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Sample records for clinical dosimetry protocol

  1. Clinical dosimetry in molecular radiotherapy: protocol optimization and clinical implementation

    International Nuclear Information System (INIS)

    Ferrer, Ludovic

    2011-01-01

    Molecular radiotherapy (mrt) consists in destructing tumour targets by radiolabelled vectors. This nuclear medicine specialty is being considered with increasing interest for example via the success achieved in the treatment of non-Hodgkin lymphomas by radioimmunotherapy. One of the keys of mrt optimization relies on the personalising of absorbed doses delivered to the patient: This is required to ascertain that irradiation is focused on tumour cells while keeping surrounding healthy tissue irradiation at an acceptable - non-toxic - level. Radiation dose evaluation in mrt requires in one hand, the spatial and temporal localization of injected radioactive sources by scintigraphic imaging, and on a second hand, the knowledge of the emitted radiation propagating media, given by CT imaging. Global accuracy relies on the accuracy of each of the steps that contribute to clinical dosimetry. There is no reference, standardized dosimetric protocol to date. Due to heterogeneous implementations, evaluation of the accuracy of the absorbed dose is a difficult task. In this thesis, we developed and evaluated different dosimetric approaches that allow us to find a relationship between the absorbed dose to the bone marrow and haematological toxicity. Besides, we built a scientific project, called DosiTest, which aims at evaluating the impact of the various step that contribute to the realization of a dosimetric study, by means of a virtual multicentric comparison based on Monte-Carlo modelling. (author) [fr

  2. Comparison of IAEA protocols for clinical electron beam dosimetry

    International Nuclear Information System (INIS)

    Novotny, J.; Soukup, M.

    2002-01-01

    In most beam calibration protocols so far used in clinical practice, the method recommended for the determination of absorbed dose to water in high-energy electron beams is based on either an exposure or an air kerma calibration factor of an ionisation chamber in a C0 60 gamma-ray or 2 MV x-ray beam. These protocols are complex and the overall uncertainty in the absorbed dose to water under reference conditions is about 3-4%. The new generation of protocols, namely IAEA TRS 398, are based on absorbed dose-to-water standards in photon beams from Co 60 and accelerator beams. The possible errors in absorbed dose determination in reference conditions in practical clinical dosimetry caused by replacement of TRS 277 and TRS 381 protocols for a new TRS 398 protocol were carefully studied for clinical electron beams in energy range 6-20 MeV. All measurements were performed on Varian CLINAC 2100 C linear accelerator. The electron beam energy ranged from 6 to 20 MeV. Basically three different detectors were used for measurements: PTW Roos plane-parallel ionization chamber, calibrated PTW 30002 Farmer type, ionization, Scanditronix electron diode detector. Measurements of central axis percentage depth doses were made by diode using Wellhoefer WP700 beam scanner in 40 cm x 40 cm x 50 cm water phantom. A reference chamber or semiconductor diode mounted on electron treatment cone was used to correct beam output variations for a chamber or diode measurements during scanning. Absolute dose measurements were carried out with Roos plane-parallel chamber connected to PTW UNIDOS electrometer always for preselected number of monitor units. In a new IAEA dosimetry protocol clinical reference dosimetry for electron beam is performed at depth of d ref = 0.6R 50 - 0.1 [cm] instead of d max as in previous ones. To check the stability of electron beams for energy and to establish d ref and standard deviation for reference depth position, the depth dose curves obtained during the quality

  3. Clinical dosimetry

    International Nuclear Information System (INIS)

    Rassow, J.

    1973-01-01

    The main point of this paper on clinical dosimetry which is to be understood here as application of physical dosimetry on accelerators in medical practice, is based on dosimetric methodics. Following an explanation of the dose parameters and description of the dose distribution important for clinical practice as well as geometric irradiation parameters, the significance of a series of physical parameters such as accelerator energy, surface energy of average stopping power etc. is dealt with in detail. Following a section on field homogenization with bremsstrahlung and electron radiation, details on dosimetry in clinical practice are given. Finally, a few problems of dosemeter or monitor calibration on accelerators are described. The explanations are supplemented by a series of diagrams and tables. (ORU/LH) [de

  4. The French dosimetry protocol

    International Nuclear Information System (INIS)

    Dutreix, A.

    1985-01-01

    After a general introduction the protocol is divided in five sections dealing with: determination of the quality of X-ray, γ-ray and electron beams; the measuring instrument; calibration of the reference instrument; determination of the reference absorbed dose in the user's beams; determination of the absorbed dose in water at other points, in other conditions. The French protocol is not essentially different from the Nordic protocol and it is based on the experience gained in using both the American and the Nordic protocols. Therefore, only the main difference with the published protocols are discussed. (Auth.)

  5. Patient dosimetry workshop - Scanner in clinical practice: how to optimize one's protocols (acquisition, interpretation, dosimetry)? - Radiation protection in medical environment

    International Nuclear Information System (INIS)

    Valero, M.; Pilleul, F.; Favre, F.; Tack, D.; Etard, C.; Aubert, B.; Roch, P.; Sinno-Tellier, S.; Gevenois, P.A.; Marelle, P.; Noel, A.; Coquel, P.; Museux, E.; Lair, F.; Francois, A.; Lemaire, P.; Delgoffe, C.; Puech, J.L.; Haller Montejo, M.; Rousselle, I.; Noel, A.; Pierrat, N.; Lasalle, S.; Brisse, H.; Guerson, T.; Mertz, L.; Mertz, M.; Wasylczenko, T.; Bietry, J.; Notter, S.; Jahnen, A.; Back, C.; Kohler, S.; Harpes, N.

    2010-01-01

    A selection of eleven brief communications given at the 2010 French days of radiology are compiled here and deal with: 1 - patient's dosimetry in classical radiology (Valero, M.); 2 - Oncology: how to optimize monitoring (dosimetry, new response criteria)? (Pilleul, F.; Favre, F.); 3 - Thorax: how to optimize lecture (MPR - Multi-Planar Reformat, MIP - Maximum Intensity Projection, MinIP - minimum intensity projection) and dosimetry? (Braine-L'Alleud); 4 - Medical exposure of the French population to diagnostic techniques in 2007 (Etard, C.; Aubert, B.; Sinno-Tellier, S.); 5 - Doses delivered to patients in radio-diagnostics: status of a national inquiry in the public sector (Etard, C.; Sinno-Tellier, S.; Aubert, B.); 6 - External help for the dose per section optimization in tomodensitometry (Tack, D.; Jahnen, A.; Back, C.; Kohler, S.; Harpes, N.; Gevenois, P.A.); 7 - Diagnostic reference levels (DRL) in radiology and scanography: status and evolution (Roch, P.; Aubert, B.); 8 - What conclusions can be drawn from the analysis of the DRLs in conventional radiology addressed to the CEPPIM (College for the evaluation of professional practices in medical imaging) (Marelle, P.; Coquel, P.; Museux, E.; Lair, F.; Francois, A.; Lemaire, P.; Delgoffe, C.; Puech, J.L.; Haller Montejo, M.); 9 - DRL analysis in scanography, an optimization tool? (Rousselle, I.; Noel, A.); 10 - Iterative reconstruction in scanography: potential dosimetric benefit and impact on image quality (Pierrat, N.; Lasalle, S.; Guerson, T.; Brisse, H.); 11 - Development of a patient's dose optimisation aided system in medical imaging (Mertz, L.; Mertz, M.; Wasylczenko, T.; Bietry, J.; Notter, S.)

  6. Clinical dosimetry using mosfets

    International Nuclear Information System (INIS)

    Ramani, Ramaseshan; Russell, Stephen; O'Brien, Peter

    1997-01-01

    Purpose: The use of metal oxide-silicon field effect transistors (MOSFETs) as clinical dosimeters is demonstrated for a number of patients with targets at different clinical sites. Methods and Materials: Commercially available MOSFETs were characterized for energy response, angular dependency of response, and effect of accumulated dose on sensitivity and some inherent properties of MOSFETs. The doses determined both by thermoluminescence dosimetry (TLD) and MOSFETs in clinical situation were evaluated and compared to expected doses determined by calculation. Results: It was observed that a standard calibration of 0.01 Gy/mV gave MOSFET determined doses which agreed with expected doses to within 5% at the 95% confidence limit for photon beams from 6 to 25 MV and electron beams from 5 to 14 MeV. An energy-dependent variation in response of up to 28% was observed between two orientations of a MOSFET. The MOSFET doses compared very well with the doses estimated by TLDs, and the patients tolerated MOSFETs very well. A standard deviation of 3.9% between expected dose and MOSFET determined dose was observed, while for TLDs the standard deviation was 5.1%. The advantages and disadvantages of using MOSFETs for clinical dosimetry are discussed in detail. Conclusion: It was concluded that MOSFETs can be used as clinical dosimeters and can be a good alternative to TLDs. However, they have limitations under certain clinical situations

  7. Quantitative imaging for clinical dosimetry

    Energy Technology Data Exchange (ETDEWEB)

    Bardies, Manuel [INSERM U601, 9 Quai Moncousu, 44093 Nantes (France)]. E-mail: manu@nantes.inserm.fr; Flux, Glenn [Department of Physics, Royal Marsden NHS Trust, Sutton (United Kingdom); Lassmann, Michael [Department of Nuclear Medicine, Julis-Maximilians University, Wuerzburg (Germany); Monsieurs, Myriam [Department of Health Physics, University of Ghent, 9000 Ghent (Belgium); Savolainen, Sauli [Department of Physical Sciences, University of Helsinki and HUS, Helsinki Medical Imaging Center, Helsinki University Central Hospital (Finland); Strand, Sven-Erik [Medical Radiation Physics, Department of Clinical Sciences Lund, Lund University (Sweden)

    2006-12-20

    Patient-specific dosimetry in nuclear medicine is now a legal requirement in many countries throughout the EU for targeted radionuclide therapy (TRT) applications. In order to achieve that goal, an increased level of accuracy in dosimetry procedures is needed. Current research in nuclear medicine dosimetry should not only aim at developing new methods to assess the delivered radiation absorbed dose at the patient level, but also to ensure that the proposed methods can be put into practice in a sufficient number of institutions. A unified dosimetry methodology is required for making clinical outcome comparisons possible.

  8. Alanine dosimetry for clinical applications. Proceedings

    International Nuclear Information System (INIS)

    Anton, M.

    2006-05-01

    The following topics are dealt with: Therapy level alanine dosimetry at the UK Nationational Physical Laboratory, alanine as a precision validation tool for reference dosimetry, composition of alanine pellet dosimeters, the angular dependence of the alanine ESR spectrum, the CIAE alanine dosimeter for radiotherapy level, a correction for temporal evolution effects in alanine dosimetry, next-generation services foe e-traceability to ionization radiation national standards, establishing e-traceability to HIST high-dose measurement standards, alanine dosimetry of dose delivery from clinical accelerators, the e-scan alanine dosimeter reader, alanine dosimetry at ISS, verification of the integral delivered dose for IMRT treatment in the head and neck region with ESR/alanine dosimetry, alanine dosimetry in helical tomotherapy beams, ESR dosimetry research and development at the University of Palermo, lithium formate as a low-dose EPR radiation dosimeter, sensitivity enhancement of alanine/EPR dosimetry. (HSI)

  9. Radiotherapy Dosimetry Protocols For High Energy Photons And Electrons

    International Nuclear Information System (INIS)

    Thwaites, D.I.

    1999-01-01

    One vital requirement in radiotherapy is to ensure as closely as possible consistency in determination of dose between different centers and at different times, both within a given country and internationally, because the comparison and transfer of clinical experience and the evaluation of clinical trials is dependent on common statements of dose delivered. In addition at each loon] centre it is vital that the absorbed dose calibration of each beam is carried out to exacting and consistent standards, as this is the fundamental measurement upon which the quality of all treatments on that machine depend throughout its clinical lifetime. The systems in place to ensure consistency in dosimetry differ in the details from country to country, but all depend on the same basic considerations: - the use of ion chambers of similar design and similar construction materials, - traceable calibrations of these chambers to an accredited primary or secondary standard dosimetry laboratory (SSDL) in terms of some agreed relevant dosimetric quantity, - dose statements in terms of absorbed dose to a common material, water, - the application of an appropriate recommended national or international dosimetry protocol (or code of practice) which ensures commonality in the method of use of the calibrated ion chamber, the radiotherapy treatment beam calibration conditions and any data required to convert the ion chamber reading to absorbed dose to water, and - strict quality control on each step in this process

  10. TRS 398 dosimetry protocol for radiotherapy

    International Nuclear Information System (INIS)

    Palmans, H.; Smyth, V.

    2004-01-01

    Full text: In recent years, international codes of practice based on absorbed dose to water standards have been published for the clinical reference dosimetry of external beams. It has become widely accepted that dosimetry of radiotherapeutic beams should be based on these standards. These codes of practice are a major improvement over earlier ones that used air kerma calibration factors as they are based on a calibration directly in a phantom in terms of the quantity of interest. The previous codes begin with calibration in air in terms of air kerma, then use theoretical and generic conversion factors to obtain dose to water that do not take account of chamber-to-chamber variation. Other good reasons for implementing the new codes are that they are conceptually simpler, include improved physical data and improve the consistency for various ionisation chamber types as well as between different beam types. TRS-3982,3 is a new Code of Practice (CoP) for reference dosimetry of external radiotherapy beams based on absorbed dose to, water calibrations and was published by the IAEA in a joint effort with the WHO, PAHO and ESTRO. It is the first CoP of its kind comprehensively covering all external radiotherapy beams except neutrons. The Radiotherapy Interest Group (RJG) of the ACPSEM has recommended that radiotherapy centres in Australia and New Zealand implement this CoP by the end of 2004. In this workshop, the general philosophy of the CoP will be outlined which will provide a framework for each of the individual subcodes. Although it represents just one of the potential implementations of the CoP, this workshop will deal only with dosimetry based on a cylindrical ionisation chamber with an absorbed dose calibration factor in 60Co from the standards laboratory. With the framework of the code in mind, it is straightforward to identify the basic steps that are required for measuring absorbed dose under reference conditions in a high-energy photon beam. The same is true

  11. ISS protocol for EPR tooth dosimetry

    International Nuclear Information System (INIS)

    Onori, S.; Aragno, D.; Fattibene, P.; Petetti, E.; Pressello, M.C.

    2000-01-01

    The accuracy in Electron Paramagnetic Resonance (EPR) dose reconstruction with tooth enamel is affected by sample preparation, dosimetric signal amplitude evaluation and unknown dose estimate. Worldwide efforts in the field of EPR dose reconstruction with tooth enamel are focused on the optimization of the three mentioned steps in dose assessment. In the present work, the protocol implemented at ISS in the framework of the European Community Nuclear Fission Safety project 'Dose Reconstruction' is presented. A combined mechanical-chemical procedure for ground enamel sample preparation is used. The signal intensity evaluation is carried out with powder spectra simulation program. Finally, the unknown dose is evaluated individually for each sample with the additive dose method. The unknown dose is obtained by subtracting a mean native dose from the back-extrapolated dose. As an example of the capability of the ISS protocol in unknown dose evaluation, the results obtained in the framework of the 2nd International Intercomparison on EPR tooth enamel dosimetry are reported

  12. Codes of practice and protocols for the dosimetry in reference conditions of proton and ion beams

    International Nuclear Information System (INIS)

    Vatnitsky, S.; Andreo, P.

    2002-01-01

    The advantages of radiotherapy protons and heavier charged-particle beams, the technological feasibility, and the clinical results obtained so far have led to the establishment of about 20 treatment facilities worldwide and plans to open another 20 proton and light-ion therapy centres in the next five years. In order to meet the expanding capabilities of treatment techniques, considerable effort has been devoted during the last fifteen years to the development of the dosimetry and calibration of such beams. This paper reviews these developments and summarizes the present status of Codes of Practice and protocols for the dosimetry in reference conditions of proton and ion beams. The first dosimetry protocol for heavy-particle radiotherapy beams, AAPM TG 20, was based on the use of Faraday cups and calorimeters, whereas ionization chamber dosimetry received little attention. Following the trends in 'nuclear particle' radiotherapy, TG 20 included recommendations for specifying 'dose to tissue'. The lack of availability of a harmonized set of data for the different particles made this protocol to include data for stopping-powers and for the mean energy required to produce and ion pair in air, W air , from multiple authors, without enough attention being paid to their consistency. The increased focus into proton beams was materialized in the publication of the ECHED Code of Practice, dedicated exclusively to protons, where ionization dosimetry received more attention than in TG 20. It was not until the publication of the Supplement to the ECHED recommendations that ionization chambers having a 60 CO calibration factor were recommended as a reference detector for proton dosimetry, and data supplied for chambers with different wall materials. The emphasis on ionization chamber-based proton dosimetry was complemented with a recommendation for using water as dosimetry phantom material and the necessary data on tissue and water to air stopping-power ratios and W air . One of

  13. Developing an optimum protocol for thermoluminescence dosimetry with gr-200 chips using Taguchi method

    International Nuclear Information System (INIS)

    Sadeghi, Maryam; Faghihi, Reza; Sina, Sedigheh

    2017-01-01

    Thermoluminescence dosimetry (TLD) is a powerful technique with wide applications in personal, environmental and clinical dosimetry. The optimum annealing, storage and reading protocols are very effective in accuracy of TLD response. The purpose of this study is to obtain an optimum protocol for GR-200; LiF: Mg, Cu, P, by optimizing the effective parameters, to increase the reliability of the TLD response using Taguchi method. Taguchi method has been used in this study for optimization of annealing, storage and reading protocols of the TLDs. A number of 108 GR-200 chips were divided into 27 groups, each containing four chips. The TLDs were exposed to three different doses, and stored, annealed and read out by different procedures as suggested by Taguchi Method. By comparing the signal-to-noise ratios the optimum dosimetry procedure was obtained. According to the results, the optimum values for annealing temperature (de.C), Annealing Time (s), Annealing to Exposure time (d), Exposure to Readout time (d), Pre-heat Temperature (de.C), Pre-heat Time (s), Heating Rate (de.C/s), Maximum Temperature of Readout (de.C), readout time (s) and Storage Temperature (de.C) are 240, 90, 1, 2, 50, 0, 15, 240, 13 and -20, respectively. Using the optimum protocol, an efficient glow curve with low residual signals can be achieved. Using optimum protocol obtained by Taguchi method, the dosimetry can be effectively performed with great accuracy. (authors)

  14. Development of a calibration protocol for quantitative imaging for molecular radiotherapy dosimetry

    International Nuclear Information System (INIS)

    Wevrett, J.; Fenwick, A.; Scuffham, J.; Nisbet, A.

