full Text Available Cervical cancer is a major public health problem in Latin America, and in much of the underdeveloped world. This issue has not historically been addressed as a health priority, but in recent years is receiving increased attention and funding. This ethnographic study on the experience of cervical cancer was conducted in Iquitos, Peru, between August 1998 and May 1999. Research methodologies included: (1 observation and household interviews to obtain background knowledge about the region, medical systems, and local cultural understanding of illness; (2 cancer experience interviews; and (3 case studies of women in various stages of cervical cancer or diagnosis. Findings are presented related to local knowledge and experience of Pap smears and cervical cancer and the ineffectiveness of a recently initiated cervical cancer screening program. The findings guide recommendations for interventions in the region in relation to: (1 needed changes in health education, (2 screening frequency and age, (3 sites for screening and treatment, (4 type and availability of treatment, (5 payment issues, (6 documentation of care, and (7 the potential of herbal remedies.

  13. 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 ...

  14. FFTF operations procedures preparation guide. Revision 2

    Energy Technology Data Exchange (ETDEWEB)

    1976-12-01

    The Guide is intended to provide guidelines for the initial preparation of FFTF Operating Procedures. The Procedures Preparation Guide was developed from the plan presented and approved in the FFTF Reactor Plant Procedures Plan, PC-1, Revision 3.

  15. 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.

  16. 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

  17. Consumer Health Education. Breast Cancer.

    Science.gov (United States)

    Arkansas Univ., Fayetteville, Cooperative Extension Service.

    This short booklet is designed to be used by health educators when teaching women about breast cancer and its early detection and the procedure for breast self-examination. It includes the following: (1) A one-page teaching plan consisting of objectives, subject matter, methods (including titles of films and printed materials), target audience,…

  18. Improving bladder cancer treatment with radiotherapy using separate intensity modulated radiotherapy plans for boost and elective fields

    International Nuclear Information System (INIS)

    The aim of this study is to investigate to what extent IMRT can decrease the dose to the organs at risk in bladder cancer treatment compared with conformal treatment while making separate treatment plans for the elective field and the boost. Special attention is paid to sparing small intestines. Twenty patients who were treated with the field-in-field technique (FiF) were re-planned with intensity modulated radiotherapy (IMRT) using five and seven beams, respectively. Separate treatment plans were made for the elective field (including the pelvic lymph nodes) and the boost, which enables position correction for bone and tumour separately. The prescribed dose was 40 Gy to the elective field and 55 or 60 Gy to the planning target volume (PTV). For bladder and rectum, V45Gy and V55Gy were compared, and for small intestines, V25Gy and V40Gy. The dose distribution with IMRT conformed better to the shape of the target. There was no significant difference between the techniques in dose to the healthy bladder. The median V40Gy of the small intestines decreased from 114 to 66 cc (P = 0.001) with five beam IMRT, and to 55 cc (P = 0.001) with seven beam IMRT compared with FiF. V45Gy for rectum decreased from 34.2% to 17.5% (P = 0.004) for both five and seven beam plans, while V55Gy for rectum remained the same. With IMRT, a statistically significant dose decrease to the small intestines can be achieved while covering both tumour and elective PTV adequately.

  19. 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

  20. Dosimetric impact of systematic MLC positional errors on step and shoot IMRT for prostate cancer: a planning study

    International Nuclear Information System (INIS)