    2017-01-01

    Within the field of molecular radiotherapy, there is a significant need for standardisation in dosimetry, in both quantitative imaging and dosimetry calculations. Currently, there are a wide range of techniques used by different clinical centres and as a result there is no means to compare patient doses between centres. To help address this need, a 3 year project was funded by the European Metrology Research Programme, and a number of clinical centres were involved in the project. One of the required outcomes of the project was to develop a calibration protocol for three dimensional quantitative imaging of volumes of interest. Two radionuclides were selected as being of particular interest: iodine-131 ( 131 I, used to treat thyroid disorders) and lutetium-177 ( 177 Lu, used to treat neuroendocrine tumours). A small volume of activity within a scatter medium (water), representing a lesion within a patient body, was chosen as the calibration method. To ensure ease of use in clinical centres, an “off-the-shelf” solution was proposed – to avoid the need for in-house manufacturing. The BIODEX elliptical Jaszczak phantom and 16 ml fillable sphere were selected. The protocol was developed for use on SPECT/CT gamma cameras only, where the CT dataset would be used to correct the imaging data for attenuation of the emitted photons within the phantom. The protocol corrects for scatter of emitted photons using the triple energy window correction technique utilised by most clinical systems. A number of clinical systems were tested in the development of this protocol, covering the major manufacturers of gamma camera generally used in Europe. Initial imaging was performed with 131 I and 177 Lu at a number of clinical centres, but due to time constraints in the project, some acquisitions were performed with 177 Lu only. The protocol is relatively simplistic, and does not account for the effects of dead-time in high activity patients, the presence of background activity

  15. Developing an Optimum Protocol for Thermoluminescence Dosimetry with GR-200 Chips using Taguchi Method.

    Science.gov (United States)

    Sadeghi, Maryam; Faghihi, Reza; Sina, Sedigheh

    2017-06-15

    Thermoluminescence dosimetry (TLD) is a powerful technique with wide applications in personal, environmental and clinical dosimetry. The optimum annealing, storage and reading protocols are very effective in accuracy of TLD response. The purpose of this study is to obtain an optimum protocol for GR-200; LiF: Mg, Cu, P, by optimizing the effective parameters, to increase the reliability of the TLD response using Taguchi method. Taguchi method has been used in this study for optimization of annealing, storage and reading protocols of the TLDs. A number of 108 GR-200 chips were divided into 27 groups, each containing four chips. The TLDs were exposed to three different doses, and stored, annealed and read out by different procedures as suggested by Taguchi Method. By comparing the signal-to-noise ratios the optimum dosimetry procedure was obtained. According to the results, the optimum values for annealing temperature (°C), Annealing Time (s), Annealing to Exposure time (d), Exposure to Readout time (d), Pre-heat Temperature (°C), Pre-heat Time (s), Heating Rate (°C/s), Maximum Temperature of Readout (°C), readout time (s) and Storage Temperature (°C) are 240, 90, 1, 2, 50, 0, 15, 240, 13 and -20, respectively. Using the optimum protocol, an efficient glow curve with low residual signals can be achieved. Using optimum protocol obtained by Taguchi method, the dosimetry can be effectively performed with great accuracy. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  16. Radiosynoviorthesis. Clinical and preclinical dosimetry

    International Nuclear Information System (INIS)

    Torres Berdeguez, Mirta B; Ayra Pardo, Fernando E

    2006-01-01

    Accurate calculation of internal dose estimates in the Radiosynoviorthesis treatment requires several steps of analysis. The use of animal models (rabbits) to predict human kinetics and dosimetry is an essential first step in the evaluation of new radiocolloids, but involves many uncertainties. There is no gold standard method for extrapolating animal data to humans. Nonetheless, human dose estimates based on animal data are considered to be reasonable approximations to be used for proceeding with dose estimates based on human data, which are ultimately used to assess the safety and efficacy evaluations of radiopharmaceuticals, and continues to be an important element in the radiopharmaceutical approval process. The obtained absorbed dose profiles versus synovial tissue, bone and articular cartilage depth will permit the specialist to prescribe the adequate dose of radionuclide to treat rheumatoid arthritis in medium and large joints without expose the healthy structures of the synovial joint to an excessive and unnecessary irradiation risk, eliminating the fixed dose and fixed radionuclides for each joints (Author)

  17. Clinical dosimetry in diagnostic and interventional radiology

    International Nuclear Information System (INIS)

    Dimcheva, M.; Sergieva, S.; Jovanovska, A.

    2012-01-01

    Full text: Introduction: Diagnostic and interventional procedures involving x-rays are the most significant contributor to total population dose form man made sources of ionizing radiation. Purpose and aim: X-ray imaging generally covers a diverse range of examination types, many of which are increasing in frequency and technical complexity. Materials and methods: The European Directives 96/29 and 97/43 EURATOM stress the importance of accurate dosimetry and require calibration of all measuring equipment related to application of ionizing radiation in medicine. Results: The paper gives and overview of current system of dosimetry of ionizing radiations that is relevant for metrology and clinical applications. It also reflects recently achieved international harmonization in the field promoted by International Atomic Energy Agency (IAEA). Discussion: Objectives of clinical dose measurements in diagnostic and interventional radiology are multiple, as assessment of equipment performance, or assessment of risk emerging from use of ionizing radiation Conclusion: Therefore, from the clinical point of view, the requirements for dosimeters and procedures to assess dose to standard dosimetry phantoms and patients in clinical diverse modalities, as computed tomography are presented

  18. Validation of internal dosimetry protocols based on stochastic method

    International Nuclear Information System (INIS)

    Mendes, Bruno M.; Fonseca, Telma C.F.; Almeida, Iassudara G.; Trindade, Bruno M.; Campos, Tarcisio P.R.

    2015-01-01

    Computational phantoms adapted to Monte Carlo codes have been applied successfully in radiation dosimetry fields. NRI research group has been developing Internal Dosimetry Protocols - IDPs, addressing distinct methodologies, software and computational human-simulators, to perform internal dosimetry, especially for new radiopharmaceuticals. Validation of the IDPs is critical to ensure the reliability of the simulations results. Inter comparisons of data from literature with those produced by our IDPs is a suitable method for validation. The aim of this study was to validate the IDPs following such inter comparison procedure. The Golem phantom has been reconfigured to run on MCNP5. The specific absorbed fractions (SAF) for photon at 30, 100 and 1000 keV energies were simulated based on the IDPs and compared with reference values (RV) published by Zankl and Petoussi-Henss, 1998. The SAF average differences from RV and those obtained in IDP simulations was 2.3 %. The SAF largest differences were found in situations involving low energy photons at 30 keV. The Adrenals and thyroid, i.e. the lowest mass organs, had the highest SAF discrepancies towards RV as 7.2 % and 3.8 %, respectively. The statistic differences of SAF applying our IDPs from reference values were considered acceptable at the 30, 100 and 1000 keV spectra. We believe that the main reason for the discrepancies in IDPs run, found in lower masses organs, was due to our source definition methodology. Improvements of source spatial distribution in the voxels may provide outputs more consistent with reference values for lower masses organs. (author)

  19. Validation of internal dosimetry protocols based on stochastic method

    Energy Technology Data Exchange (ETDEWEB)

    Mendes, Bruno M.; Fonseca, Telma C.F., E-mail: bmm@cdtn.br [Centro de Desenvolvimento da Tecnologia Nuclear (CDTN/CNEN-MG), Belo Horizonte, MG (Brazil); Almeida, Iassudara G.; Trindade, Bruno M.; Campos, Tarcisio P.R., E-mail: tprcampos@yahoo.com.br [Universidade Federal de Minas Gerais (DEN/UFMG), Belo Horizonte, MG (Brazil). Departamento de Engenharia Nuclear

    2015-07-01

    Computational phantoms adapted to Monte Carlo codes have been applied successfully in radiation dosimetry fields. NRI research group has been developing Internal Dosimetry Protocols - IDPs, addressing distinct methodologies, software and computational human-simulators, to perform internal dosimetry, especially for new radiopharmaceuticals. Validation of the IDPs is critical to ensure the reliability of the simulations results. Inter comparisons of data from literature with those produced by our IDPs is a suitable method for validation. The aim of this study was to validate the IDPs following such inter comparison procedure. The Golem phantom has been reconfigured to run on MCNP5. The specific absorbed fractions (SAF) for photon at 30, 100 and 1000 keV energies were simulated based on the IDPs and compared with reference values (RV) published by Zankl and Petoussi-Henss, 1998. The SAF average differences from RV and those obtained in IDP simulations was 2.3 %. The SAF largest differences were found in situations involving low energy photons at 30 keV. The Adrenals and thyroid, i.e. the lowest mass organs, had the highest SAF discrepancies towards RV as 7.2 % and 3.8 %, respectively. The statistic differences of SAF applying our IDPs from reference values were considered acceptable at the 30, 100 and 1000 keV spectra. We believe that the main reason for the discrepancies in IDPs run, found in lower masses organs, was due to our source definition methodology. Improvements of source spatial distribution in the voxels may provide outputs more consistent with reference values for lower masses organs. (author)

  20. Measurement protocols for performance testing of dosimetry services for external radiations

    International Nuclear Information System (INIS)

    1993-01-01

    In the Health and Safety Executive's ''Requirements for the Approval of Dosimetry Services under the Ionising Radiations Regulations 1985'', it is stipulated that dosimetry services seeking approval must show that they have successfully completed a performance test. The services must arrange for the tests to be carried out on application and thereafter every 18 months, by a laboratory which has received accreditation from the National Measurement Accreditation Service (NAMAS) for the whole performance testing activity. The performance tests must be carried out to published protocols and the purpose here is to provide protocols for external, whole body film and TLD dosimetry services, and for skin and extremity dosimetry services. (Author)

  1. MO-B-BRB-02: 3D Dosimetry in the Clinic: IMRT Technique Validation in Sweden

    International Nuclear Information System (INIS)

    Ceberg, S.

    2016-01-01

    Full three-dimensional (3D) dosimetry using volumetric chemical dosimeters probed by 3D imaging systems has long been a promising technique for the radiation therapy clinic, since it provides a unique methodology for dose measurements in the volume irradiated using complex conformal delivery techniques such as IMRT and VMAT. To date true 3D dosimetry is still not widely practiced in the community; it has been confined to centres of specialized expertise especially for quality assurance or commissioning roles where other dosimetry techniques are difficult to implement. The potential for improved clinical applicability has been advanced considerably in the last decade by the development of improved 3D dosimeters (e.g., radiochromic plastics, radiochromic gel dosimeters and normoxic polymer gel systems) and by improved readout protocols using optical computed tomography or magnetic resonance imaging. In this session, established users of some current 3D chemical dosimeters will briefly review the current status of 3D dosimetry, describe several dosimeters and their appropriate imaging for dose readout, present workflow procedures required for good dosimetry, and analyze some limitations for applications in select settings. We will review the application of 3D dosimetry to various clinical situations describing how 3D approaches can complement other dose delivery validation approaches already available in the clinic. The applications presented will be selected to inform attendees of the unique features provided by full 3D techniques. Learning Objectives: L. John Schreiner: Background and Motivation Understand recent developments enabling clinically practical 3D dosimetry, Appreciate 3D dosimetry workflow and dosimetry procedures, and Observe select examples from the clinic. Sofie Ceberg: Application to dynamic radiotherapy Observe full dosimetry under dynamic radiotherapy during respiratory motion, and Understand how the measurement of high resolution dose data in an

  2. MO-B-BRB-01: 3D Dosimetry in the Clinic: Background and Motivation

    International Nuclear Information System (INIS)

    Schreiner, L.

    2016-01-01

    Full three-dimensional (3D) dosimetry using volumetric chemical dosimeters probed by 3D imaging systems has long been a promising technique for the radiation therapy clinic, since it provides a unique methodology for dose measurements in the volume irradiated using complex conformal delivery techniques such as IMRT and VMAT. To date true 3D dosimetry is still not widely practiced in the community; it has been confined to centres of specialized expertise especially for quality assurance or commissioning roles where other dosimetry techniques are difficult to implement. The potential for improved clinical applicability has been advanced considerably in the last decade by the development of improved 3D dosimeters (e.g., radiochromic plastics, radiochromic gel dosimeters and normoxic polymer gel systems) and by improved readout protocols using optical computed tomography or magnetic resonance imaging. In this session, established users of some current 3D chemical dosimeters will briefly review the current status of 3D dosimetry, describe several dosimeters and their appropriate imaging for dose readout, present workflow procedures required for good dosimetry, and analyze some limitations for applications in select settings. We will review the application of 3D dosimetry to various clinical situations describing how 3D approaches can complement other dose delivery validation approaches already available in the clinic. The applications presented will be selected to inform attendees of the unique features provided by full 3D techniques. Learning Objectives: L. John Schreiner: Background and Motivation Understand recent developments enabling clinically practical 3D dosimetry, Appreciate 3D dosimetry workflow and dosimetry procedures, and Observe select examples from the clinic. Sofie Ceberg: Application to dynamic radiotherapy Observe full dosimetry under dynamic radiotherapy during respiratory motion, and Understand how the measurement of high resolution dose data in an

  3. MO-B-BRB-03: 3D Dosimetry in the Clinic: Validating Special Techniques

    International Nuclear Information System (INIS)

    Juang, T.

    2016-01-01

    Full three-dimensional (3D) dosimetry using volumetric chemical dosimeters probed by 3D imaging systems has long been a promising technique for the radiation therapy clinic, since it provides a unique methodology for dose measurements in the volume irradiated using complex conformal delivery techniques such as IMRT and VMAT. To date true 3D dosimetry is still not widely practiced in the community; it has been confined to centres of specialized expertise especially for quality assurance or commissioning roles where other dosimetry techniques are difficult to implement. The potential for improved clinical applicability has been advanced considerably in the last decade by the development of improved 3D dosimeters (e.g., radiochromic plastics, radiochromic gel dosimeters and normoxic polymer gel systems) and by improved readout protocols using optical computed tomography or magnetic resonance imaging. In this session, established users of some current 3D chemical dosimeters will briefly review the current status of 3D dosimetry, describe several dosimeters and their appropriate imaging for dose readout, present workflow procedures required for good dosimetry, and analyze some limitations for applications in select settings. We will review the application of 3D dosimetry to various clinical situations describing how 3D approaches can complement other dose delivery validation approaches already available in the clinic. The applications presented will be selected to inform attendees of the unique features provided by full 3D techniques. Learning Objectives: L. John Schreiner: Background and Motivation Understand recent developments enabling clinically practical 3D dosimetry, Appreciate 3D dosimetry workflow and dosimetry procedures, and Observe select examples from the clinic. Sofie Ceberg: Application to dynamic radiotherapy Observe full dosimetry under dynamic radiotherapy during respiratory motion, and Understand how the measurement of high resolution dose data in an

  4. MO-B-BRB-03: 3D Dosimetry in the Clinic: Validating Special Techniques

    Energy Technology Data Exchange (ETDEWEB)

    Juang, T. [Stanford Cancer Center (United States)

    2016-06-15

    Full three-dimensional (3D) dosimetry using volumetric chemical dosimeters probed by 3D imaging systems has long been a promising technique for the radiation therapy clinic, since it provides a unique methodology for dose measurements in the volume irradiated using complex conformal delivery techniques such as IMRT and VMAT. To date true 3D dosimetry is still not widely practiced in the community; it has been confined to centres of specialized expertise especially for quality assurance or commissioning roles where other dosimetry techniques are difficult to implement. The potential for improved clinical applicability has been advanced considerably in the last decade by the development of improved 3D dosimeters (e.g., radiochromic plastics, radiochromic gel dosimeters and normoxic polymer gel systems) and by improved readout protocols using optical computed tomography or magnetic resonance imaging. In this session, established users of some current 3D chemical dosimeters will briefly review the current status of 3D dosimetry, describe several dosimeters and their appropriate imaging for dose readout, present workflow procedures required for good dosimetry, and analyze some limitations for applications in select settings. We will review the application of 3D dosimetry to various clinical situations describing how 3D approaches can complement other dose delivery validation approaches already available in the clinic. The applications presented will be selected to inform attendees of the unique features provided by full 3D techniques. Learning Objectives: L. John Schreiner: Background and Motivation Understand recent developments enabling clinically practical 3D dosimetry, Appreciate 3D dosimetry workflow and dosimetry procedures, and Observe select examples from the clinic. Sofie Ceberg: Application to dynamic radiotherapy Observe full dosimetry under dynamic radiotherapy during respiratory motion, and Understand how the measurement of high resolution dose data in an

  5. MO-B-BRB-01: 3D Dosimetry in the Clinic: Background and Motivation

    Energy Technology Data Exchange (ETDEWEB)

    Schreiner, L. [Cancer Center of Southeastern Ontario (Canada)

    2016-06-15

    Full three-dimensional (3D) dosimetry using volumetric chemical dosimeters probed by 3D imaging systems has long been a promising technique for the radiation therapy clinic, since it provides a unique methodology for dose measurements in the volume irradiated using complex conformal delivery techniques such as IMRT and VMAT. To date true 3D dosimetry is still not widely practiced in the community; it has been confined to centres of specialized expertise especially for quality assurance or commissioning roles where other dosimetry techniques are difficult to implement. The potential for improved clinical applicability has been advanced considerably in the last decade by the development of improved 3D dosimeters (e.g., radiochromic plastics, radiochromic gel dosimeters and normoxic polymer gel systems) and by improved readout protocols using optical computed tomography or magnetic resonance imaging. In this session, established users of some current 3D chemical dosimeters will briefly review the current status of 3D dosimetry, describe several dosimeters and their appropriate imaging for dose readout, present workflow procedures required for good dosimetry, and analyze some limitations for applications in select settings. We will review the application of 3D dosimetry to various clinical situations describing how 3D approaches can complement other dose delivery validation approaches already available in the clinic. The applications presented will be selected to inform attendees of the unique features provided by full 3D techniques. Learning Objectives: L. John Schreiner: Background and Motivation Understand recent developments enabling clinically practical 3D dosimetry, Appreciate 3D dosimetry workflow and dosimetry procedures, and Observe select examples from the clinic. Sofie Ceberg: Application to dynamic radiotherapy Observe full dosimetry under dynamic radiotherapy during respiratory motion, and Understand how the measurement of high resolution dose data in an

  6. MO-B-BRB-02: 3D Dosimetry in the Clinic: IMRT Technique Validation in Sweden

    Energy Technology Data Exchange (ETDEWEB)

    Ceberg, S. [Lund University (Sweden)

    2016-06-15

    Full three-dimensional (3D) dosimetry using volumetric chemical dosimeters probed by 3D imaging systems has long been a promising technique for the radiation therapy clinic, since it provides a unique methodology for dose measurements in the volume irradiated using complex conformal delivery techniques such as IMRT and VMAT. To date true 3D dosimetry is still not widely practiced in the community; it has been confined to centres of specialized expertise especially for quality assurance or commissioning roles where other dosimetry techniques are difficult to implement. The potential for improved clinical applicability has been advanced considerably in the last decade by the development of improved 3D dosimeters (e.g., radiochromic plastics, radiochromic gel dosimeters and normoxic polymer gel systems) and by improved readout protocols using optical computed tomography or magnetic resonance imaging. In this session, established users of some current 3D chemical dosimeters will briefly review the current status of 3D dosimetry, describe several dosimeters and their appropriate imaging for dose readout, present workflow procedures required for good dosimetry, and analyze some limitations for applications in select settings. We will review the application of 3D dosimetry to various clinical situations describing how 3D approaches can complement other dose delivery validation approaches already available in the clinic. The applications presented will be selected to inform attendees of the unique features provided by full 3D techniques. Learning Objectives: L. John Schreiner: Background and Motivation Understand recent developments enabling clinically practical 3D dosimetry, Appreciate 3D dosimetry workflow and dosimetry procedures, and Observe select examples from the clinic. Sofie Ceberg: Application to dynamic radiotherapy Observe full dosimetry under dynamic radiotherapy during respiratory motion, and Understand how the measurement of high resolution dose data in an

  7. Clinical electron beam dosimetry: transition from AAPM TG-25 to AAPM TG-70

    International Nuclear Information System (INIS)

    Mihailidis, Dimitris

    2017-01-01

    The absolute calibration of clinical electron beams is increasingly based on TG-51 protocol. In addition, recently published dosimetry data on electrons beams bring up the question of how would one need to modify the widely used TG-25 that originally was based on TG-21 calibration protocol? The answer to the question is given by the recently published TG-70. This new protocol operates as supplement and update to TG-25 on issues that need to be modified because of TG-51 approach to electron dosimetry and because of newer data on clinical electron beams. It describes in detail the procedure of converting measured depth-ionization curves with ion chambers into depth-dose curves, making use of recently published stopping-power ratios and other conversion factors. It also describes the use of water equivalent phantoms to perform relative electron dosimetry based on recently published conversions factors. The report discusses small and irregularly shaped electron field dosimetry using the concept of lateral buildup ratio (LBR) as an avenue to evaluate electronic equilibrium and compute dose per MU for those fields. Finally, it gives some common clinical examples where electron beam dosimetry are applied

  8. The development of UK protocols for electron beam dosimetry

    International Nuclear Information System (INIS)

    Thwaites, D.I.