    Full text: The positional accuracy of multileaf collimators (MLC) is crucial in ensuring precise delivery of intensity-modulated radiotherapy (IMRT). The aim of this planning study was to investigate the dosimetric impact of systematic MLC positional errors on step and shoot IMRT of prostate cancer. A total of 12 perturbations of MLC leaf banks were introduced to six prostate IMRT treatment plans to simulate MLC systematic positional errors. Dose volume histograms (DVHs) were generated for the extraction of dose endpoint parameters. Plans were evaluated in terms of changes to the defined endpoint dose parameters, conformity index (CI) and healthy tissue avoidance (HTA) to planning target volume (PTV), rectum and bladder. Negative perturbations of MLC had been found to produce greater changes to endpoint dose parameters than positive perturbations of MLC (p 95 of -1.2 and 0.9% respectively. Negative and positive synchronised MLC perturbations of I mm in one direction resulted in median changes in D95 of -2.3 and 1.8% respectively. Doses to rectum were generally more sensitive to systematic MLC en-ors compared to bladder (p < 0.01). Negative and positive synchronised MLC perturbations of I mm in one direction resulted in median changes in endpoint dose parameters of rectum and bladder from 1.0 to 2.5%. Maximum reduction of -4.4 and -7.3% were recorded for conformity index (CI) and healthy tissue avoidance (HT A) respectively due to synchronised MLC perturbation of 1 mm. MLC errors resulted in dosimetric changes in IMRT plans for prostate. (author)

  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. 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...

  3. 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.

  4. Effect of Bladder Distension on Dose Distribution of Intracavitary Brachytherapy for Cervical Cancer: Three-Dimensional Computed Tomography Plan Evaluation

    International Nuclear Information System (INIS)

    Purpose: To quantify the effect of bladder volume on the dose distribution during intracavitary brachytherapy for cervical cancer. Methods and Patients: The study was performed on 10 women with cervical cancer who underwent brachytherapy treatment. After insertion of the brachytherapy applicator, the patients were transferred to the computed tomography unit. Two sets of computed tomography slices were taken, including the pelvis, one with an empty bladder and one after the bladder was filled with saline. The target and critical organs were delineated by the radiation oncologist and checked by the expert radiologist. The radiotherapy plan was run on the Plato planning system, version 14.1, to determine the dose distributions, dose-volume histograms, and maximal dose points. The doses and organ volumes were compared with the Wilcoxon signed ranks test on a personal computer using the Statistical Package for Social Sciences, version 11.0, statistical program. Results: No significant difference regarding the dose distribution and target volumes between an empty or full bladder was observed. Bladder fullness significantly affected the dose to the small intestine, rectum, and bladder. The median of maximal doses to the small intestine was significantly greater with an empty bladder (493 vs. 284 cGy). Although dosimetry revealed lower doses for larger volumes of bladder, the median maximal dose to the bladder was significantly greater with a full bladder (993 vs. 925 cGy). The rectal doses were also affected by bladder distension. The median maximal dose was significantly lower in the distended bladder (481vs. 628 cGy). Conclusions: Bladder fullness changed the dose distributions to the bladder, rectum, and small intestine. The clinical importance of these changes is not known and an increase in the use of three-dimensional brachytherapy planning will highlight the answer to this question

  5. Dosimetric evaluation of planning target volume margin reduction for prostate cancer via image-guided intensity-modulated radiation therapy

    Science.gov (United States)

    Hwang, Taejin; Kang, Sei-Kwon; Cheong, Kwang-Ho; Park, Soah; Yoon, Jai-Woong; Han, Taejin; Kim, Haeyoung; Lee, Meyeon; Kim, Kyoung-Joo; Bae, Hoonsik; Suh, Tae-Suk

    2015-07-01

    The aim of this study was to quantitatively estimate the dosimetric benefits of the image-guided radiation therapy (IGRT) system for the prostate intensity-modulated radiation therapy (IMRT) delivery. The cases of eleven patients who underwent IMRT for prostate cancer without a prostatectomy at our institution between October 2012 and April 2014 were retrospectively analyzed. For every patient, clinical target volume (CTV) to planning target volume (PTV) margins were uniformly used: 3 mm, 5 mm, 7 mm, 10 mm, 12 mm, and 15 mm. For each margin size, the IMRT plans were independently optimized by one medical physicist using Pinnalce3 (ver. 8.0.d, Philips Medical System, Madison, WI) in order to maintain the plan quality. The maximum geometrical margin (MGM) for every CT image set, defined as the smallest margin encompassing the rectum at least at one slice, was between 13 mm and 26 mm. The percentage rectum overlapping PTV (%V ROV ), the rectal normal tissue complication probability (NTCP) and the mean rectal dose (%RD mean ) increased in proportion to the increase of PTV margin. However the bladder NTCP remained around zero to some extent regardless of the increase of PTV margin while the percentage bladder overlapping PTV (%V BOV ) and the mean bladder dose (%BD mean ) increased in proportion to the increase of PTV margin. Without relatively large rectum or small bladder, the increase observed for rectal NTCP, %RDmean and %BD mean per 1-mm PTV margin size were 1.84%, 2.44% and 2.90%, respectively. Unlike the behavior of the rectum or the bladder, the maximum dose on each femoral head had little effect on PTV margin. This quantitative study of the PTV margin reduction supported that IG-IMRT has enhanced the clinical effects over prostate cancer with the reduction of normal organ complications under the similar level of PTV control.

  6. Neck control after definitive radiochemotherapy without planned neck dissection in node-positive head and neck cancers

    International Nuclear Information System (INIS)

    The purpose of this study was to evaluate neck control outcomes after definitive radiochemotherapy without planned neck dissection in node-positive head and neck cancer. We retrospectively reviewed medical records of fifty patients with node-positive head and neck cancer who received definitive radiochemotherapy. Twelve patients subsequently underwent neck dissection for suspicious recurrent or persistent disease. A median dose of 70 Gy (range 60-70.6) was delivered to involved nodes. Response evaluation was performed at a median of 5 weeks after completion of radiotherapy. Neck failure was observed in 11 patients and the 3-year regional control (RC) rate was 77.1%. Neck dissection was performed in 10 of the 11 patients; seven of these cases were successfully salvaged, and the ultimate rate of neck control was 92%. The remaining two patients who received neck dissection had negative pathologic results. On univariate analysis, initial nodal size > 2 cm, a less-than-complete response at the primary site, post-radiotherapy nodal size > 1.5 cm, and post-radiotherapy nodal necrosis were associated with RC. On multivariate analysis, less-than-complete primary site response and post-radiotherapy nodal necrosis were identified as independent prognostic factors for RC. The neck failure rate after definitive radiochemotherapy without planned neck dissection was 22%. Two-thirds of these were successfully salvaged with neck dissection and the ultimate neck control rate was 92%. Our results suggest that planned neck dissection might not be necessary in patients with complete response of primary site, no evidence of residual lesion > 1.5 cm, or no necrotic lymph nodes at the 1-2 months follow-up evaluation after radiotherapy

  7. 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

  8. 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

    International Nuclear Information System (INIS)

    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.)

  9. 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.)

  10. 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.

  11. Effectiveness, Mediators, and Effect Predictors of Internet Interventions for Chronic Cancer-Related Fatigue : The Design and an Analysis Plan of a 3-Armed Randomized Controlled Trial

    OpenAIRE

    Wolvers, Marije DJ; Bruggeman-Everts, Fieke Z; van der Lee, Marije L; van de Schoot, Rens; Vollenbroek-Hutten, Miriam MR

    2015-01-01

    BACKGROUND: Internet interventions offer advantages that especially cancer survivors who suffer from fatigue could benefit from. Given the growing number of such patients, Internet interventions could supplement and strengthen currently available health care. OBJECTIVE: This paper describes the design and analysis plan that will be used to study 2 Internet interventions aimed at reducing severe fatigue in cancer survivors: a mobile ambulant activity feedback therapy supported through a weekly...

  12. 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 ...

  13. Microbeam radiation therapy. Physical and biological aspects of a new cancer therapy and development of a treatment planning system

    International Nuclear Information System (INIS)

    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.

  14. 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.

  15. Inadequate preoperative colonic evaluation for synchronous colorectal cancer

    DEFF Research Database (Denmark)

    Achiam, M P; Burgdorf, S K; Wilhelmsen, M; Alamili, M; Rosenberg, J

    2009-01-01

    BACKGROUND AND AIMS: Synchronous cancers (SC) are well known (2-11%) in patients with colorectal carcinoma (CRC). One study has shown that intraoperative palpation can miss up to 69% of the SC while other studies have shown altered planned surgical procedure due to preoperatively diagnosed...... possibility of advanced staging of the cancer which is also exemplified in this study....