    1995-01-01

    The IPSM Electron Dosimetry Working Party has completed a new set of recommendations for clinical electron beam dosimetry to replace the 1985 Code of Practice and its 1992 addendum. The current approach takes account of the significant body of relevant work over the last ten years and adopts the best consistent set of physical data currently available. It is still an air-kerma based approach, but adopts the N D formalism. This means that single conversion/correction factors are no longer retained. The new Code of Practice is intended to provide a solid basis for clinical practice at present, and to allow confident assessment of the introduction of the direct absorbed dose calibration service for electrons, currently under development by NPL, when that is ready. The structure of the new Code is reviewed, with discussion of changes from the 1985 approach and of the physical data incorporated. In particular the changes for parallel plate chamber calibration and use are discussed. Points of similarity and difference to other international codes are noted and the doses measured using different codes are compared

  9. Patient-Specific Internal Dosimetry Protocol for 131 treatment of differentiated thyroid cancer

    International Nuclear Information System (INIS)

    Deluca, G.M.; Rojo, Ana M.; Llina Fuentes, C.S.; Cabrejas, Mariana L.; Cabrejas, R.; Fadel, A.M.

    2008-01-01

    Full text: The most effective treatment against Differentiated Thyroid Cancer (DTC), in its most frequently types: papillar and follicular, is the administration of radioiodine. As a result of a multidisciplinary work, a dosimetrical protocol for radiological protection purpose has been developed that suggests the standards and formalisms for the determination of absorbed doses due to the administration of 131 I activity to DTC patients. This dosimetrical protocol takes into account individual data of each patient (age, gender, the presence or absence of metastases, physiology, physiopathology, biochemical parameters) and involves clinical aspects, the equipment that should be used and the dose assessment procedure of each treatment. Based on the Medical Internal radiation Dose (MIRD) scheme and considering the major critical organs for this therapy, the dosimetrical protocol states the 'how-to' of the following procedures, in adults and paediatric cases: 1) estimation of the red marrow dose (with/without bone metastases) to avoid mielotoxicity (200 cGy); 2) Estimation of the retention / dose rate / dose in lungs after 48 hours from the administration of radioiodine to avoid lung fibrosis; 3) Estimation of the testes dose in young male patients to avoid oligospermia; 4) Estimation of the maximum activity which can be safely administered without damaging the most critical organ for each patient; and 5) Acquisition of images and retention data from patients. This dosimetrical protocol also specifies the requirements and basic steps that should be followed, the essential information, the complementary studies and the basic equipment required to perform an appropriate internal dosimetry evaluation. To be fully implemented, the dosimetrical protocol needs the constitution of a multidisciplinary team including physicians, medical physicists and technicians. Clear instructions should be provided to the patient as his full collaboration is essential. Even though empirical

  10. Comparison of absorbed dose determinations using the IAEA dosimetry protocol and the ferrous sulphate dosimeter

    International Nuclear Information System (INIS)

    Mattsson, Olof

    1988-01-01

    In 1985 a comparison of different revised protocols for the dosimetry of high-energy photon and electron beams was published (Mattsson, 1985). The conclusions were that the agreement in absorbed dose to water determined using the different protocols is very good and that the agreement between ionization chamber and ferrous sulphate dosimetry is generally good. For electron beams the differences obtained with the ionization chamber and ferrous sulphate dosimeters were up to about 2%. The influence of the energy and angular distribution of the electron beams on the ionization chamber dosimetry is not fully considered in the dosimetry protocols. The basis for the ionization chamber dosimetry has recently been changed when the Bureau International des Poids et Mesures (BIPM) in 1986 changed the air-kerma standard. The reason was the adaption of the new stopping-power values reported in the ICRU Report No. 37. To achieve consistency in the ionization chamber dosimetry the interaction coefficients and correction factors given in the dosimetry protocols should also be based on the same set of stopping-power values. This is not the case with the protocols included in the comparison made by Mattsson. However, in the international code of practice by the International Atomic Energy Agency (IAEA, 1987) the new stopping-power values have been used. The formalism is the same as in most of the previous protocols. Mattsson et al. (1989) have shown that the differences in the various steps cancel out for the protocols published by NACP (1980) and by IAEA (1987) for cobalt-60 gamma quality. However, it is also of interest to investigate the influence of the new air-kerma standard and the new values on coefficients and factors given in the IAEA protocol for other beam qualities. Therefore, the data given by Mattsson (1985) have been recalculated using the new air-kerma standard and the IAEA protocol

  11. International Standardization of the Clinical Dosimetry of Beta Radiation Brachytherapy Sources: Progress of an ISO Standard

    Science.gov (United States)

    Soares, Christopher

    2006-03-01

    In 2004 a new work item proposal (NWIP) was accepted by the International Organization for Standardization (ISO) Technical Committee 85 (TC85 -- Nuclear Energy), Subcommittee 2 (Radiation Protection) for the development of a standard for the clinical dosimetry of beta radiation sources used for brachytherapy. To develop this standard, a new Working Group (WG 22 - Ionizing Radiation Dosimetry and Protocols in Medical Applications) was formed. The standard is based on the work of an ad-hoc working group initiated by the Dosimetry task group of the Deutsches Insitiut für Normung (DIN). Initially the work was geared mainly towards the needs of intravascular brachytherapy, but with the decline of this application, more focus has been placed on the challenges of accurate dosimetry for the concave eye plaques used to treat ocular melanoma. Guidance is given for dosimetry formalisms, reference data to be used, calibrations, measurement methods, modeling, uncertainty determinations, treatment planning and reporting, and clinical quality control. The document is currently undergoing review by the ISO member bodies for acceptance as a Committee Draft (CD) with publication of the final standard expected by 2007. There are opportunities for other ISO standards for medical dosimetry within the framework of WG22.

  12. Australian clinical dosimetry service at ARPANSA

    International Nuclear Information System (INIS)

    McDonald, Abel; Williams, Ivan

    2010-01-01

    Full text: Earlier this year, the Australian Health Ministers' Advisory Council accepted the Federal Government's offer to fund the establishment and operation for 3 years of an Australian Clinical Dosimetry Service (ACDS). The service will be located within the Australian Radiation Protection and Nuclear Safety Agency in Yallambie, Victoria and will commence operation at the beginning of 20II. The purpose of the ACDS is to make available independent checks and auditing services to all Australian radiotherapy services. These services will range form postal audits to site visits, and include treatment dose assessments using phantoms (Level III audits). There will be a Clinical Advisory Group to oversee the development of the service, so the ACPSEM and other professional groups will playa key role in developing the ACDS. In consultation with radiotherapy facilities, the ACDS will establish an Audit Panel which will be made up of local staff to assist with on site work and minimise travel costs. The results of all measurements made by the ACDS will be confi dential: only de-identified data would be publicly reported. The service will be free to participating facilities in the first 3 years. An independent review will be conducted in the third year to determine the ongoing arrangements for the service.

  13. Code of practice for clinical proton dosimetry

    International Nuclear Information System (INIS)

    Vynckier, S.

    1991-01-01

    The objective of this document is to make recommendations for the determination of absorbed dose to tissue for clinical proton beams and to achieve uniformity in proton dosimetry. A Code of Practice (CoP) has been chosen, providing specific guidelines for the choice of the detector and the method of determination of absorbed dose for proton beams only. This CoP is confined specifically to the determination of absorbed dose and is not concerned with the biological effects of proton beams. It is recommended that dosimeters be calibrated by comparison with a calorimeter. If this is not available, a Faraday cup, or alter-natively, an ionization chamber, with a 60 Co calibration factor should be used. Physical parameters for determining the dose from tissue-equivalent ionization chamber measurements are given together with a worksheet. It is recommended that calibrations be carried out in water at the centre of the spread-out-Bragg-peak and that dose distributions be measured in a water phantom. It is estimated that the error in the calibrations will be less than +-5 per cent (1 S.D.) in all cases. Adoption and implementation of this CoP will facilitate the exchange of clinical information. (author). 34 refs.; 5 figs.; 5 tabs

  14. Comparison between IAEA/TRS-277 and IAEA/TRS-398 protocols for electron beam dosimetry with cylindrical ionization chambers

    International Nuclear Information System (INIS)

    Souza, Roberto Salomon de

    2004-01-01

    With the purpose to guarantee an uncertainty in the dosimetry in radiation therapy, the International Atomic Energy Agency (IAEA) published in 1987 the Technical Reports Series (TRS) number 277 - Absorbed Dose Determination in Photon and Electron Beams - An International Code of Practice -, updated in 1997, when was published its second edition. In 2000 was published the TRS number 398 - Absorbed Dose Determination in External Beam Radiotherapy - An International Code of Practice for Dosimetry Based on Standards of Absorbed Dose to Water. The TRS number 398 brings a great conceptual change in relation to the basis of the formalism, before based on calibration factor in terms of air kerma, and now based on calibration factor in terms of absorbed dose in water. Since the TRS number 398 was published, the Secondary Standard Dosimetry Laboratories are calibrating the user's ionization chambers in terms of absorbed dose to water. However, nor all the clinics in Rio de Janeiro and Brazil have its ionization chambers calibrated in terms of absorbed dose to water. The National Cancer Institute, where the measurements were taken, was the first institution in the Rio de Janeiro to have its ionization chambers calibrated in terms of a new formalism. This work describes a comparison between dosimetry done with a cylindrical ionization chamber under electron beams utilizing the TRS number 277 formalism, based on air kerma, and the TRS number 398 formalism, based on absorbed dose to water, reporting the uncertainties variation of the dosimetry associated to each protocol. (author)

  15. European protocol for neutron dosimetry for external beam therapy

    International Nuclear Information System (INIS)

    Broerse, J.J.; Mijnheer, B.J.; Williams, J.R.

    1981-01-01

    The paper attempts to serve the needs of European centres participating in the High LET Therapy Project Group set up under the sponsorship of The European Organization for Research on Treatment of Cancer, to promote cooperation between physicists involved in fast neutron therapy and establish a common basis for neutron dosimetry. Differences in dosimetry procedures between European and American Groups are indicated if relevant. The subject is dealt with under the following main headings: principles of dosimetry of neutron fields, dosimetric methods, physical parameters, determination of absorbed dose at a reference point, determination of absorbed dose at any point, check of absorbed dose given to a patient, dosimetry intercomparisons between institutes. There is an ample bibliography. (U.K.)

  16. Clinical dosimetry in photon radiotherapy. A Monte Carlo based investigation

    International Nuclear Information System (INIS)

    Wulff, Joerg

    2010-01-01

    Practical clinical dosimetry is a fundamental step within the radiation therapy process and aims at quantifying the absorbed radiation dose within a 1-2% uncertainty. To achieve this level of accuracy, corrections are needed for calibrated and air-filled ionization chambers, which are used for dose measurement. The procedures of correction are based on cavity theory of Spencer-Attix and are defined in current dosimetry protocols. Energy dependent corrections for deviations from calibration beams account for changed ionization chamber response in the treatment beam. The corrections applied are usually based on semi-analytical models or measurements and are generally hard to determine due to their magnitude of only a few percents or even less. Furthermore the corrections are defined for fixed geometrical reference-conditions and do not apply to non-reference conditions in modern radiotherapy applications. The stochastic Monte Carlo method for the simulation of radiation transport is becoming a valuable tool in the field of Medical Physics. As a suitable tool for calculation of these corrections with high accuracy the simulations enable the investigation of ionization chambers under various conditions. The aim of this work is the consistent investigation of ionization chamber dosimetry in photon radiation therapy with the use of Monte Carlo methods. Nowadays Monte Carlo systems exist, which enable the accurate calculation of ionization chamber response in principle. Still, their bare use for studies of this type is limited due to the long calculation times needed for a meaningful result with a small statistical uncertainty, inherent to every result of a Monte Carlo simulation. Besides heavy use of computer hardware, techniques methods of variance reduction to reduce the needed calculation time can be applied. Methods for increasing the efficiency in the results of simulation were developed and incorporated in a modern and established Monte Carlo simulation environment

  17. The IAEA/WHO thermoluminescent dosimetry intercomparison used for the improvement of clinical dosimetry

    International Nuclear Information System (INIS)

    Racoveanu, N.T.

    1981-01-01

    Results of thermoluminescent dosimetry collected over 5 years in the Eastern Mediterranean region of WHO were analyzed in an attempt to improve clinical dosimetry. Data for 16 radiotherapy departments showed considerable inconsistencies. It was found that the clinical dosemeters used by 3 of the departments were not working properly. The remainder of the departments had one or more dosemeters in perfect working order but the procedure for measuring machine output was inadequate or the correction factors (pressure, temperature) were wrongly applied due to lack of reliable instruments for such measurements. Problems encountered in the sending and returning of TLD dosemeters for assessment are discussed

  18. Development and clinical application of In Vivo dosimetry for radiotherapy

    International Nuclear Information System (INIS)

    Honda, Hirofumi; Oita, Masataka; Tominaga, Masahide; Oto, Yoshihiro

    2016-01-01

    In practical radiotherapy, it is important to deliver radiation to the target correctly and safely according to the treatment planning. The control of radiation dose delivered to each patient in radiotherapy mainly relies on the prediction based on the result of pre-treatment verification and irradiation accuracy of treatment machines. In Vivo dosimetry in radiotherapy is the procedure of quality assurance by the way of direct measurement for the patient whether the calculated prescribed dose in the treatment planning is delivered precisely. The history of In Vivo dosimetry is relatively long, and the TLD dosimetry for clinical radiotherapy started in early 1970's. After 1980's, owing to the development of semiconductor devices such as diode detectors, semiconductor arrays, the clinical applications for the dosimetry and diagnostic radiation imaging devices which contributed to the development of electric portal imaging devices and 2D semiconductor detectors were introduced. In recent years, these radiation measurement devices and non-invasive methods have been developed, they are becoming widespread as clinical practice. In this paper, we reviewed the In Vivo dosimetry devices and their characteristics, and technical application for radiotherapy. (author)

  19. Protocol for X-ray dosimetry and exposure arrangements employed in studies of late somatic effects in mammals

    International Nuclear Information System (INIS)

    Zoetelief, J.; Kogel, A.J. van der; Broerse, J.J.; Scarpa, G.; Dixon-Brown, A.

    1985-01-01

    A number of European laboratories studying the late effects of ionizing radiation in animals have established an effective cooperation within the European Late Effects Project Group (EULEP) since 1970. To facilitate the exchange of biological results several techniques, including quality control of the experimental animals, pathology and dosimetry, have to be standardized. The most important aspects of the procedures for X-irradiation and dosimetry of small animals are summarized. These include recommendations on irradiation conditions, dosimetry methods, characteristics of phantoms and factors affecting X-ray dosimetry. X-irradiation procedures employed by the participating institutes are described and the results of five X-ray dosimetry intercomparisons are reported. The introduction of a common dosimetry protocol has resulted in improvements in exposure arrangements and absolute dosimetry. (author)

  20. Clinical application of in vivo dosimetry for external telecobalt machine

    International Nuclear Information System (INIS)

    Mohammed, H. H. M.

    2011-01-01

    In external beam radiotherapy quality assurance is carried out on the individual components of treatment chain. The patient simulating device, planning system and treatment machine are tested regularly according to set protocols developed by national and international organizations. Even thought these individual systems are not tested for errors which can be made in the transfer between the systems. The best quality assurance for the treatment planning chain. In vivo dosimetry is used as a quality assurance tool for verifying dosimetry as either the entrance or exit surface of the patient undergoing external beam radiotherapy. It is a proven reliable method of checking overall treatment accuracy, allowing verification of dosimetry and dose calculation as well as patient treatment setup. Accurate in vivo dosimetry is carried out if diodes and thermoluminescence dosimeters (TLDs). the main detector types in use for in vivo dosimetry, are carefully calibrated and the factors influencing their sensitivity are taken into account. The aim of this study was to verify the response of TLDs type (LiF: Mg, Cu, p) use in radiotherapy, to establish calibration procedure for TLDs and to evaluate entrance dose obtained by the treatment planning system with measured dose using thermoluminescence detectors. Calibration of TLDs was done using Cobalt-60 teletherapy machine, linearity and calibration factors were determined. Measurements were performed in random phantom for breast irradiation (for the breast irradiation ( For the breast irradiation technique considered, wedge field was used). All TLDs were processed and analyzed at RICK. In vivo dosimetry represents a technique that has been widely employed to evaluate the dose to the patient mainly in radiotherapy. Thermoluminescent dosimeters are considered the gold stander for in vivo dosimetry and do not require cables for measurements which makes them ideal for mail based studies and have no dose rate or temperature dependence

  1. TU-D-201-03: Results of a Survey On the Implementation of the TG-51 Protocol and Associated Addendum On Reference Dosimetry of External Beams

    Energy Technology Data Exchange (ETDEWEB)

    Kim, G [University of California, San Diego, La Jolla, CA (United States); Muir, B [National Research Council, Ottawa, AB (Canada); Culberson, W [University of Wisconsin Madison, Madison, WI (United States); Davis, S [McGill University Health Center, Montreal, QC (Canada); Huang, Y [Henry Ford Health System, West Bloomfield, MI (United States); Lee, S [University of Maryland School of Medicine, Columbia, MD (United States); Lowenstein, J [UT MD Anderson Cancer Center, Houston, TX (United States); Sarfehnia, A [Sunnybrook Health Science Center, Toronto, ON (Canada); Tolani, N [Michael E. DeBakey VA Medical Center, Sugarland (United States); Siebers, J [University of Virginia Health System, Charlottesville, VA (United States)

    2016-06-15

    Purpose: The working group on the review and extension of the TG-51 protocol (WGTG51) collected data from American Association of Physicists in Medicine (AAPM) members with respect to their current TG-51 and associated addendum usage in the interest of considering future protocol addenda and guidance on reference dosimetry best practices. This study reports an overview of this survey on dosimetry of external beams. Methods: Fourteen survey questions were developed by WGTG51 and released in November 2015. The questions collected information on reference dosimetry, beam quality specification, and ancillary calibration equipment. Results: Of the 190 submissions completed worldwide (U.S. 70%), 83% were AAPM members. Of the respondents, 33.5% implemented the TG-51 addendum, with the maximum calibration difference for any photon beam, with respect to the original TG-51 protocol, being <1% for 97.4% of responses. One major finding is that 81.8% of respondents used the same cylindrical ionization chamber for photon and electron dosimetry, implying that many clinics are foregoing the use of parallel-plate chambers. Other evidence suggests equivalent dosimetric results can be obtained with both cylindrical and parallel-plate chambers in electron beams. This, combined with users comfort with cylindrical chambers for electrons will likely impact recommendations put forward in an upcoming electron beam addendum to the TG-51 protocol. Data collected on ancillary equipment showed 58.2% (45.0%) of the thermometers (barometers) in use for beam calibration had NIST traceable calibration certificates, but 48.4% (42.7%) were never recalibrated. Conclusion: This survey provides a snapshot of TG-51 external beam reference dosimetry practice in radiotherapy centers. Findings demonstrate the rapid take-up of the TG-51 photon beam addendum and raise issues for the WGTG51 to focus on going forward, including guidelines on ancillary equipment and the choice of chamber for electron beam

  2. Fast protocol for radiochromic film dosimetry using a cloud computing web application.

    Science.gov (United States)

    Calvo-Ortega, Juan-Francisco; Pozo, Miquel; Moragues, Sandra; Casals, Joan

    2017-07-01

    To investigate the feasibility of a fast protocol for radiochromic film dosimetry to verify intensity-modulated radiotherapy (IMRT) plans. EBT3 film dosimetry was conducted in this study using the triple-channel method implemented in the cloud computing application (Radiochromic.com). We described a fast protocol for radiochromic film dosimetry to obtain measurement results within 1h. Ten IMRT plans were delivered to evaluate the feasibility of the fast protocol. The dose distribution of the verification film was derived at 15, 30, 45min using the fast protocol and also at 24h after completing the irradiation. The four dose maps obtained per plan were compared using global and local gamma index (5%/3mm) with the calculated one by the treatment planning system. Gamma passing rates obtained for 15, 30 and 45min post-exposure were compared with those obtained after 24h. Small differences respect to the 24h protocol were found in the gamma passing rates obtained for films digitized at 15min (global: 99.6%±0.9% vs. 99.7%±0.5%; local: 96.3%±3.4% vs. 96.3%±3.8%), at 30min (global: 99.5%±0.9% vs. 99.7%±0.5%; local: 96.5%±3.2% vs. 96.3±3.8%) and at 45min (global: 99.2%±1.5% vs. 99.7%±0.5%; local: 96.1%±3.8% vs. 96.3±3.8%). The fast protocol permits dosimetric results within 1h when IMRT plans are verified, with similar results as those reported by the standard 24h protocol. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  3. Dosimetry

    International Nuclear Information System (INIS)

    Anon.