  16. Reduction scan time pitch for media measurement procedures ITV in lung cancer with CT-CT fusion

    International Nuclear Information System (INIS)

    The evolution of CT technology has led to the non-specific scanners for radiotherapy the scan time maximum is reduced to 2 seconds. This forces us to change the procedure for obtaining similar results.

  17. 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

  18. 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...

  19. 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.

  20. 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.

  1. 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...

  2. Impact of PET/CT on radiotherapy planning and prediction of primary radiotherapy effects in non-small-cell lung cancer

    International Nuclear Information System (INIS)

    Positron emission tomography (PET)/CT is increasingly used in the clinical management of many cancers. This technique enables more accurate and convenient identification of tumors. We evaluated the impact of PET/CT on radiotherapy planning and prediction of primary radiotherapy effects for 12 patients with non-small-cell lung cancer. PET/CT provided valuable information about gross tumor volume and allowed detection of unsuspected nodal disease. PET/CT is also useful for prediction of primary radiotherapy effects in non-small-cell lung cancer. (author)

  3. 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.)

  4. Mastectomy -- The Surgical Procedure

    Medline Plus

    Full Text Available ... Following Your Treatment Plan Supportive Care and Symptom Management Managing Pain Related to Treatment Survival and Risk ... Breast Cancer Treatment Emerging Areas in Treatment Symptom Management & Supportive Care Managing Pain Support Friends & Family Assistance & ...

  5. SU-E-J-70: Feasibility Study of Dynamic Arc and IMRT Treatment Plans Utilizing Vero Treatment Unit and IPlan Planning Computer for SRS/FSRT Brain Cancer Patients

    International Nuclear Information System (INIS)

    Purpose: To investigate the feasibility of utilizing Dynamic Arc (DA) and IMRT with 5mm MLC leaf of VERO treatment unit for SRS/FSRT brain cancer patients with non-invasive stereotactic treatments. The DA and IMRT plans using the VERO unit (BrainLab Inc, USA) are compared with cone-based planning and proton plans to evaluate their dosimetric advantages. Methods: The Vero treatment has unique features like no rotational or translational movements of the table during treatments, Dynamic Arc/IMRT, tracking of IR markers, limitation of Ring rotation. Accuracies of the image fusions using CBCT, orthogonal x-rays, and CT are evaluated less than ∼ 0.7mm with a custom-made target phantom with 18 hidden targets. 1mm margin is given to GTV to determine PTV for planning constraints considering all the uncertainties of planning computer and mechanical uncertainties of the treatment unit. Also, double-scattering proton plans with 6F to 9F beams and typical clinical parameters, multiple isocenter plans with 6 to 21 isocenters, and DA/IMRT plans are evaluated to investigate the dosimetric advantages of the DA/IMRT for complex shape of targets. Results: 3 Groups of the patients are divided: (1) Group A (complex target shape), CI's are same for IMRT, and DGI of the proton plan are better by 9.5% than that of the IMRT, (2) Group B, CI of the DA plans (1.91+/−0.4) are better than cone-based plan, while DGI of the DA plan is 4.60+/−1.1 is better than cone-based plan (5.32+/−1.4), (3) Group C (small spherical targets), CI of the DA and cone-based plans are almost the same. Conclusion: For small spherical targets, cone-based plans are superior to other 2 plans: DS proton and DA plans. For complex or irregular plans, dynamic and IMRT plans are comparable to cone-based and proton plans for complex targets

  6. 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.