    1990-01-01

    The purpose of ionizing radiation dosimetry is the measurement of the physical and biological consequences of exposure to radiation. As these consequences are proportional to the local absorption of energy, the dosimetry of ionizing radiation is based on the measurement of this quantity. Owing to the size of the effects of ionizing radiation on materials in all of these area, dosimetry plays an essential role in the prevention and the control of radiation exposure. Its use is of great importance in two areas in particular where the employment of ionizing radiation relates to human health: radiation protection, and medical applications. Dosimetry is different for various reasons: owing to the diversity of the physical characteristics produced by different kinds of radiation according to their nature (X- and γ-photons, electrons, neutrons,...), their energy (from several keV to several MeV), the orders of magnitude of the doses being estimated (a factor of about 10 5 between diagnostic and therapeutic applications); and the temporal and spatial variation of the biological parameters entering into the calculations. On the practical level, dosimetry poses two distinct yet closely related problems: the determination of the absorbed dose received by a subject exposed to radiation from a source external to his body (external dosimetry); and the determination of the absorbed dose received by a subject owing to the presence within his body of some radioactive substance (internal dosimetry)

  4. Dosimetry for audit and clinical trials: challenges and requirements

    International Nuclear Information System (INIS)

    Kron, T; Haworth, A; Williams, I

    2013-01-01

    Many important dosimetry audit networks for radiotherapy have their roots in clinical trial quality assurance (QA). In both scenarios it is essential to test two issues: does the treatment plan conform with the clinical requirements and is the plan a reasonable representation of what is actually delivered to a patient throughout their course of treatment. Part of a sound quality program would be an external audit of these issues with verification of the equivalence of plan and treatment typically referred to as a dosimetry audit. The increasing complexity of radiotherapy planning and delivery makes audits challenging. While verification of absolute dose delivered at a reference point was the standard of external dosimetry audits two decades ago this is often deemed inadequate for verification of treatment approaches such as Intensity Modulated Radiation Therapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT). As such, most dosimetry audit networks have successfully introduced more complex tests of dose delivery using anthropomorphic phantoms that can be imaged, planned and treated as a patient would. The new challenge is to adapt this approach to ever more diversified radiotherapy procedures with image guided/adaptive radiotherapy, motion management and brachytherapy being the focus of current research.

  5. Dosimetry

    International Nuclear Information System (INIS)

    Rezende, D.A.O. de

    1976-01-01

    The fundamental units of dosimetry are defined, such as exposure rate, absorbed dose and equivalent dose. A table is given of relative biological effectiveness values for the different types of radiation. The relation between the roentgen and rad units is calculated and the concepts of physical half-life, biological half-life and effective half-life are discussed. Referring to internal dosimetry, a mathematical treatment is given to β particle-and γ radiation dosimetry. The absorbed dose is calculated and a practical example is given of the calculation of the exposure and of the dose rate for a gama source [pt

  6. Calculation of uncertainties in the protocol of dosimetry for Co 60 beams in Radiotherapy

    International Nuclear Information System (INIS)

    Velazquez M, S.; Carrera M, F.; Sanchez S, J.

    1998-01-01

    The objective in this work is to show how the uncertainty is possible to know in the determination of the absorbed dose in Co 60 photon beams and to establish in a rational form, tolerance levels for this. It is took as base the spanish protocol of dosimetry in Radiotherapy. We have been centered in a Co 60 beam. We utilized the statistical theory of little samples. We allowed to suggest a new approach about the treatment of the tolerance levels and the uncertainty of the measurement. After two years of experience in the practical hospitable application we have gotten to put around 1 % uncertainty in the absolute dosimetry of the Co 60 beam. The presented protocol allows to execute the accuracy requirements in the determination of absorbed doses. (Author)

  7. A round-robin gamma stereotactic radiosurgery dosimetry interinstitution comparison of calibration protocols

    Energy Technology Data Exchange (ETDEWEB)

    Drzymala, R. E., E-mail: drzymala@wustl.edu [Department of Radiation Oncology, Washington University, St. Louis, Missouri 63110 (United States); Alvarez, P. E. [Imaging and Radiation Oncology Core Houston, UT MD Anderson Cancer Center, Houston, Texas 77030 (United States); Bednarz, G. [Radiation Oncology Department, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15232 (United States); Bourland, J. D. [Department of Radiation Oncology, Wake Forest University, Winston-Salem, North Carolina 27157 (United States); DeWerd, L. A. [Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin 53705 (United States); Ma, L. [Department of Radiation Oncology, University California San Francisco, San Francisco, California 94143 (United States); Meltsner, S. G. [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina 27710 (United States); Neyman, G. [Department of Radiation Oncology, The Cleveland Clinic Foundation, Cleveland, Ohio 44195 (United States); Novotny, J. [Medical Physics Department, Hospital Na Homolce, Prague 15030 (Czech Republic); Petti, P. L. [Gamma Knife Center, Washington Hospital Healthcare System, Fremont, California 94538 (United States); Rivard, M. J. [Department of Radiation Oncology, Tufts University School of Medicine, Boston, Massachusetts 02111 (United States); Shiu, A. S. [Department of Radiation Oncology, University of Southern California, Los Angeles, California 90033 (United States); Goetsch, S. J. [San Diego Medical Physics, Inc., La Jolla, California 92037 (United States)

    2015-11-15

    Purpose: Absorbed dose calibration for gamma stereotactic radiosurgery is challenging due to the unique geometric conditions, dosimetry characteristics, and nonstandard field size of these devices. Members of the American Association of Physicists in Medicine (AAPM) Task Group 178 on Gamma Stereotactic Radiosurgery Dosimetry and Quality Assurance have participated in a round-robin exchange of calibrated measurement instrumentation and phantoms exploring two approved and two proposed calibration protocols or formalisms on ten gamma radiosurgery units. The objectives of this study were to benchmark and compare new formalisms to existing calibration methods, while maintaining traceability to U.S. primary dosimetry calibration laboratory standards. Methods: Nine institutions made measurements using ten gamma stereotactic radiosurgery units in three different 160 mm diameter spherical phantoms [acrylonitrile butadiene styrene (ABS) plastic, Solid Water, and liquid water] and in air using a positioning jig. Two calibrated miniature ionization chambers and one calibrated electrometer were circulated for all measurements. Reference dose-rates at the phantom center were determined using the well-established AAPM TG-21 or TG-51 dose calibration protocols and using two proposed dose calibration protocols/formalisms: an in-air protocol and a formalism proposed by the International Atomic Energy Agency (IAEA) working group for small and nonstandard radiation fields. Each institution’s results were normalized to the dose-rate determined at that institution using the TG-21 protocol in the ABS phantom. Results: Percentages of dose-rates within 1.5% of the reference dose-rate (TG-21 + ABS phantom) for the eight chamber-protocol-phantom combinations were the following: 88% for TG-21, 70% for TG-51, 93% for the new IAEA nonstandard-field formalism, and 65% for the new in-air protocol. Averages and standard deviations for dose-rates over all measurements relative to the TG-21 + ABS

  8. Development of a 3D remote dosimetry protocol compatible with MRgIMRT.

    Science.gov (United States)

    Mein, Stewart; Rankine, Leith; Adamovics, John; Li, Harold; Oldham, Mark

    2017-11-01

    To develop a novel remote 3D dosimetry protocol to verify Magnetic Resonance-guided Radiation Therapy (MRgRT) treatments. The protocol was applied to investigate the accuracy of TG-119 IMRT irradiations delivered by the MRIdian ® system (ViewRay ® , Oakwood Village, OH, USA) allowing for a 48-hour delay between irradiation at a field institution and subsequent readout at a base institution. The 3D dosimetry protocol utilizes a novel formulation of PRESAGE ® radiochromic dosimeters developed for high postirradiation stability and compatibility with optical-CT readout. Optical-CT readout was performed with an in-house system utilizing telecentric lenses affording high-resolution scanning. The protocol was developed from preparatory experiments to characterize PRESAGE ® response in relevant conditions. First, linearity and sensitivity of PRESAGE ® dose-response in the presence of a magnetic field was evaluated in a small volume study (4 ml cuvettes) conducted under MRgRT conditions and irradiated with doses 0-15 Gy. Temporal and spatial stability of the dose-response were investigated in large volume studies utilizing large field-of-view (FOV) 2 kg cylindrical PRESAGE ® dosimeters. Dosimeters were imaged at t = 1 hr and t = 48 hrs enabling the development of correction terms to model any observed spatial and temporal changes postirradiation. Polynomial correction factors for temporal and spatial changes in PRESAGE ® dosimeters (C T and C R respectively) were obtained by numerical fitting to time-point data acquired in six irradiated dosimeters. A remote dosimetry protocol was developed where PRESAGE ® change in optical-density (ΔOD) readings at time t = X (the irradiation to return shipment time interval) were corrected back to a convenient standard time t = 1 hr using the C T and C R corrections. This refined protocol was then applied to TG-119 (American Association of Physicists in Medicine, Task Group 119) plan deliveries on the MRIdian

  9. Do we need 3D tube current modulation information for accurate organ dosimetry in chest CT? Protocols dose comparisons.

    Science.gov (United States)

    Lopez-Rendon, Xochitl; Zhang, Guozhi; Coudyzer, Walter; Develter, Wim; Bosmans, Hilde; Zanca, Federica

    2017-11-01

    To compare the lung and breast dose associated with three chest protocols: standard, organ-based tube current modulation (OBTCM) and fast-speed scanning; and to estimate the error associated with organ dose when modelling the longitudinal (z-) TCM versus the 3D-TCM in Monte Carlo simulations (MC) for these three protocols. Five adult and three paediatric cadavers with different BMI were scanned. The CTDI vol of the OBTCM and the fast-speed protocols were matched to the patient-specific CTDI vol of the standard protocol. Lung and breast doses were estimated using MC with both z- and 3D-TCM simulated and compared between protocols. The fast-speed scanning protocol delivered the highest doses. A slight reduction for breast dose (up to 5.1%) was observed for two of the three female cadavers with the OBTCM in comparison to the standard. For both adult and paediatric, the implementation of the z-TCM data only for organ dose estimation resulted in 10.0% accuracy for the standard and fast-speed protocols, while relative dose differences were up to 15.3% for the OBTCM protocol. At identical CTDI vol values, the standard protocol delivered the lowest overall doses. Only for the OBTCM protocol is the 3D-TCM needed if an accurate (<10.0%) organ dosimetry is desired. • The z-TCM information is sufficient for accurate dosimetry for standard protocols. • The z-TCM information is sufficient for accurate dosimetry for fast-speed scanning protocols. • For organ-based TCM schemes, the 3D-TCM information is necessary for accurate dosimetry. • At identical CTDI vol , the fast-speed scanning protocol delivered the highest doses. • Lung dose was higher in XCare than standard protocol at identical CTDI vol .

  10. Dosimetry and clinical implementation of dynamic wedge

    International Nuclear Information System (INIS)

    Klein, Eric E.; Low, Daniel A.; Meigooni, Ali S.; Purdy, James A.

    1995-01-01

    Purpose: Wedge-shaped isodoses are desired in a number of clinical situations. Physical wedge filters have provided nominal angled isodoses with dosimetric consequences of beam hardening, increased peripheral dosing, nonidealized gradients at deep depths, along with the practical consequences of filter handling and placement problems. Dynamic wedging uses a combination of a moving jaw and changing dose rate to achieve angled isodoses. The clinical implementation of dynamic wedge and an accompanying quality assurance program are discussed in detail. Methods and Materials: The accelerator at our facility has two photon energies (6 MV and 18 MV), currently with dynamic wedge angles of 15 deg. , 30 deg. , 45 deg. , and 60 deg. . The segmented treatment tables (STT) that drive the jaw in concert with a changing dose rate are unique for field sizes ranging from 4.0 cm to 20.0 cm in 05 cm steps, resulting in 256 STTs. Transmission wedge factors were measured for each STT with an ion chamber. Isodose profiles were accumulated with film after dose conversion. For treatment-planning purposes, d max orthogonal dose profiles were measured for open and dynamic fields. Physical filters were assigned empirically via the ratio of open and wedge profiles. Results: A nonlinear relationship with wedge factor and field size was found. The factors were found to be independent of the stationary field setting or second order blocking. Dynamic wedging provided more consistent gradients across the field compared with physical filters. Percent depth doses were found to be closer to open field. The created physical filters provided planned isodoses that closely resembled measured isodoses. Comparative isodose plans show improvement with dynamic wedging. Conclusions: Dynamic weding has practical and dosimetric advantages over physical filters. Table collisions with physical filters are alleviated. Treatment planning has been solved with an empirical solution. Dynamic wedge is a positive

  11. [Computerized clinical protocol for occlusion].

    Science.gov (United States)

    Salsench, J; Ferrer, J; Nogueras, J

    1988-11-01

    In making a protocol it is necessary that all members of the team who are going to collect information have the same unity of criterion about the different variables that compose it. The drawing up of this document is as much or more necessary than the protocol itself. In this work we all data collected in the protocol and we give the explanations of each concept.

  12. Comparison and uncertainty evaluation of different calibration protocols and ionization chambers for low-energy surface brachytherapy dosimetry

    Energy Technology Data Exchange (ETDEWEB)

    Candela-Juan, C., E-mail: ccanjuan@gmail.com [Radiation Oncology Department, La Fe University and Polytechnic Hospital, Valencia 46026 (Spain); Vijande, J. [Department of Atomic, Molecular, and Nuclear Physics, University of Valencia, Burjassot 46100, Spain and Instituto de Física Corpuscular (UV-CSIC), Paterna 46980 (Spain); García-Martínez, T. [Radiation Oncology Department, Hospital La Ribera, Alzira 46600 (Spain); Niatsetski, Y.; Nauta, G.; Schuurman, J. [Elekta Brachytherapy, Veenendaal 3905 TH (Netherlands); Ouhib, Z. [Radiation Oncology Department, Lynn Regional Cancer Center, Boca Raton Community Hospital, Boca Raton, Florida 33486 (United States); Ballester, F. [Department of Atomic, Molecular, and Nuclear Physics, University of Valencia, Burjassot 46100 (Spain); Perez-Calatayud, J. [Radiation Oncology Department, La Fe University and Polytechnic Hospital, Valencia 46026, Spain and Department of Radiotherapy, Clínica Benidorm, Benidorm 03501 (Spain)

    2015-08-15

    Purpose: A surface electronic brachytherapy (EBT) device is in fact an x-ray source collimated with specific applicators. Low-energy (<100 kVp) x-ray beam dosimetry faces several challenges that need to be addressed. A number of calibration protocols have been published for x-ray beam dosimetry. The media in which measurements are performed are the fundamental difference between them. The aim of this study was to evaluate the surface dose rate of a low-energy x-ray source with small field applicators using different calibration standards and different small-volume ionization chambers, comparing the values and uncertainties of each methodology. Methods: The surface dose rate of the EBT unit Esteya (Elekta Brachytherapy, The Netherlands), a 69.5 kVp x-ray source with applicators of 10, 15, 20, 25, and 30 mm diameter, was evaluated using the AAPM TG-61 (based on air kerma) and International Atomic Energy Agency (IAEA) TRS-398 (based on absorbed dose to water) dosimetry protocols for low-energy photon beams. A plane parallel T34013 ionization chamber (PTW Freiburg, Germany) calibrated in terms of both absorbed dose to water and air kerma was used to compare the two dosimetry protocols. Another PTW chamber of the same model was used to evaluate the reproducibility between these chambers. Measurements were also performed with two different Exradin A20 (Standard Imaging, Inc., Middleton, WI) chambers calibrated in terms of air kerma. Results: Differences between surface dose rates measured in air and in water using the T34013 chamber range from 1.6% to 3.3%. No field size dependence has been observed. Differences are below 3.7% when measurements with the A20 and the T34013 chambers calibrated in air are compared. Estimated uncertainty (with coverage factor k = 1) for the T34013 chamber calibrated in water is 2.2%–2.4%, whereas it increases to 2.5% and 2.7% for the A20 and T34013 chambers calibrated in air, respectively. The output factors, measured with the PTW chambers

  13. Role of humidity and other correction factors in the AAPM TG-21 dosimetry protocol

    International Nuclear Information System (INIS)

    Rogers, D.W.; Ross, C.K.

    1988-01-01

    A detailed derivation is presented of the formulas required to determine Ngas and Dmed in the AAPM TG-21 dosimetry protocol. This protocol specifies how to determine the absorbed dose in an electron or photon beam when using exposure or absorbed dose calibrated ion chambers. It is shown that the expression given in TG-21's recent letter of clarification is incorrect. Accounting for humidity correctly increases, by 0.4%, all absorbed dose determinations using an exposure calibrated ion chamber. Taking into account other correction factors in the equation for exposure could also have varying, but significant effects (possibly over 1%). These are the stem scatter correction, the axial nonuniformity correction and the electrode correction for electrodes made of different materials from the wall. Attention is drawn to differences in the definitions of the exposure and absorbed dose calibration factors, Nx and ND, respectively, as supplied by the NBS and the NRCC

  14. Dosimetry study comparing NCS report-2 versus IAEA TRS-398 protocol for high energy photon beams

    International Nuclear Information System (INIS)

    Attalaa, E.M.; Khaled, N.E.; Abou Elenein, H.S.; Elsayed, A.A.

    2005-01-01

    In this work a dosimetry study is presented in which the results of absorbed dose determined at reference condition according to the IAEA TRS-398 protocol and the NCS report-2 are compared. The IAEA TRS-398 protocol for absorbed dose calibration is based on ionization chamber having absorbed dose to water calibration factor N d w, while the NCS-2 dosimetry report for absorbed dose calibration is based on an ionization chamber having air- kerma calibration factor N k . This study shows that the absorbed dose which is calculated with The IAEA TRS-398 formalisms is higher than that calculated with NCS report-2 formalisms within range from 0.4 to 0.9% in cobalt-60 beam as sensed by different ionization chambers, and from 0.2 to 1.1% for different higher energy photon beams of 6, 8 and 18 MV. The chambers used are PTW 30001, 30004, and NE-2571; which have calibration factors N k and N d w traceable to the BIPM (Bureau International des Poids et Mesures)

  15. An in vivo investigative protocol for HDR prostate brachytherapy using urethral and rectal thermoluminescence dosimetry

    International Nuclear Information System (INIS)

    Toye, Warren; Das, Ram; Kron, Tomas; Franich, Rick; Johnston, Peter; Duchesne, Gillian

    2009-01-01

    Purpose: To develop an in vivo dosimetry based investigative action level relevant for a corrective protocol for HDR brachytherapy boost treatment. Methods and materials: The dose delivered to points within the urethra and rectum was measured using TLD in vivo dosimetry in 56 patients. Comparisons between the urethral and rectal measurements and TPS calculations showed differences, which are related to the relative position of the implant and TLD trains, and allowed shifts of implant position relative to the prostate to be estimated. Results and conclusions: Analysis of rectal dose measurements is consistent with implant movement, which was previously only identified with the urethral data. Shift corrected doses were compared with results from the TPS. Comparison of peak doses to the urethra and rectum has been assessed against the proposed corrective protocol to limit overdosing these critical structures. An initial investigative level of 20% difference between measured and TPS peak dose was established, which corresponds to 1/3 of patients which was practical for the caseload. These patients were assessed resulting in corrective action being applied for one patient. Multiple triggering for selective investigative action is outlined. The use of a single in vivo measurement in the first fraction optimizes patient benefit at acceptable cost.

  16. Clinical experience with routine diode dosimetry for electron beam radiotherapy

    International Nuclear Information System (INIS)

    Yaparpalvi, Ravindra; Fontenla, Doracy P.; Vikram, Bhadrasain

    2000-01-01

    Purpose: Electron beam radiotherapy is frequently administered based on clinical setups without formal treatment planning. We felt, therefore, that it was important to monitor electron beam treatments by in vivo dosimetry to prevent errors in treatment delivery. In this study, we present our clinical experience with patient dose verification using electron diodes and quantitatively assess the dose perturbations caused by the diodes during electron beam radiotherapy. Methods and Materials: A commercial diode dosimeter was used for the in vivo dose measurements. During patient dosimetry, the patients were set up as usual by the therapists. Before treatment, a diode was placed on the patient's skin surface and secured with hypoallergenic tape. The patient was then treated and the diode response registered and stored in the patient radiotherapy system database via our in-house software. A customized patient in vivo dosimetry report showing patient details, expected and measured dose, and percent difference was then generated and printed for analysis and record keeping. We studied the perturbation of electron beams by diodes using film dosimetry. Beam profiles at the 90% prescription isodose depths were obtained with and without the diode on the beam central axis, for 6-20 MeV electron beams and applicator/insert sizes ranging from a 3-cm diameter circular field to a 25 x 25 cm open field. Results: In vivo dose measurements on 360 patients resulted in the following ranges of deviations from the expected dose at the various anatomic sites: Breast (222 patients) -20.3 to +23.5% (median deviation 0%); Head and Neck (63 patients) -21.5 to +14.8% (median -0.7%); Other sites (75 patients) -17.6 to +18.8% (median +0.5%). Routine diode dosimetry during the first treatment on 360 patients (460 treatment sites) resulted in 11.5% of the measurements outside our acceptable ±6% dose deviation window. Only 3.7% of the total measurements were outside ±10% dose deviation. Detailed

  17. A novel micro liquid ionization chamber for clinical dosimetry

    International Nuclear Information System (INIS)

    Stewart, K.J.; Seuntjens, J.P.

    2002-01-01

    Absorbed-dose-based protocols recommend calibration of clinical linear accelerators using airfilled ionization chambers for which an absorbed-dose to water calibration factor has been established in a 60 Co beam. The factor k Q in these protocols involves the ratio of the mean restricted collision mass stopping power water-to-air, which is energy dependent. For high-energy clinical photon beams, the stopping power ratio water-to-air varies by up to 4%, whereas for electron beams the variation is even larger. For certain insulating liquids, however, the stopping power ratio water-to-liquid shows very little energy dependence, making a liquid-filled ionization chamber a potentially attractive dosimeter for clinical reference dosimetry. In this work some properties of two liquid-filled ionization chambers are investigated including ion recombination and variation of response as a function of energy for photon beams. In this work we used an Exradin A14P planar microchamber with chamber body and electrodes composed of C552 plastic. This chamber was modified, reducing the gap between the cap and collecting electrode to 0.5 mm. The diameter of the collecting electrode is 1.5 mm and the nominal sensitive volume of 1.12 mm 3 was filled with isooctane. This chamber will be referred to as the MicroLIC. The energy response of the MicroLIC was compared to previous results measured using the LIC 9902-mix chamber, developed by G. Wickman of Umea University, Sweden. The sensitive volume of this chamber has a diameter of 2.5 mm, thickness of 0.35 mm and is filled with 60% isooctane, 40% tetramethylsilane by weight. The linear accelerator used was a Varian Clinac 21EX with nominal photon beam energies of 6 and 18 MV. Measurements were done in a 20x20x20 cm 3 RMI Solid Water phantom at 10 cm depth with a 10x10 cm 2 field at the phantom surface. Absorbed dose was determined using an Exradin A12 chamber with an absorbed-dose to water calibration factor for 60 Co established at a

  18. Clinical application of radiation dosimetry on X-ray radiotherapy

    International Nuclear Information System (INIS)

    Mizutani, Takeo

    1995-01-01

    In the case of radiotherapy, it is important to give proper dose for a tumor, to be treated with the objective of therapy, and to evaluate the dose, considering dose for other organs at risk to a sufficient extent. To provide an exposure dose at the target volume of tumor parts, it should be required to get a good understanding of the correct dosimetric method and also to apply this to clinical application in practice. All over the country, so as not to produce any difference in the given dose, 'A practical code for the dosimetry of high energy X-rays in radiotherapy' was issued by the Japanese Associations of radiological physicists in 1972. In 1986, it was revised. At about 85% of therapeutic facilities in the country, radiation engineers perform dose measurements and controls. Therefore, I have explained the process of measurement and dose calculation, with the main objective directed at the engineers in charge of the radiotherapy so as to easily radiation dosimetry of X-ray with dosemeters and phantom used at each facility according to the 'practical code'. (author)

  19. Establishing treatment protocols for clinical mastitis.

    Science.gov (United States)

    Roberson, Jerry R

    2003-03-01

    Each farm has a unique mix of mastitis pathogens and management procedures that have evolved over time. The herd veterinarian should work with the manager/owner to systematically develop treatment protocols that meet the needs and management of the farm. To establish a mastitis treatment protocol, it is necessary to develop a system to routinely identify clinical mastitis cases, develop a herd-specific severity level assessment system, manage the clinical mastitis cases based on severity level and culture result (when available), avoid antibiotic residues, and monitor the success of the system and alter the protocol as necessary.

  20. Water calorimetry and ionization chamber dosimetry in an 85-MeV clinical proton beam.

    Science.gov (United States)

    Palmans, H; Seuntjens, J; Verhaegen, F; Denis, J M; Vynckier, S; Thierens, H

    1996-05-01

    In recent years, the increased use of proton beams for clinical purposes has enhanced the demand for accurate absolute dosimetry for protons. As calorimetry is the most direct way to establish the absorbed dose and because water has recently been accepted as standard material for this type of beam, the importance of water calorimetry is obvious. In this work we report water calorimeter operation in an 85-MeV proton beam and a comparison of the absorbed dose to water measured by ionometry with the dose resulting from water calorimetric measurements. To ensure a proper understanding of the heat defect for defined impurities in water for this type of radiation, a relative response study was first done in comparison with theoretical calculations of the heat defect. The results showed that pure hypoxic water and hydrogen-saturated water yielded the same response with practically zero heat defect, in agreement with the model calculations. The absorbed dose inferred from these measurements was then compared with the dose derived from ionometry by applying the European Charged Heavy Particle Dosimetry (ECHED) protocol. Restricting the comparison to chambers recommended in the protocol, the calorimeter dose was found to be 2.6% +/- 0.9% lower than the average ionometry dose. In order to estimate the significance of chamber-dependent effects in this deviation, measurements were performed using a set of ten ionization chambers of five different types. The maximum internal deviation in the ionometry results amounted to 1.1%. We detected no systematic chamber volume dependence, but observed a small but systematic effect of the chamber wall thickness. The observed deviation between calorimetry and ionometry can be attributed to a combination of the value of (Wair/e)p for protons, adopted in the ECHED protocol, the mass stopping power ratios of water to air for protons, and possibly small ionization chamber wall effects.

  1. Dosimetry

    Energy Technology Data Exchange (ETDEWEB)

    Hurst, G S; Ritchie, R H; Sanders, F W; Reinhardt, P W; Auxier, J A; Wagner, E B; Callihan, A D; Morgan, K Z [Health Physics Division, Oak Ridge National Laboratory, Oak Ridge, TN (United States)

    1962-03-15

    The methods of dosimetry used for investigation of the doses received by the individuals exposed in the Yugoslav accident were essentially those used in connection with the Oak Ridge Y-12 accident. An outline of the general scheme is as follows: When fast neutrons enter the human body, most of these are moderated to thermal energy and a small fraction of these are captured by a (n, gamma) process in Na sup 2 sup 3 , giving rise to Na sup 2 sup 4 , which by virtue of its emission of high-energy gamma rays with a half life of 14.8 h, is easily detected. It has been shown that the probability of capture, making Na sup 2 sup 4 , is not a strong function of the energy of the fast neutrons and that the probability of capture for neutrons is higher in the fast region than in the thermal region. Thus, the uniform distribution of Na sup 2 sup 3 in the human body provides an excellent means of normalizing the neutron exposure of an individual. in particular, for a given neutron energy spectrum the fast neutron dose is proportional to the ratio Na sup 2 sup 4 /Na sup 2 sup 3 in the body or in the blood system. This method of normalization is quite important in the dosimetry of radiation accidents since no assumptions need be made about the exact location of an individual at the time of the energy release. The importance of this fact can be made clear by reference to the Y-12 accident where it was shown by calculation of the neutron dose based on the known number of fissions and the stated location of the individual that one of the surviving individuals would have received a dose several times the lethal value. To accomplish the measurements described, the zero power R sub B reactor was operated in two ranges of power level, 'low' power and 'high 'power. Neutron leakage spectrum was obtained by multigroup approximation of the Boltzmann transport equation. Prompt gamma rays from fission products, from capture in the moderator and fuel cladding as well as in tank walls are given

  2. Dosimetry

    Energy Technology Data Exchange (ETDEWEB)

    Hurst, G S; Ritchie, R H; Sanders, F W; Reinhardt, P W; Auxier, J A; Wagner, E B; Callihan, A D; Morgan, K Z [Health Physics Division, Oak Ridge National Laboratory, Oak Ridge, TN (United States)

    1962-03-01

    The methods of dosimetry used for investigation of the doses received by the individuals exposed in the Yugoslav accident were essentially those used in connection with the Oak Ridge Y-12 accident. An outline of the general scheme is as follows: When fast neutrons enter the human body, most of these are moderated to thermal energy and a small fraction of these are captured by a (n, {gamma}) process in Na{sup 23}, giving rise to Na{sup 24}, which by virtue of its emission of high-energy gamma rays with a half life of 14.8 h, is easily detected. It has been shown that the probability of capture, making Na{sup 24}, is not a strong function of the energy of the fast neutrons and that the probability of capture for neutrons is higher in the fast region than in the thermal region. Thus, the uniform distribution of Na{sup 23} in the human body provides an excellent means of normalizing the neutron exposure of an individual. in particular, for a given neutron energy spectrum the fast neutron dose is proportional to the ratio Na{sup 24}/Na{sup 23} in the body or in the blood system. This method of normalization is quite important in the dosimetry of radiation accidents since no assumptions need be made about the exact location of an individual at the time of the energy release. The importance of this fact can be made clear by reference to the Y-12 accident where it was shown by calculation of the neutron dose based on the known number of fissions and the stated location of the individual that one of the surviving individuals would have received a dose several times the lethal value. To accomplish the measurements described, the zero power R{sub B} reactor was operated in two ranges of power level, 'low' power and 'high 'power. Neutron leakage spectrum was obtained by multigroup approximation of the Boltzman transport equation. Prompt gamma rays from fission products, from capture in the moderator and fuel cladding as well as in tank walls are given. A summary of the 4{pi

  3. Dosimetry investigation of MOSFET for clinical IMRT dose verification.

    Science.gov (United States)

    Deshpande, Sudesh; Kumar, Rajesh; Ghadi, Yogesh; Neharu, R M; Kannan, V

    2013-06-01

    In IMRT, patient-specific dose verification is followed regularly at each centre. Simple and efficient dosimetry techniques play a very important role in routine clinical dosimetry QA. The MOSFET dosimeter offers several advantages over the conventional dosimeters such as its small detector size, immediate readout, immediate reuse, multiple point dose measurements. To use the MOSFET as routine clinical dosimetry system for pre-treatment dose verification in IMRT, a comprehensive set of experiments has been conducted, to investigate its linearity, reproducibility, dose rate effect and angular dependence for 6 MV x-ray beam. The MOSFETs shows a linear response with linearity coefficient of 0.992 for a dose range of 35 cGy to 427 cGy. The reproducibility of the MOSFET was measured by irradiating the MOSFET for ten consecutive irradiations in the dose range of 35 cGy to 427 cGy. The measured reproducibility of MOSFET was found to be within 4% up to 70 cGy and within 1.4% above 70 cGy. The dose rate effect on the MOSFET was investigated in the dose rate range 100 MU/min to 600 MU/min. The response of the MOSFET varies from -1.7% to 2.1%. The angular responses of the MOSFETs were measured at 10 degrees intervals from 90 to 270 degrees in an anticlockwise direction and normalized at gantry angle zero and it was found to be in the range of 0.98 ± 0.014 to 1.01 ± 0.014. The MOSFETs were calibrated in a phantom which was later used for IMRT verification. The measured calibration coefficients were found to be 1 mV/cGy and 2.995 mV/cGy in standard and high sensitivity mode respectively. The MOSFETs were used for pre-treatment dose verification in IMRT. Nine dosimeters were used for each patient to measure the dose in different plane. The average variation between calculated and measured dose at any location was within 3%. Dose verification using MOSFET and IMRT phantom was found to quick and efficient and well suited for a busy radiotherapy

  4. Investigation of optimal scanning protocol for X-ray computed tomography polymer gel dosimetry

    Energy Technology Data Exchange (ETDEWEB)

    Sellakumar, P. [Bangalore Institute of Oncology, 44-45/2, II Cross, RRMR Extension, Bangalore 560 027 (India)], E-mail: psellakumar@rediffmail.com; James Jebaseelan Samuel, E. [School of Science and Humanities, VIT University, Vellore 632 014 (India); Supe, Sanjay S. [Department of Radiation Physics, Kidwai Memorial Institute of Oncology, Hosur Road, Bangalore 560 027 (India)

    2007-11-15

    X-ray computed tomography is one of the potential tool used to evaluate the polymer gel dosimeters in three dimensions. The purpose of this study is to investigate the factors which affect the image noise for X-ray CT polymer gel dosimetry. A cylindrical water filled phantom was imaged with single slice Siemens Somatom Emotion CT scanner. The imaging parameters like tube voltage, tube current, slice scan time, slice thickness and reconstruction algorithm were varied independently to study the dependence of noise on each other. Reductions of noise with number of images to be averaged and spatial uniformity of the image were also investigated. Normoxic polymer gel PAGAT was manufactured and irradiated using Siemens Primus linear accelerator. The radiation induced change in CT number was evaluated using X-ray CT scanner. From this study it is clear that image noise is reduced with increase in tube voltage, tube current, slice scan time, slice thickness and also reduced with increasing the number of images averaged. However to reduce the tube load and total scan time, it was concluded that tube voltage of 130 kV, tube current of 200 mA, scan time of 1.5 s, slice thickness of 3 mm for high dose gradient and 5 mm for low dose gradient were optimal scanning protocols for this scanner. Optimum number of images to be averaged was concluded to be 25 for X-ray CT polymer gel dosimetry. Choice of reconstruction algorithm was also critical. From the study it is also clear that CT number increase with imaging tube voltage and shows the energy dependency of polymer gel dosimeter. Hence for evaluation of polymer gel dosimeters with X-ray CT scanner needs the optimization of scanning protocols to reduce the image noise.

  5. Clinical application of dosimetry in electron beam therapy

    International Nuclear Information System (INIS)

    Yoshiura, Takao

    1995-01-01

    In everyday radiotherapy we must carry out the determination of absorbed dose measurement according to JARP's protocol. We explained an outline of JARP's 1974 and 1986 protocol in electron beam therapy, and mentioned it about the matter that should examined. To use it easily in clinic, a simplified procedure based on precisely to JARP's 1986 protocol is practical, the character of this procedure settles briefly the determination of mean incident energy of electron beams and get ready to table of ionization to absorbed dose conversion factor for various ionization chamber. Also, this procedure almost not influence on the accuracy of determination. We described systematically practical procedure for requisite absorbed dose calculation in a patient in electron beam therapy. (author)

  6. Clinical dosimetry with plastic scintillators - Almost energy independent, direct absorbed dose reading with high resolution

    Energy Technology Data Exchange (ETDEWEB)

    Quast, U; Fluehs, D [Department of Radiotherapy, Essen (Germany). Div. of Clinical Radiation Physics; Fluehs, D; Kolanoski, H [Dortmund Univ. (Germany). Inst. fuer Physik

    1996-08-01

    Clinical dosimetry is still far behind the goal to measure any spatial or temporal distribution of absorbed dose fast and precise without disturbing the physical situation by the dosimetry procedure. NE 102A plastic scintillators overcome this border. These tissue substituting dosemeter probes open a wide range of new clinical applications of dosimetry. This versatile new dosimetry system enables fast measurement of the absorbed dose to water in water also in regions with a steep dose gradient, close to interfaces, or in partly shielded regions. It allows direct reading dosimetry in the energy range of all clinically used external photon and electron beams, or around all branchytherapy sources. Thin detector arrays permit fast and high resolution measurements in quality assurance, such as in-vivo dosimetry or even afterloading dose monitoring. A main field of application is the dosimetric treatment planning, the individual optimization of brachytherapy applicators. Thus, plastic scintillator dosemeters cover optimally all difficult fields of clinical dosimetry. An overview about its characteristics and applications is given here. 20 refs, 1 fig.