  7. Dosimetric impact of systematic MLC positional errors on step and shoot IMRT for prostate cancer: a planning study

    International Nuclear Information System (INIS)

    Full text: The positional accuracy of multi leaf collimators (MLC) is crucial in ensuring precise delivery of intensity-modulated radiotherapy (IMRT). The aim of this planning study was to investigate the dosimetric impact of systematic MLC errors on step and shoot IMRT of prostate cancer. Twelve MLC leaf banks perturbations were introduced to six prostate IMRT treatment plans to simulate MLC systematic errors. Dose volume histograms (OYHs) were generated for the extraction of dose endpoint parameters. Plans were evaluated in terms of changes to the defined endpoint dose parameters, conformity index (CI) and healthy tissue avoidance (HTA) to planning target volume (PTY), rectum and bladder. Negative perturbations of MLC had been found to produce greater changes to endpoint dose parameters than positive perturbations of MLC (p < 0.05). Negative and positive synchronized MLC perturbations of I mm resulted in median changes of -2.32 and 1.78%, respectively to 095% of PTY whereas asynchronized MLC perturbations of the same direction and magnitude resulted in median changes of 1.18 and 0.90%, respectively. Doses to rectum were generally more sensitive to systematic MLC errors compared to bladder. Synchronized MLC perturbations of I mm resulted in median changes of endpoint dose parameters to both rectum and bladder from about I to 3%. Maximum reduction of -4.44 and -7.29% were recorded for CI and HTA, respectively, due to synchronized MLC perturbation of I mm. In summary, MLC errors resulted in measurable amount of dose changes to PTY and surrounding critical structures in prostate LMRT. (author)

  8. Application of deformable registration and empirical method to calculate the accumulated dose for normal tissues and organs at risks in lung cancer radiotherapy plans

    International Nuclear Information System (INIS)

    Objective: To evaluate the accumulated doses to normal tissues and organs at risks (OARs) of patients with lung cancer in radiotherapy plans by using the deformable registration method, and make comparison with the empirical calculation method. Methods: Ten patients with lung cancer were analyzed retrospectively. 3D-CRT or IMRT plans were designed before treatment. CT to simulator was rescanned and the same treatment plan was redesigned during radiotherapy. Based on the deformable registration method, the Mimvista software was used to calculate the accumulated doses to normal tissues and OARs in two CT images respectively. The empirical estimation algorithm was calculated by the linear relationship between the fractions and the total prescribed dose. Results: The target coverage of patients had no significant difference in two plans. There were no significant differences in all the dose volume parameters for normal tissues and OARs, except the mean dose to right lung (t=2.98, P<0.05) when the the same plan was conducted in position-setting and reposition CT images. Conclusions: The empirical estimation for the accumulated dose could be used to evaluate the dose and volume parameters for normal tissues and OARs in lung cancer by the same plan. (authors)

  9. 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

  10. Diabetes insipidus and breast cancer - planning radiotherapy by the use of MRT

    International Nuclear Information System (INIS)

    In patients with advanced breast cancer the incidence of diabetes insipidus is between 0,1% and 0,9%. Satisfactory symptomatic relief can be obtained with Desmorpressin-acetat. In the presence of this symptom complex magnetic resonance imaging (MRI) can aid in the detection of metastases to the posterior pituitary. By the use of magnetic resonance imaging, the incidence for and implementation of local radiotherapy can be firmly grounded. (orig.)

  11. The dosimetric results of IMRT planning based on indices for head and neck cancers

    International Nuclear Information System (INIS)

    The main objective of this study was to evaluate the dosimetric parameters based on the indices for the Gross Tumor Volume (GTV) and Planning Target Volume (PTV). It also describes the unique aspects of the IMRT system used in the treatment of head and neck

  12. Surgical outcomes of 2041 consecutive laparoscopic gastrectomy procedures for gastric cancer: a large-scale case control study.