  7. Do we need 3D tube current modulation information for accurate organ dosimetry in chest CT? Protocols dose comparisons

    Energy Technology Data Exchange (ETDEWEB)

    Lopez-Rendon, Xochitl; Develter, Wim [KU Leuven, Department of Imaging and Pathology, Division of Medical Physics and Quality Assessment, Leuven (Belgium); Zhang, Guozhi; Coudyzer, Walter; Zanca, Federica [University Hospitals of the KU Leuven, Department of Radiology, Leuven (Belgium); Bosmans, Hilde [KU Leuven, Department of Imaging and Pathology, Division of Medical Physics and Quality Assessment, Leuven (Belgium); University Hospitals of the KU Leuven, Department of Radiology, Leuven (Belgium)

    2017-11-15

    To compare the lung and breast dose associated with three chest protocols: standard, organ-based tube current modulation (OBTCM) and fast-speed scanning; and to estimate the error associated with organ dose when modelling the longitudinal (z-) TCM versus the 3D-TCM in Monte Carlo simulations (MC) for these three protocols. Five adult and three paediatric cadavers with different BMI were scanned. The CTDI{sub vol} of the OBTCM and the fast-speed protocols were matched to the patient-specific CTDI{sub vol} of the standard protocol. Lung and breast doses were estimated using MC with both z- and 3D-TCM simulated and compared between protocols. The fast-speed scanning protocol delivered the highest doses. A slight reduction for breast dose (up to 5.1%) was observed for two of the three female cadavers with the OBTCM in comparison to the standard. For both adult and paediatric, the implementation of the z-TCM data only for organ dose estimation resulted in 10.0% accuracy for the standard and fast-speed protocols, while relative dose differences were up to 15.3% for the OBTCM protocol. At identical CTDI{sub vol} values, the standard protocol delivered the lowest overall doses. Only for the OBTCM protocol is the 3D-TCM needed if an accurate (<10.0%) organ dosimetry is desired. (orig.)

  8. Experimental determination of beam quality conversion factors kQ in clinical photon beams using ferrous sulphate (Fricke) dosimetry

    International Nuclear Information System (INIS)

    Palm, A.; Mattsson, Olof

    2002-01-01

    The implementation of protocols based on absorbed dose to water standards requires beam quality conversion factors, k Q . Calculated values of k Q are available for ionization chambers used for reference dosimetry. Ideally, k Q should be experimentally determined at the same beam qualities as that of the user. In this work we measure k Q factors in clinical photon beams and compare them with calculated and measured values. Beam quality conversion factors are determined for clinical photon beams of nominal energies 4 MV, 6 MV, 15 MV, and 25 MV, for commonly used cylindrical ionization chambers. Twelve chambers of eight different types are used. For three of them, no experimental data have previously been available. The experimental procedure is based on measurements with ionization chambers and Fricke dosimetry in the reference beam ( 60 Co γ radiation) and in clinical linear accelerator beams. The k Q values determined in this work generally agree within 0.5% with previously reported experimental values both when %dd(10) x and TPR 20,10 are used for beam quality specification. The agreement with calculated data is generally within 0.5%, except for the 15 MV beam. For this beam the measured values are usually between 0.5% and 1% lower than the data taken from the TG-51 protocol or the TRS-398 code of practice. For three NE2571 chambers and three NE2581 chambers, the maximum observed deviation of individual k Q values is 0.2% and 0.4%, respectively

  9. Using the OSL single-aliquot regenerative-dose protocol with quartz extracted from building materials in retrospective dosimetry

    International Nuclear Information System (INIS)

    Boetter-Jensen, L.; Solongo, S.; Murray, A.S.; Banerjee, D.; Jungner, H.

    2000-01-01

    We report on the application of the single-aliquot regenerative-dose (SAR) protocol to the optically stimulated luminescence signal from quartz extracted from fired bricks and unfired mortar in retrospective dosimetry. The samples came from a radioactive materials storage facility, with ambient dose rates of about 0.1 mGy/h. A detailed dose-depth profile was analysed from one brick, and compared with dose records from area TL dosemeters. Small-aliquot dose-distributions were analysed from the mortar samples; one associated with the exposed brick, and one from a remote site exposed only to background radiation. We conclude that unfired materials have considerable potential in retrospective dosimetry

  10. The international protocol for the dosimetry of external radiotherapy beams based on standards of absorbed dose to water

    International Nuclear Information System (INIS)

    Andreo, P.

    2001-01-01

    An International Code of Practice (CoP, or dosimetry protocol) for external beam radiotherapy dosimetry based on standards of absorbed dose to water has been published by the IAEA on behalf of IAEA, WHO, PAHO and ESTRO. The CoP provides a systematic and internationally unified approach for the determination of the absorbed dose to water in reference conditions with radiotherapy beams. The development of absorbed-dose-to-water standards for high-energy photons and electrons offers the possibility of reducing the uncertainty in the dosimetry of radiotherapy beams. Many laboratories already provide calibrations at the radiation quality of 60Co gamma-rays and some have extended calibrations to high-energy photon and electron beams. The dosimetry of kilovoltage x-rays, as well as that of proton and ion beams can also be based on these standards. Thus, a coherent dosimetry system based on the same formalism is achieved for practically all radiotherapy beams. The practical use of the CoP as simple. The document is formed by a set of different CoPs for each radiation type, which include detailed procedures and worksheets. All CoPs are based on ND,w chamber calibrations at a reference beam quality Qo, together with radiation beam quality correction factors kQ preferably measured directly for the user's chamber in a standards laboratory. Calculated values of kQ are provided together with their uncertainty estimates. Beam quality specifiers are 60Co, TPR20,10 (high-energy photons), R50 (electrons), HVL and kV (x-rays) and Rres (protons and ions) [es

  11. Dosimetry study on the conventional and three dimensional conformal radiation treatment planning protocols for rectal cancer

    International Nuclear Information System (INIS)

    Cai Yong; He Yuxiang; Han Shukui; Wu Hao; Gong Jian; Xu Bo

    2007-01-01

    Objective: To compare the dose distribution of clinical target volume (CTV), in normal tissues and organs for patients with rectal cancer on the conventional radiotherapy (2D) and three dimension- al conformal radiation treatment (3DCRT). Methods: The CT image data of 36 rectal cancer patients treated with 3DCRT were studied. The CTV, small bowel, colon, bladder, pelvic bone marrow, and femoral head and neck were contoured on consecutive axial slices of CT images. Two 3DCRT and three conventional treatment planning protocols were simulated using three dimensional treatment planning system (CMS Focus 2.31), were defined as 3D-3, 3D-4, 2D-2, 2D-3, 2D-4. The difference of five treatment planning protocols on the CTV and normal structure by analysis of dose-volume histograms (DVHs) were compared. Results: The D 95 and V 95 of these five protocols all exceeded 97%. The conformity index(CI) of 3D was obviously larger than that of 2D protocol. The dose inhomogeneity(DI) in 4 DCRT was less than that of 3 DCRT. The 3D as compared with the 2D, significantly reduced the mean dose of 45 Gy to the small bowel and colon. The 3D-3 as compared with the 2D-3, the 3D-4 as compared with the 2D-4, the mean dose of small bowel and colon was reduced by 28.5% and 25.7%, respectively. The 3D-3 as compared with the 2D-2, the 3D-3 as compared with the 2D-3 and the 3D4 as compared with the 2D-4, the percentage volume of small bowel and colon which received 45 Gy was reduced by 80.8% , 51.1% and 54.7% , respectively. Either the mean dose, or the percentage volume receiving 35 Gy and 45 Gy to the pelvic bone and bladder, the 3D planning protocols had advanage over the 2D planning protocols. The V 45 of bladder in 2D-2 planning proto- col was the highest in all planning protocols, exceeding 98%, but the highest V 45 of bladder was only 50% in the other planning protocols. Conclusions: Even though the difference in pelvic CTV of rectal cancer patients between the conventional radiotherapy and 3

  12. Radiation dosimetry assessment of routine CT scanning protocols used in Western Australia

    International Nuclear Information System (INIS)

    Moorin, Rachael E; Forsyth, Rene; Gibson, David J; Fox, Richard

    2013-01-01

    Technical data on local CT practice in Western Australia were collected for five major CT providers using a self-completed questionnaire. The CTDIvol DLP and effective dose for each protocol were obtained and providers were ranked according to radiation burden for each clinical scenario. The mean, median, 75th percentile and standard deviation were calculated for both effective dose and DLP for each scenario and these values were compared with published data. CT utilisation data were used to estimate the attributable radiation dose to the WA population and the potential change in population annual effective dose according to the protocol used was estimated. We found that wide variations in technique and radiation dose exist across providers for similar examinations, producing a higher radiation burden than reported internationally. As expected, the CT protocol used dramatically affects the radiation dose received, and this has a significant effect on annual population dose. This study highlights the need for recognition and understanding of both the degree of variation in radiation dose across providers and the relatively high radiation burden afforded by protocols in use in Western Australia so that necessary dialogue can be launched for practitioner consensus on appropriate diagnostic reference levels in CT scanning. (paper)

  13. Using the OSL single-aliquot regenerative-dose protocol with quartz extracted from building materials in retrospective dosimetry

    DEFF Research Database (Denmark)

    Bøtter-Jensen, L.; Solongo, S.; Murray, A.S.

    2000-01-01

    We report on the application of the single-aliquot regenerative-dose (SAR) protocol to the optically stimulated luminescence signal from quartz extracted from fired bricks acid unfired mortar in retrospective dosimetry. The samples came from a radioactive materials storage facility, with ambient...... dose rates of about 0.1 mGy/h. A detailed dose-depth profile was analysed from one brick, and compared with dose records from area TL dosemeters. Small-aliquot dose-distributions were analysed from the mortar samples; one associated with the exposed brick, and one from a remote site exposed only...

  14. Revisiting photodynamic therapy dosimetry: reductionist and surrogate approaches to facilitate clinical success

    International Nuclear Information System (INIS)

    Pogue, Brian W; Elliott, Jonathan T; Kanick, Stephen C; Davis, Scott C; Samkoe, Kimberley S; Maytin, Edward V; Pereira, Stephen P; Hasan, Tayyaba

    2016-01-01

    Photodynamic therapy (PDT) can be a highly complex treatment, with many parameters influencing treatment efficacy. The extent to which dosimetry is used to monitor and standardize treatment delivery varies widely, ranging from measurement of a single surrogate marker to comprehensive approaches that aim to measure or estimate as many relevant parameters as possible. Today, most clinical PDT treatments are still administered with little more than application of a prescribed drug dose and timed light delivery, and thus the role of patient-specific dosimetry has not reached widespread clinical adoption. This disconnect is at least partly due to the inherent conflict between the need to measure and understand multiple parameters in vivo in order to optimize treatment, and the need for expedience in the clinic and in the regulatory and commercialization process. Thus, a methodical approach to selecting primary dosimetry metrics is required at each stage of translation of a treatment procedure, moving from complex measurements to understand PDT mechanisms in pre-clinical and early phase I trials, towards the identification and application of essential dose-limiting and/or surrogate measurements in phase II/III trials. If successful, identifying the essential and/or reliable surrogate dosimetry measurements should help facilitate increased adoption of clinical PDT. In this paper, examples of essential dosimetry points and surrogate dosimetry tools that may be implemented in phase II/III trials are discussed. For example, the treatment efficacy as limited by light penetration in interstitial PDT may be predicted by the amount of contrast uptake in CT, and so this could be utilized as a surrogate dosimetry measurement to prescribe light doses based upon pre-treatment contrast. Success of clinical ALA-based skin lesion treatment is predicted almost uniquely by the explicit or implicit measurements of photosensitizer and photobleaching, yet the individualization of treatment

  15. Revisiting photodynamic therapy dosimetry: reductionist & surrogate approaches to facilitate clinical success

    Science.gov (United States)

    Pogue, Brian W.; Elliott, Jonathan T.; Kanick, Stephen C.; Davis, Scott C.; Samkoe, Kimberley S.; Maytin, Edward V.; Pereira, Stephen P.; Hasan, Tayyaba

    2016-04-01

    Photodynamic therapy (PDT) can be a highly complex treatment, with many parameters influencing treatment efficacy. The extent to which dosimetry is used to monitor and standardize treatment delivery varies widely, ranging from measurement of a single surrogate marker to comprehensive approaches that aim to measure or estimate as many relevant parameters as possible. Today, most clinical PDT treatments are still administered with little more than application of a prescribed drug dose and timed light delivery, and thus the role of patient-specific dosimetry has not reached widespread clinical adoption. This disconnect is at least partly due to the inherent conflict between the need to measure and understand multiple parameters in vivo in order to optimize treatment, and the need for expedience in the clinic and in the regulatory and commercialization process. Thus, a methodical approach to selecting primary dosimetry metrics is required at each stage of translation of a treatment procedure, moving from complex measurements to understand PDT mechanisms in pre-clinical and early phase I trials, towards the identification and application of essential dose-limiting and/or surrogate measurements in phase II/III trials. If successful, identifying the essential and/or reliable surrogate dosimetry measurements should help facilitate increased adoption of clinical PDT. In this paper, examples of essential dosimetry points and surrogate dosimetry tools that may be implemented in phase II/III trials are discussed. For example, the treatment efficacy as limited by light penetration in interstitial PDT may be predicted by the amount of contrast uptake in CT, and so this could be utilized as a surrogate dosimetry measurement to prescribe light doses based upon pre-treatment contrast. Success of clinical ALA-based skin lesion treatment is predicted almost uniquely by the explicit or implicit measurements of photosensitizer and photobleaching, yet the individualization of treatment

  16. SU-C-201-07: Towards Clinical Cherenkov Emission Dosimetry: Stopping Power-To-Cherenkov Power Ratios and Beam Quality Specification of Clinical Electron Beams

    International Nuclear Information System (INIS)

    Zlateva, Y; Seuntjens, J; El Naqa, I

    2016-01-01

    Purpose: We propose a Cherenkov emission (CE)-based reference dosimetry method, which in contrast to ionization chamber-based dosimetry, employs spectrum-averaged electron restricted mass collision stopping power-to-Cherenkov power ratios (SCRs), and we examine Monte Carlo-calculated SCRs and beam quality specification of clinical electron beams. Methods: The EGSnrc user code SPRRZnrc was modified to compute SCRs instead of stopping-power ratios (single medium: water; cut-off: CE threshold (observing Spencer-Attix conditions); CE power: Frank-Tamm). SCRs are calculated with BEAMnrc for realistic electron beams with nominal energies of 6–22 MeV from three Varian accelerators (TrueBeam Clinac 21EX, Clinac 2100C/D) and for mono-energetic beams of energies equal to the mean electron energy at the water surface. Sources of deviation between clinical and mono-energetic SCRs are analyzed quantitatively. A universal fit for the beam-quality index R_5_0 in terms of the depth of 50% CE C_5_0 is carried out. Results: SCRs at reference depth are overestimated by mono-energetic values by up to 0.2% for a 6-MeV beam and underestimated by up to 2.3% for a 22-MeV beam. The variation is mainly due to the clinical beam spectrum and photon contamination. Beam angular spread has a small effect across all depths and energies. The influence of the electron spectrum becomes increasingly significant at large depths, while at shallow depths and high beam energies photon contamination is predominant (up to 2.0%). The universal data fit reveals a strong linear correlation between R_5_0 and C_5_0 (ρ > 0.99999). Conclusion: CE is inherent to radiotherapy beams and can be detected outside the beam with available optical technologies, which makes it an ideal candidate for out-of-beam high-resolution 3D dosimetry. Successful clinical implementation of CE dosimetry hinges on the development of robust protocols for converting measured CE to radiation dose. Our findings constitute a key step

  17. Development of a graphite probe calorimeter for absolute clinical dosimetry

    International Nuclear Information System (INIS)

    Renaud, James; Seuntjens, Jan; Sarfehnia, Arman; Marchington, David

    2013-01-01

    The aim of this work is to present the numerical design optimization, construction, and experimental proof of concept of a graphite probe calorimeter (GPC) conceived for dose measurement in the clinical environment (U.S. provisional patent 61/652,540). A finite element method (FEM) based numerical heat transfer study was conducted using a commercial software package to explore the feasibility of the GPC and to optimize the shape, dimensions, and materials used in its design. A functioning prototype was constructed inhouse and used to perform dose to water measurements under a 6 MV photon beam at 400 and 1000 MU/min, in a thermally insulated water phantom. Heat loss correction factors were determined using FEM analysis while the radiation field perturbation and the graphite to water absorbed dose conversion factors were calculated using Monte Carlo simulations. The difference in the average measured dose to water for the 400 and 1000 MU/min runs using the TG-51 protocol and the GPC was 0.2% and 1.2%, respectively. Heat loss correction factors ranged from 1.001 to 1.002, while the product of the perturbation and dose conversion factors was calculated to be 1.130. The combined relative uncertainty was estimated to be 1.4%, with the largest contributors being the specific heat capacity of the graphite (type B, 0.8%) and the reproducibility, defined as the standard deviation of the mean measured dose (type A, 0.6%). By establishing the feasibility of using the GPC as a practical clinical absolute photon dosimeter, this work lays the foundation for further device enhancements, including the development of an isothermal mode of operation and an overall miniaturization, making it potentially suitable for use in small and composite radiation fields. It is anticipated that, through the incorporation of isothermal stabilization provided by temperature controllers, a subpercent overall uncertainty will be achieved.

  18. Semi- and virtual 3D dosimetry in clinical practice

    DEFF Research Database (Denmark)

    Korreman, S. S.

    2013-01-01

    In this review, 3D dosimetry is divided in three categories; "true" 3D, semi-3D and virtual 3D. Virtual 3D involves the use of measurement arrays either before or after beam entry in the patient/phantom, whereas semi-3D involves use of measurement arrays in phantoms mimicking the patient. True 3D...... involves the measurement of dose in a volume mimicking the patient.There are different advantages and limitations of all three categories and of systems within these categories. Choice of measurement method in a given case depends on the aim of the measurement, and examples are given of verification...... measurements with various aims....

  19. Dosimetry in clinical static magnetic fields using plastic scintillation detectors

    DEFF Research Database (Denmark)

    Stefanowicz, S.; Latzel, H.; Lindvold, Lars René

    2013-01-01

    . In conclusion, we found some deviations up to 7% of the supposed signal. Although the scintillators are of much denser material, we measured the same behavior in signal as in (Meijsing et al., 2009) for a Farmer ionization chamber or as in (Raaijmakers et al., 2007) for films described which indicates radiation......-vivo dosimetry in radiation treatments and diagnostics and could be, being all-optical, promising candidates for this application. To study the basic feasibility of using PSDs with organic scintillators in magnetic fields, we measured the response of these dosimeters in presence of magnetic fields up to 1 T...