    Directory of Open Access Journals (Sweden)

    Jian-Xian Lin

    Full Text Available BACKGROUND: Laparoscopic gastrectomy (LG for gastric cancer has increased in popularity due to advances in surgical techniques. The aim of this study is to validate the efficacy and safety of laparoscopic gastrectomy for gastric cancer compared with open gastrectomy (OG. METHODS: The study comprised 3,580 patients who were treated with curative intent either by laparoscopic gastrectomy (2,041 patients or open gastrectomy (1,539 patents between January 2005 and October 2013. The surgical outcomes were compared between the two groups. RESULTS: Laparoscopic gastrectomy was associated with significantly less blood loss, transfused patient number, time to ground activities, and post-operative hospital stay, but with similar operation time, time to first flatus, and time to resumption of diet, compared with the open gastrectomy. No significant difference in the number of lymph nodes dissected was observed between these two groups. The morbidity and mortality rates of the LG group were comparable to those of the OG group (13.6% vs. 14.4%, P = 0.526, and 0.3% vs. 0.2%, P = 0.740. The 3-year disease-free and overall survival rates between the two groups were statistically significant (P<0.05. According to the UICC TNM classification of gastric cancer, the 3-year disease-free and overall survival rates were not statistically different at each stage. CONCLUSIONS: Our single-center study of a large patient series revealed that LG for gastric cancer yields comparable surgical outcomes. This result was also true of local advanced gastric cancer (AGC. A well-designed randomized controlled trial comparing surgical outcomes between LG and OG in a larger number of patients for AGC can be carried out.

  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. 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.

  15. 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.

  16. Navigated Early Survivorship Transition in Improving Survivorship Care Planning in Patients With Newly Diagnosed Stage I-III Breast, Lung, Prostate, or Colorectal Cancer and Their Caregivers

    Science.gov (United States)

    2015-12-17

    Cancer Survivor; Caregiver; Stage I Colon Cancer; Stage I Lung Cancer; Stage I Prostate Cancer; Stage I Rectal Cancer; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage II Lung Cancer; Stage IIA Breast Cancer; Stage IIA Colon Cancer; Stage IIA Prostate Cancer; Stage IIA Rectal Cancer; Stage IIB Breast Cancer; Stage IIB Colon Cancer; Stage IIB Prostate Cancer; Stage IIB Rectal Cancer; Stage III Lung Cancer; Stage III Prostate Cancer; Stage IIIA Breast Cancer; Stage IIIA Colon Cancer; Stage IIIA Rectal Cancer; Stage IIIB Breast Cancer; Stage IIIB Colon Cancer; Stage IIIB Rectal Cancer; Stage IIIC Colon Cancer; Stage IIIC Rectal Cancer

  17. 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

  18. 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

  19. 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

  20. 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

  1. 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

    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 ...

  2. 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

  3. 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.

  4. Pancreatic Cancer Tumor Size on CT Scan Versus Pathologic Specimen: Implications for Radiation Treatment Planning

    International Nuclear Information System (INIS)

    Purpose: Pancreatic cancer primary tumor size measurements are often discordant between computed tomography (CT) and pathologic specimen after resection. Dimensions of the primary tumor are increasingly relevant in an era of highly conformal radiotherapy. Methods and Materials: We retrospectively evaluated 97 consecutive patients with resected pancreatic cancer at two Boston hospitals. All patients had CT scans before surgical resection. Primary endpoints were maximum dimension (in millimeters) of the primary tumor in any direction as reported by the radiologist on CT and by the pathologist for the resected gross fresh specimen. Endoscopic ultrasound (EUS) findings were analyzed if available. Results: Of the patients, 87 (90%) had preoperative CT scans available for review and 46 (47%) had EUS. Among proximal tumors (n = 69), 40 (58%) had pathologic duodenal invasion, which was seen on CT in only 3 cases. The pathologic tumor size was a median of 7 mm larger compared with CT size for the same patient (range, -15 to 43 mm; p < 0.0001), with 73 patients (84%) having a primary tumor larger on pathology than CT. Endoscopic ultrasound was somewhat more accurate, with pathologic tumor size being a median of only 5 mm larger compared with EUS size (range, -15 to 35 mm; p = 0.0003). Conclusions: Computed tomography scans significantly under-represent pancreatic cancer tumor size compared with pathologic specimens in resectable cases. We propose a clinical target volume expansion formula for the primary tumor based on our data. The high rate of pathologic duodenal invasion suggests a risk of duodenal undercoverage with highly conformal radiotherapy.