  20. Influence of the curve density relative electron in dosimetry clinic in treatments stereo tactics

    International Nuclear Information System (INIS)

    Moreno Saiz, C.; Benitez Villegas, E. M.; Casado Villalon, F. J.; Parra Osorio, V.; Bodineau Gil, C.; Garcia Pareja, S.

    2013-01-01

    The objective of this study is to analyze the difference between clinical dosimetry in the treatments with radiosurgery and stereotactic radiotherapy fractional obtained from the relative Electron density curve (Schneider 1996) tabulated and provided with the scanner's radiation therapy. (Author)

  1. Biological and clinical dosimetry, July 1, 1964 to December 31, 1984. Final report

    International Nuclear Information System (INIS)

    Laughlin, J.S.; Zeitz, L.

    1986-01-01

    The goal was to develop systems for the determination of absorbed dose in biological research and clinical applications. The primary method under study is the local absorbed dose calorimeter. In addition, secondary dosimetric systems such as ionization chambers, chemical dosimeters and thermoluminescent dosimeters (TLD) are being developed and applied to provide an absolute basis for the evaluation and comparison of experiments, treatments and other procedures using radiation. In keeping with these objectives this project has accomplished significant advances in the following areas: (1) local absorbed dose calorimetry; (2) neutron dosimetry; (3) dosimetry of ultra-high intensity radiation sources; (4) solid state detector and germanium gamma camera program; (5) dosimetry for brachytherapy; and (6) ''non-isolated sensor'' calorimeters

  2. SPIRIT 2013 Statement: defining standard protocol items for clinical trials.

    Science.gov (United States)

    Chan, An-Wen; Tetzlaff, Jennifer M; Altman, Douglas G; Laupacis, Andreas; Gøtzsche, Peter C; Krle A-Jerić, Karmela; Hrobjartsson, Asbjørn; Mann, Howard; Dickersin, Kay; Berlin, Jesse A; Dore, Caroline J; Parulekar, Wendy R; Summerskill, William S M; Groves, Trish; Schulz, Kenneth F; Sox, Harold C; Rockhold, Frank W; Rennie, Drummond; Moher, David

    2015-12-01

    The protocol of a clinical trial serves as the foundation for study planning, conduct, reporting, and appraisal. However, trial protocols and existing protocol guidelines vary greatly in content and quality. This article describes the systematic development and scope of SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) 2013, a guideline for the minimum content of a clinical trial protocol. The 33-item SPIRIT checklist applies to protocols for all clinical trials and focuses on content rather than format. The checklist recommends a full description of what is planned; it does not prescribe how to design or conduct a trial. By providing guidance for key content, the SPIRIT recommendations aim to facilitate the drafting of high-quality protocols. Adherence to SPIRIT would also enhance the transparency and completeness of trial protocols for the benefit of investigators, trial participants, patients, sponsors, funders, research ethics committees or institutional review boards, peer reviewers, journals, trial registries, policymakers, regulators, and other key stakeholders.

  3. Correction factors for clinical dosemeters used in large field dosimetry

    International Nuclear Information System (INIS)

    Campos, L.L.; Caldas, L.

    1989-08-01

    The determination of the absorbed dose in high-energy photon and electron beams by the user is carried out as a two-step procedure. First the ionization chamber is calibrated at a reference quality by the user at a standard laboratory, and then the chamber is used to determine the absorbed dose with the user's beam. A number of conversion and correction factors have to be applied. Different sets of factors are needed depending on the physical quantity the calibration refers to, the calibration geometry and the chamber design. Another correction factor to be introduced for the absorbed dose determination in large fields refers to radiation effects on the stem, cable and sometimes connectors. A simple method was developed to be suggested to hospital physicists to be followed during large radiation field dosimetry, in order to evaluate the radiation effects of cables and connectors and to determine correction factors for each system or geometry. (author) [pt

  4. Intercomparison of absorbed dose to water and air-kerma based dosimetry protocols for photon and electron beams

    International Nuclear Information System (INIS)

    Huq, M.S.

    2002-01-01

    Full text: During the last three decades the International Atomic Energy Agency (IAEA), the American Association of Physicists in Medicine (AAPM) and organizations from various countries have published Codes of Practice (CoP) and dosimetry protocols for the calibration of high-energy photon and electron beams. They are based on the air-kerma or exposure calibration factor of an ionization chamber in a 60 Co gamma ray beam and formalism for the determination of absorbed dose to water in reference conditions. In recent years, the IAEA (IAEA TRS-398) and the AAPM (AAPM TG-51) have published new external beam dosimetry protocols that are based on the use of an ionization chamber calibrated in terms of absorbed dose to water in a standards laboratory's reference quality beam. These two new protocols follow those by the German Standard DIN, the British IPSM and the IAEA CoP for plane-parallel chambers, which have discussed and implemented the procedures for the determination of absorbed dose-to-water based on standards of absorbed dose-to-water. Since the publication of these protocols and CoPs, many comparisons, theoretical as well as experimental, between them have been published in the literature providing valuable information about the sources of similarities and discrepancies that exist among them. For example, the differences in the basic data for photon and electron beams included in the various IAEA CoPs are very small for the second edition of TRS-277 for photons, TRS-381 for electrons and TRS-398. In these cases the data changes posed by the adoption of TRS-398 are within about ±0.3% for the most commonly used energies. When implementing TRS-398 in these cases, the main difference will arise from the transition from K air to D w standards. For example, experimental comparison of absorbed doses between TRS-398 and TRS-277 for photons show an average difference of about 0.3% for most commonly used energies with a maximum difference of about 1% at a TPR 20

  5. Monte Carlo study of correction factors for the use of plastic phantoms in clinical electron dosimetry

    International Nuclear Information System (INIS)

    Araki, Fujio

    2007-01-01

    In some recent dosimetry protocols, plastic is allowed as a phantom material for the determination of an absorbed dose to water in electron beams, especially for low energy with beam qualities R 50 2 . In electron dosimetry with plastic, a depth-scaling factor, c pl , and a chamber-dependent fluence correction factor, h pl , are needed to convert the dose measured at a water-equivalent reference depth in plastic to a dose at a reference depth in water. The purpose of this study is to calculate correction factors for the use of plastic phantoms for clinical electron dosimetry using the EGSnrc Monte Carlo code system. RMI-457 and WE-211 were investigated as phantom materials. First the c pl values for plastic materials were calculated as a function of a half-value depth of maximum ionization, I 50 , in plastic. The c pl values for RMI-457 and WE-211 varied from 0.992 to 1.002 and from 0.971 to 0.979, respectively, in a range of nominal energies from 4 MeV to 18 MeV, and varied slightly as a function of I 50 in plastic. Since h pl values depend on the wall correction factor, P wall , of the chamber used, they are evaluated using a pure electron fluence correction factor, φ pl w , and P wall w and P wall pl for a combination of water or plastic phantoms and plane-parallel ionization chambers (NACP-02, Markus and Roos). The φ pl w and P wall (P wall w and P wall pl ) values were calculated as a function of the water-equivalent depth in plastic materials and at a reference depth as a function of R 50 in water, respectively. The φ pl w values varied from 1.024 at 4 MeV to 1.013 at 18 MeV for RMI-457, and from 1.025 to 1.016 for WE-211. P wall w values for plane-parallel chambers showed values in the order of 1.5% to 2% larger than unity at 4 MeV, consistent with earlier results. The P wall pl values of RMI-457 and WE-211 were close to unity for all the energy beams. Finally, calculated h pl values of RMI-457 ranged from 1.009 to 1.005, from 1.010 to 1.003 and from 1

  6. Clinical characterization of OSL dosimeters for use in dosimetry of teletherapy beams in conventional fractionation

    International Nuclear Information System (INIS)

    Lopez V, A.; Gutierrez M, J. G.; Rivera M, T.; Velazquez T, J. J.

    2015-10-01

    Optically stimulated materials are increasingly used for dosimetry in clinical settings; to be sure of the obtained reading their proper clinical characterization is necessary. Is important to know the homogeneity of a batch, reproducibility, be exposed to the same conditions of irradiation repeatedly and other dependences that could present such as energy, angular, the type of radiation which are exposed and the dose deposited in them. For characterization they were designed and implemented tests for each of the factors of interest, taking into account the need for them (calculations, manufacture of mannequins, conditions, practicality, etc.) It was shown that we can apply this dosimetry in clinical practice within a radiotherapy center, relying on the readings and practicality. (Author)

  7. Clinical proton dosimetry. Part 1: Beam production, beam delivery and measurement of absorbed dose

    International Nuclear Information System (INIS)

    1998-01-01

    The development of accurate and uniform standards for radiation treatment dosimetry has been a continuing effort since the earliest days of radiotherapy. This ICRU Report is intended to promote uniformity of standards that will provide a basis for world-wide comparison of clinical results and allow the development of meaningful clinical trials. This Report describes current practice in proton therapy and recommends standards for the dosimetry of proton treatments. Established proton treatment facilities might use this Report as a source of information for the maintenance of accurate standards. New facilities may build their procedures from recommendations found in this Report and planners of new facilities may examine alternatives within current practice for the production and monitoring of treatment beams. This Report includes a description of the interaction of protons with matter, various methods of beam production, the characteristics of proton beams in clinical use, current methods for beam monitoring and specific recommendations for dose calibration

  8. Leksell Gammaknife PerfexionTM and discussion on clinical dosimetry

    International Nuclear Information System (INIS)

    Eriksson, O.; Johansson, J.; Kjaell, P.; Lundin, A.; Nordstroem, H.

    2008-01-01

    Leksell GammaKnife has been a well established treatment modality for more than 20 years in the field of stereotactic radiosurgery. In 2006 a new model was presented that introduces a number of new features at the same time as it keeps all the beneficial features of the other models. This new model, Leksell GammaKnife Perfexion TM , has a significantly improved radiation shielding capacity towards patient and treatment room walls, all collimators are built into the unit and therefore no changes of collimator helmets between shots are needed, the sources are placed on eight individually controllable mechanical structures meaning that one shot may be composed of several different collimator sizes, the patient is moved into position by the entire couch therefore increasing patient comfort significantly. This presentation aims at describing the entire Leksell GammaKnife Perfexion TM system from a physicist's point of view: design of the collimator system, dosimetry, design of radiation shielding, leakage field in the treatment room, design of secondary barriers, applicable QA-procedures, calibration -dosimetric and mechanical

  9. Dosimetry of clinical neutron and proton beams: An overview of recommendations

    International Nuclear Information System (INIS)

    Vynckier, S.

    2004-01-01

    Neutron therapy beams are obtained by accelerating protons or deuterons on Beryllium. These neutron therapy beams present comparable dosimetric characteristics as those for photon beams obtained with linear accelerators; for instance, the penetration of a p(65) + Be neutron beam is comparable with the penetration of an 8 MV photon beam. In order to be competitive with conventional photon beam therapy, the dosimetric characteristics of the neutron beam should therefore not deviate too much from the photon beam characteristics. This paper presents a brief summary of the neutron beams used in radiotherapy. The dosimetry of the clinical neutron beams is described. Finally, recent and future developments in the field of physics for neutron therapy is mentioned. In the last two decades, a considerable number of centres have established radiotherapy treatment facilities using proton beams with energies between 50 and 250 MeV. Clinical applications require a relatively uniform dose to be delivered to the volume to be treated, and for this purpose the proton beam has to be spread out, both laterally and in depth. The technique is called 'beam modulation' and creates a region of high dose uniformity referred to as the 'spread-out Bragg peak'. Meanwhile, reference dosimetry in these beams had to catch up with photon and electron beams for which a much longer tradition of dosimetry exists. Proton beam dosimetry can be performed using different types of dosemeters, such as calorimeters, Faraday cups, track detectors and ionisation chambers. National standard dosimetry laboratories will, however, not provide a standard for the dosimetry of proton beams. To achieve uniformity on an international level, the use of an ionisation chamber should be considered. This paper reviews and summarises the basic principles and recommendations for the absorbed dose determination in a proton beam, utilising ionisation chambers calibrated in terms of absorbed dose to water. These recommendations

  10. The need for international standardization in clinical beta dosimetry for brachytherapy

    International Nuclear Information System (INIS)

    Quast, U.; Boehm, J.; Kaulich, T.W.

    2002-01-01

    Beta radiation has found increasing interest in radiotherapy. Besides the curative treatment of small and medium-sized intraocular tumors by means of ophthalmic beta radiation plaques, intravascular brachytherapy has proven to successfully overcome the severe problem of restenosis after interventional treatment of arterial stenosis in coronaries and peripheral vessels in many clinical trials with a large number of patients. Prior to initiating procedures applying beta radiation in radiotherapy, however, there is a common need to specify methods for the determination and specification of the absorbed dose to water or tissue and their spatial distributions. The IAEA-TECDOC-1274 Calibration of photon and beta ray sources used in brachytherapy (2002) is a help for photon brachytherapy calibration. But, for beta seed and line sources, IAEA recommends well type ionization chambers as working standards which are far from measuring absorbed dose to water of the radiation clinically used. Although the application of such working standards seems to be more precise, large errors can occur when the medical physicist has to convert the calibration data to absorbed dose to water of the beta radiation emitted. The user must believe that the source is equally activated and that the manufacturer did not change the design and construction of the source encapsulation. With the DGMP Report 16 (2001) Guidelines for medical physical aspects of intravascular brachytherapy a very detailed code of practice is given, especially for the calibration and clinical dosimetry of intravascular beta radiation sources. As there is a global need for standardization in clinical dosimetry for intravascular brachytherapy utilizing beta radiation, the DIN-NAR, the German committee on standardization in radiology, task group dosimetry, has initiated an international adhoc working group for a new ISO work item proposal on the standardization of procedures in clinical dosimetry to guarantee reliable

  11. Evaluation of thermoluminescent dosimeters using water equivalent phantoms for application in clinical electrons beams dosimetry

    International Nuclear Information System (INIS)

    Bravim, Amanda

    2010-01-01

    The dosimetry in Radiotherapy provides the calibration of the radiation beam as well as the quality control of the dose in the clinical routine. Its main objective is to determine with greater accuracy the dose absorbed by the tumor. This study aimed to evaluate the behavior of three thermoluminescent dosimeters for the clinical electron beam dosimetry. The performance of the calcium sulfate detector doped with dysprosium (CaSO 4 : Dy) produced by IPEN was compared with two dosimeters commercially available by Harshaw. Both are named TLD-100, however they differ in their dimensions. The dosimeters were evaluated using water, solid water (RMI-457) and PMMA phantoms in different exposure fields for 4, 6, 9, 12 and 16 MeV electron beam energies. It was also performed measurements in photon beams of 6 and 15 MV (2 and 5 MeV) only for comparison. The dose-response curves were obtained for the 60 Co gamma radiation in air and under conditions of electronic equilibrium, both for clinical beam of photons and electrons in maximum dose depths. The sensitivity, reproducibility, intrinsic efficiency and energy dependence response of dosimeters were studied. The CaSO 4 : Dy showed the same behavior of TLD-100, demonstrating only an advantage in the sensitivity to the beams and radiation doses studied. Thus, the dosimeter produced by IPEN can be considered a new alternative for dosimetry in Radiotherapy departments. (author)

  12. Postimplant Dosimetry Using a Monte Carlo Dose Calculation Engine: A New Clinical Standard

    International Nuclear Information System (INIS)

    Carrier, Jean-Francois; D'Amours, Michel; Verhaegen, Frank; Reniers, Brigitte; Martin, Andre-Guy; Vigneault, Eric; Beaulieu, Luc

    2007-01-01

    Purpose: To use the Monte Carlo (MC) method as a dose calculation engine for postimplant dosimetry. To compare the results with clinically approved data for a sample of 28 patients. Two effects not taken into account by the clinical calculation, interseed attenuation and tissue composition, are being specifically investigated. Methods and Materials: An automated MC program was developed. The dose distributions were calculated for the target volume and organs at risk (OAR) for 28 patients. Additional MC techniques were developed to focus specifically on the interseed attenuation and tissue effects. Results: For the clinical target volume (CTV) D 90 parameter, the mean difference between the clinical technique and the complete MC method is 10.7 Gy, with cases reaching up to 17 Gy. For all cases, the clinical technique overestimates the deposited dose in the CTV. This overestimation is mainly from a combination of two effects: the interseed attenuation (average, 6.8 Gy) and tissue composition (average, 4.1 Gy). The deposited dose in the OARs is also overestimated in the clinical calculation. Conclusions: The clinical technique systematically overestimates the deposited dose in the prostate and in the OARs. To reduce this systematic inaccuracy, the MC method should be considered in establishing a new standard for clinical postimplant dosimetry and dose-outcome studies in a near future

  13. Photon dosimetry intercomparisons at Tygerberg and Groote Schuur hospitals

    International Nuclear Information System (INIS)

    Jones, D.T.L.; Symons, J.E.; Schreuder, A.N.; Van der Merwe, E.J.; Rossouw, A.; Hough, J.K.; Lazarus, G.L.

    1994-08-01

    A national photon dosimetry intercomparison was undertaken at 8 hospitals at the beginning of 1989 prior to the commencement of randomised clinical trials involving neutron therapy at the National Accelerator Centre. The results obtained were in agreement at all but two hospitals. Following these studies it was agreed that a uniform photon dosimetry protocol, the AAPM TG2 protocol, be adopted countrywide. The clinical program at the National Accelerator Centre is now far advanced and it was deemed appropriate to undertake a new photon dosimetry intercomparison at two local hospitals, through which all patients are referred. The procedure involved was to compare the doses measured at each hospital under specified conditions by National Accelerator staff with the doses measured by the hospital physicists using their own equipment and protocols. The results obtained were in good agreement, confirming the validity of the dosimetry techniques used. 8 refs., 8 tabs

  14. SU-G-TeP2-03: Comparison of Standard Dosimetry Protocol in Japan and AAPM TG-51 Addendum in Order to Establish Optimal Dosimetry for FFF Beam

    Energy Technology Data Exchange (ETDEWEB)

    Matsunaga, T; Adachi, Y [Department of Radiology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka (Japan); Hayashi, N [Graduate School of Health Sciences, Fujita Health University, Tayoake, Aichi (Japan); Nozue, M [Department of Radiation Oncology, Seirei Hamamtsu General Hospital, Hamamatsu, Shizuoka (Japan)

    2016-06-15

    Purpose: Japan Standard Dosimetry of Absorbed dose to water in external beam radiotherapy (JSDP12) is widely used to measure radiation dose in radiotherapy. However, JSDP12 does not take flattening-filter-free (FFF) beam into consideration. In addition, JSDP12 applied TPR20,10 for dose quality index for photon beam. The purpose of this study is to compare JSDP12 with AAPM TG-51 addendum in order to establish optimal dosimetry procedure for FFF beam. Method: We evaluated the ion-recombination factor (ks) and the correction factor of radial beam profile (Prp) in FFF beam dosimetry. The ks was introduced by 2 voltages method and verified by Jaffe’s plot. The Prp was given by both film measurement and calculation of treatment planning system, and compared them. Next, we compared the dose quality indexes (kQ) between TPR20,10 method and PDD(10)x method. Finally we considered optimal dosimetry protocol for FFF photon beam using JSDP12 with referring TG-51 addendum protocols. The FFF photon beams of 6 MV (6X-FFF) and 10 MV (10X-FFF) from TrueBeam were investigated in this study. Results: The ks for 6X-FFF and 10X-FFF beams were 1.005 and 1.010, respectively. The Prp of 0.6 cc ionization chamber for 6X-FFF and 10X-FFF beams (Film, TPS) were (1.004, 1.008) and (1.005, 1.008), respectively. The kQ for 6X-FFF and 10X-FFF beams (JSDP12, TG-51 addendum) were (0.9950, 0.9947) and (0.9851, 0.9845), respectively. The most effective factor for uncertainty in FFF photon beam measurement was Prp for JSDP12 formalism. Total dosimetric differences between JSDP12 and TG-51 addendum for 6X-FFF and 10X-FFF were -0.47% and -0.73%, respectively. Conclusion: The total dosimetric difference between JSDP12 and TG-51 addendum was within 1%. The introduction of kQ given by JSDP is feasible for FFF photon beam dosimetry. However, we think Prp should be considered for optimal dosimetry procedure even if JSDP12 is used for FFF photon beam dosimetry.