  5. 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

  6. 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

  7. Physical and biological pretreatment quality assurance of the head and neck cancer plan with the volumetric modulated arc therapy

    Science.gov (United States)

    Park, So-Hyun; Lee, Dong-Soo; Lee, Yun-Hee; Lee, Seu-Ran; Kim, Min-Ju; Suh, Tae-Suk

    2015-09-01

    The aim of this work is to demonstrate both the physical and the biological quality assurance (QA) aspects as pretreatment QA of the head and neck (H&N) cancer plan for the volumetric modulated arc therapy (VMAT). Ten H&N plans were studied. The COMPASS® dosimetry analysis system and the tumor control probability (TCP) and the normal tissue complication probability (NTCP) calculation free program were used as the respective measurement and calculation tools. The reliability of these tools was verified by a benchmark study in accordance with the TG-166 report. For the physical component of QA, the gamma passing rates and the false negative cases between the calculated and the measured data were evaluated. The biological component of QA was performed based on the equivalent uniform dose (EUD), TCP and NTCP values. The evaluation was performed for the planning target volumes (PTVs) and the organs at risks (OARs), including the eyes, the lens, the parotid glands, the esophagus, the spinal cord, and the brainstem. All cases had gamma passing rates above 95% at an acceptance tolerance level with the 3%/3 mm criteria. In addition, the false negative instances were presented for the PTVs and OARs. The gamma passing rates exhibited a weak correlation with false negative cases. For the biological QA, the physical dose errors affect the EUD and the TCP for the PTVs, but no linear correlation existed between them. The EUD and NTCP for the OARs were shown the random differences that could not be attributed to the dose errors from the physical QA. The differences in the EUD and NTCP between the calculated and the measured results were mainly demonstrated for the parotid glands. This study describes the importance and the necessity of improved QA to accompany both the physical and the biological aspects for accurate radiation treatment.

  8. Intensity-Modulated Radiotherapy for Locally Advanced Non-Small-Cell Lung Cancer: A Dose-Escalation Planning Study

    International Nuclear Information System (INIS)

    Purpose: To evaluate the potential for dose escalation with intensity-modulated radiotherapy (IMRT) in positron emission tomography-based radiotherapy planning for locally advanced non-small-cell lung cancer (LA-NSCLC). Methods and Materials: For 35 LA-NSCLC patients, three-dimensional conformal radiotherapy and IMRT plans were made to a prescription dose (PD) of 66 Gy in 2-Gy fractions. Dose escalation was performed toward the maximal PD using secondary endpoint constraints for the lung, spinal cord, and heart, with de-escalation according to defined esophageal tolerance. Dose calculation was performed using the Eclipse pencil beam algorithm, and all plans were recalculated using a collapsed cone algorithm. The normal tissue complication probabilities were calculated for the lung (Grade 2 pneumonitis) and esophagus (acute toxicity, grade 2 or greater, and late toxicity). Results: IMRT resulted in statistically significant decreases in the mean lung (p <.0001) and maximal spinal cord (p = .002 and 0005) doses, allowing an average increase in the PD of 8.6-14.2 Gy (p ≤.0001). This advantage was lost after de-escalation within the defined esophageal dose limits. The lung normal tissue complication probabilities were significantly lower for IMRT (p <.0001), even after dose escalation. For esophageal toxicity, IMRT significantly decreased the acute NTCP values at the low dose levels (p = .0009 and p <.0001). After maximal dose escalation, late esophageal tolerance became critical (p <.0001), especially when using IMRT, owing to the parallel increases in the esophageal dose and PD. Conclusion: In LA-NSCLC, IMRT offers the potential to significantly escalate the PD, dependent on the lung and spinal cord tolerance. However, parallel increases in the esophageal dose abolished the advantage, even when using collapsed cone algorithms. This is important to consider in the context of concomitant chemoradiotherapy schedules using IMRT.

  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, A