  15. The evidence base for the use of internal dosimetry in the clinical practice of molecular radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Strigari, Lidia [Regina Elena National Cancer Institute, Laboratory of Medical Physics and Expert Systems, Rome (Italy); Konijnenberg, Mark [Erasmus MC, Department of Nuclear Medicine, Rotterdam (Netherlands); Chiesa, Carlo [Instituto Nazionale Tumori, Department of Nuclear Medicine, Milan (Italy); Bardies, Manuel [UMR 1037 INSERM / Universite Paul Sabatier, Centre de Recherche en Cancerologie de Toulouse, Toulouse (France); Du, Yong [Royal Marsden NHS Foundation Trust, Department of Nuclear Medicine and PET/CT, Sutton, London (United Kingdom); Gleisner, Katarina Sjoegreen [Medical Radiation Physics, Clinical Sciences, Lund (Sweden); Lassmann, Michael [University of Wuerzburg, Department of Nuclear Medicine, Wuerzburg (Germany); Flux, Glenn [Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Joint Department of Physics, Sutton (United Kingdom)

    2014-10-15

    Molecular radiotherapy (MRT) has demonstrated unique therapeutic advantages in the treatment of an increasing number of cancers. As with other treatment modalities, there is related toxicity to a number of organs at risk. Despite the large number of clinical trials over the past several decades, considerable uncertainties still remain regarding the optimization of this therapeutic approach and one of the vital issues to be answered is whether an absorbed radiation dose-response exists that could be used to guide personalized treatment. There are only limited and sporadic data investigating MRT dosimetry. The determination of dose-effect relationships for MRT has yet to be the explicit aim of a clinical trial. The aim of this article was to collate and discuss the available evidence for an absorbed radiation dose-effect relationships in MRT through a review of published data. Based on a PubMed search, 92 papers were found. Out of 79 studies investigating dosimetry, an absorbed dose-effect correlation was found in 48. The application of radiobiological modelling to clinical data is of increasing importance and the limited published data on absorbed dose-effect relationships based on these models are also reviewed. Based on National Cancer Institute guideline definition, the studies had a moderate or low rate of clinical relevance due to the limited number of studies investigating overall survival and absorbed dose. Nevertheless, the evidence strongly implies a correlation between the absorbed doses delivered and the response and toxicity, indicating that dosimetry-based personalized treatments would improve outcome and increase survival. (orig.)

  16. Patient-specific dosimetry in peptide receptor radionuclide therapy: a clinical review

    International Nuclear Information System (INIS)

    Chalkia, M.T.; Stefanoyiannis, A.P.; Chatziioannou, S.N.; Efstathopoulos, E.P.; Round, W.H.; Nikiforidis, G.C.

    2015-01-01

    Neuroendocrine tumours (NETs) belong to a relatively rare class of neoplasms. Nonetheless, their prevalence has increased significantly during the last decades. Peptide receptor radionuclide therapy (PRRT) is a relatively new treatment approach for inoperable or metastasised NETs. The therapeutic effect is based on the binding of radiolabelled somatostatin analogue peptides with NETs’ somatostatin receptors, resulting in internal irradiation of tumours. Pre-therapeutic patient-specific dosimetry is essential to ensure that a treatment course has high levels of safety and efficacy. This paper reviews the methods applied for PRRT dosimetry, as well as the dosimetric results presented in the literature. Focus is given on data concerning the therapeutic somatostatin analogue radiopeptides 111 In-[DTPA o , D -Phe 1 ]-octreotide ( 111 In-DTPA-octreotide), 90 Y-[DOTA o ,Tyr 3 ]-octreotide ( 90 Y-DOTATOC) and 177 Lu-[DOTA o ,Tyr 3 ,Thr 8 ]-octreotide ( 177 Lu-DOTATATE). Following the Medical Internal Radiation Dose (MIRD) Committee formalism, dosimetric analysis demonstrates large interpatient variability in tumour and organ uptake, with kidneys and bone marrow being the critical organs. The results are dependent on the image acquisition and processing protocol, as well as the dosimetric imaging radiopharmaceutical.

  17. Recent developments of optically stimulated luminescence materials and techniques for radiation dosimetry and clinical applications

    Directory of Open Access Journals (Sweden)

    Pradhan A

    2008-01-01

    Full Text Available During the last 10 years, optically stimulated luminescence (OSL has emerged as a formidable competitor not only to thermoluminescence dosimetry (TLD but also to several other dosimetry systems. Though a large number of materials have been synthesized and studied for OSL, Al 2 O 3 :C continues to dominate the dosimetric applications. Re-investigations of OSL in BeOindicate that this material might provide an alternative to Al 2 O 3 :C. Study of OSL of electronic components of mobile phones and ID cards appears to have opened up a feasibility of dosimetry and dose reconstruction using the electronic components of gadgets of everyday use in the events of unforeseen situations of radiological accidents, including the event of a dirty bomb by terrorist groups. Among the newly reported materials, a very recent development of NaMgF 3 :Eu 2+ appears fascinating because of its high OSL sensitivity and tolerable tissue equivalence. In clinical dosimetry, an OSL as a passive dosimeter could do all that TLD can do, much faster with a better or at least the same efficiency; and in addition, it provides a possibility of repeated readout unlike TLD, in which all the dose information is lost in a single readout. Of late, OSL has also emerged as a practical real-time dosimeter for in vivo measurements in radiation therapy (for both external beams and brachytherapy and in various diagnostic radiological examinations including mammography and CT dosimetry. For in vivo measurements, a probe of Al 2 O 3 :C of size of a fraction of a millimeter provides the information on both the dose rate and the total dose from the readout of radioluminescence and OSL signals respectively, from the same probe. The availability of OSL dosimeters in various sizes and shapes and their performance characteristics as compared to established dosimeters such as plastic scintillation dosimeters, diode detectors, MOSFET detectors, radiochromic films, etc., shows that OSL may soon become

  18. Applications of gel dosimetry

    International Nuclear Information System (INIS)

    Ibbott, Geoffrey S

    2004-01-01

    Gel dosimetry has been examined as a clinical dosimeter since the 1950s. During the last two decades, however, a rapid increase in the number of investigators has been seen, and the body of knowledge regarding gel dosimetry has expanded considerably. Gel dosimetry is still considered a research project, and the introduction of this tool into clinical use is proceeding slowly. This paper will review the characteristics of gel dosimetry that make it desirable for clinical use, the postulated and demonstrated applications of gel dosimetry, and some complications, set-backs, and failures that have contributed to the slow introduction into routine clinical use

  19. A Quality Assurance Method that Utilizes 3D Dosimetry and Facilitates Clinical Interpretation

    Energy Technology Data Exchange (ETDEWEB)

    Oldham, Mark, E-mail: mark.oldham@duke.edu [Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Thomas, Andrew; O' Daniel, Jennifer; Juang, Titania [Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Ibbott, Geoffrey [University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Adamovics, John [Rider University, Lawrenceville, New Jersey (United States); Kirkpatrick, John P. [Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States)

    2012-10-01

    Purpose: To demonstrate a new three-dimensional (3D) quality assurance (QA) method that provides comprehensive dosimetry verification and facilitates evaluation of the clinical significance of QA data acquired in a phantom. Also to apply the method to investigate the dosimetric efficacy of base-of-skull (BOS) intensity-modulated radiotherapy (IMRT) treatment. Methods and Materials: Two types of IMRT QA verification plans were created for 6 patients who received BOS IMRT. The first plan enabled conventional 2D planar IMRT QA using the Varian portal dosimetry system. The second plan enabled 3D verification using an anthropomorphic head phantom. In the latter, the 3D dose distribution was measured using the DLOS/Presage dosimetry system (DLOS = Duke Large-field-of-view Optical-CT System, Presage Heuris Pharma, Skillman, NJ), which yielded isotropic 2-mm data throughout the treated volume. In a novel step, measured 3D dose distributions were transformed back to the patient's CT to enable calculation of dose-volume histograms (DVH) and dose overlays. Measured and planned patient DVHs were compared to investigate clinical significance. Results: Close agreement between measured and calculated dose distributions was observed for all 6 cases. For gamma criteria of 3%, 2 mm, the mean passing rate for portal dosimetry was 96.8% (range, 92.0%-98.9%), compared to 94.9% (range, 90.1%-98.9%) for 3D. There was no clear correlation between 2D and 3D passing rates. Planned and measured dose distributions were evaluated on the patient's anatomy, using DVH and dose overlays. Minor deviations were detected, and the clinical significance of these are presented and discussed. Conclusions: Two advantages accrue to the methods presented here. First, treatment accuracy is evaluated throughout the whole treated volume, yielding comprehensive verification. Second, the clinical significance of any deviations can be assessed through the generation of DVH curves and dose overlays on

  20. Colon cleansing protocol in children: research conditions vs. clinical practice.

    Science.gov (United States)

    Elitsur, Yoram; Balfaqih, Yaslam; Preston, Deborah

    2018-04-01

     Colon preparation rates are the limiting factor for a successful diagnostic colonoscopy in children. Different colon cleansing protocols have been published for use in children. Unfortunately, the applicability of those published research protocols has not been formally evaluated in routine clinical practice. We investigated the success rate of our previously published colon cleansing protocol as utilized in our clinical practice.  This was a retrospective study. In the clinical practice, the colon cleansing protocol included PEG-3350 at a dose of 2 g/kg/day plus Dulcolax (Bisacodyl, Boehringer Ingelheim, TX USA) 5 mg/day for 2 days. Adequate colon preparation was graded between 1 - 5, as previously described, and grade ≥ 4.0 was considered an adequate preparation. Patients were instructed to complete a questionnaire that included PEG-3350 dose, number of stools per day, consistency of each stool, and side effects (vomiting, abdominal pain). Clinical and endoscopic results were compared between the protocol under research conditions and routine practice.  The success rate of the colon preparation in our clinical practice was similar to the results observed under our research protocol (75 % vs. 73.6 %). Moreover, the total number of stools, stool consistency, and the intubation rate of the terminal ileum were also similar. We concluded, that in our experience, the colon cleansing protocol used under research conditions was effective and appropriate for use in routine clinical practice.  We recommend testing each new protocol under the routine conditions of clinical practice to confirm its applicability for general practitioners.

  1. The international dosimetry exchange for BNCT. A basis for pooling and collectively analyzing clinical results

    International Nuclear Information System (INIS)

    Riley, K.J.; Binns, P.J.; Harling, O.K.; Kiger, W.S. III; Seppaelae, T.; Savolainen, S.; Moss, R.; Marek, M.; Rezaei, A.

    2006-01-01

    An international collaboration was organized by the Massachusetts Institute of Technology (MIT) to undertake a dosimetry exchange for the eventual purpose of combining results from various clinical centers that employ different methods for measuring and prescribing absorbed dose in the mixed radiation fields used for neutron capture therapy. Treatment plans calculated at NCT centers in the Czech Republic, Finland, The Netherlands and Sweden were normalized to corresponding measurements performed by the MIT dosimetry group in each beam. More than half of the normalizations for individual absorbed dose components (photon, fast neutron, thermal neutron and boron) determined by comparing MIT measurements to the dose specified in treatment plans from the different centers were statistically significant and ranged from 8 to 400%. Each facility had at least one dose component that would require normalization for the specified doses to be accurately compared. These normalizations establish a technical basis to begin collectively analyzing treatment plans between the European and US centers. Simple but pertinent treatment parameters such as the maximum dose to brain can now be properly compared, once the clinical data is available. This could held to more precisely and quickly determine various dose-response relationships as for example those related to adverse events. Future efforts to determine dose normalization at other centers performing human studies as well as more sophisticated analyses using combined data from several centers should be guided by clearly defined clinical objectives with active participation from clinical BNCT experts. (author)

  2. MO-B-BRB-04: 3D Dosimetry in End-To-End Dosimetry QA

    Energy Technology Data Exchange (ETDEWEB)

    Ibbott, G. [UT MD Anderson Cancer Center (United States)

    2016-06-15

    Full three-dimensional (3D) dosimetry using volumetric chemical dosimeters probed by 3D imaging systems has long been a promising technique for the radiation therapy clinic, since it provides a unique methodology for dose measurements in the volume irradiated using complex conformal delivery techniques such as IMRT and VMAT. To date true 3D dosimetry is still not widely practiced in the community; it has been confined to centres of specialized expertise especially for quality assurance or commissioning roles where other dosimetry techniques are difficult to implement. The potential for improved clinical applicability has been advanced considerably in the last decade by the development of improved 3D dosimeters (e.g., radiochromic plastics, radiochromic gel dosimeters and normoxic polymer gel systems) and by improved readout protocols using optical computed tomography or magnetic resonance imaging. In this session, established users of some current 3D chemical dosimeters will briefly review the current status of 3D dosimetry, describe several dosimeters and their appropriate imaging for dose readout, present workflow procedures required for good dosimetry, and analyze some limitations for applications in select settings. We will review the application of 3D dosimetry to various clinical situations describing how 3D approaches can complement other dose delivery validation approaches already available in the clinic. The applications presented will be selected to inform attendees of the unique features provided by full 3D techniques. Learning Objectives: L. John Schreiner: Background and Motivation Understand recent developments enabling clinically practical 3D dosimetry, Appreciate 3D dosimetry workflow and dosimetry procedures, and Observe select examples from the clinic. Sofie Ceberg: Application to dynamic radiotherapy Observe full dosimetry under dynamic radiotherapy during respiratory motion, and Understand how the measurement of high resolution dose data in an

  3. A New Dual-purpose Quality Control Dosimetry Protocol for Diagnostic Reference-level Determination in Computed Tomography.

    Science.gov (United States)

    Sohrabi, Mehdi; Parsi, Masoumeh; Sina, Sedigheh

    2018-05-17

    A diagnostic reference level is an advisory dose level set by a regulatory authority in a country as an efficient criterion for protection of patients from unwanted medical exposure. In computed tomography, the direct dose measurement and data collection methods are commonly applied for determination of diagnostic reference levels. Recently, a new quality-control-based dose survey method was proposed by the authors to simplify the diagnostic reference-level determination using a retrospective quality control database usually available at a regulatory authority in a country. In line with such a development, a prospective dual-purpose quality control dosimetry protocol is proposed for determination of diagnostic reference levels in a country, which can be simply applied by quality control service providers. This new proposed method was applied to five computed tomography scanners in Shiraz, Iran, and diagnostic reference levels for head, abdomen/pelvis, sinus, chest, and lumbar spine examinations were determined. The results were compared to those obtained by the data collection and quality-control-based dose survey methods, carried out in parallel in this study, and were found to agree well within approximately 6%. This is highly acceptable for quality-control-based methods according to International Atomic Energy Agency tolerance levels (±20%).

  4. Clinical implementation of a quality assurance program in HDR brachytherapy by in vivo dosimetry with diodes

    International Nuclear Information System (INIS)

    Alecu, R.; Feldmeier, J.J.; Court, W.S.; Alecu, M.; Orton, C.G.

    1996-01-01

    Despite the possibilities of in vivo dosimetry with diodes (e.g. control of dose to organs at risk, recorded confirmational measurements of the dose actually delivered, check of the whole treatment chain, avoidance of misadministrations, etc.) and the fact that it has proven to be very useful as part of a departmental QA program in external beam therapy, few attempts to implement it for HDR brachytherapy procedures have been reported. The reason for this is probably that there are significant technical challenges that must be met prior to its clinical use. The purpose of this study is to investigate the practicability and usefulness of dose measurements for brachytherapy patients in daily clinical practice. In our clinic a high precision patient dosimetry method has been developed, based on the use of silicon diodes. First, calibration factors have been determined under 'reference' irradiation conditions. Secondly, correction factors have been evaluated for situations deviating from the reference conditions, i.e. for different distances from the implanted sources, tissue heterogeneities, presence of different type of applicators, etc. For certain intracavitary, interstitial and surface mold applications this procedure has proven to be sufficiently accurate to allow dose determinations with diodes to be in good agreement with the expected values, i.e. calculated by the treatment planning system (VariSource unit) and checked by ion chamber measurements. The results of in vivo measurements are discussed along with the possibilities and limitations of the employed techniques

  5. TH-CD-BRA-11: Implementation and Evaluation of a New 3D Dosimetry Protocol for Validating MRI Guided Radiation Therapy Treatments

    International Nuclear Information System (INIS)

    Mein, S; Rankine, L; Adamovics, J; Li, H; Oldham, M

    2016-01-01

    Purpose: To develop, evaluate and apply a novel high-resolution 3D remote dosimetry protocol for validation of MRI guided radiation therapy treatments (MRIdian by ViewRay™). We demonstrate the first application of the protocol (including two small but required new correction terms) utilizing radiochromic 3D plastic PRESAGE™ with optical-CT readout. Methods: A detailed study of PRESAGE™ dosimeters (2kg) was conducted to investigate the temporal and spatial stability of radiation induced optical density change (ΔOD) over 8 days. Temporal stability was investigated on 3 dosimeters irradiated with four equally-spaced square 6MV fields delivering doses between 10cGy and 300cGy. Doses were imaged (read-out) by optical-CT at multiple intervals. Spatial stability of ΔOD response was investigated on 3 other dosimeters irradiated uniformly with 15MV extended-SSD fields with doses of 15cGy, 30cGy and 60cGy. Temporal and spatial (radial) changes were investigated using CERR and MATLAB’s Curve Fitting Tool-box. A protocol was developed to extrapolate measured ΔOD readings at t=48hr (the typical shipment time in remote dosimetry) to time t=1hr. Results: All dosimeters were observed to gradually darken with time (<5% per day). Consistent intra-batch sensitivity (0.0930±0.002 ΔOD/cm/Gy) and linearity (R2=0.9996) was observed at t=1hr. A small radial effect (<3%) was observed, attributed to curing thermodynamics during manufacture. The refined remote dosimetry protocol (including polynomial correction terms for temporal and spatial effects, CT and CR) was then applied to independent dosimeters irradiated with MR-IGRT treatments. Excellent line profile agreement and 3D-gamma results for 3%/3mm, 10% threshold were observed, with an average passing rate 96.5%± 3.43%. Conclusion: A novel 3D remote dosimetry protocol is presented capable of validation of advanced radiation treatments (including MR-IGRT). The protocol uses 2kg radiochromic plastic dosimeters read-out by

  6. TH-CD-BRA-11: Implementation and Evaluation of a New 3D Dosimetry Protocol for Validating MRI Guided Radiation Therapy Treatments

    Energy Technology Data Exchange (ETDEWEB)

    Mein, S [Duke University Medical Physics Graduate Program (United States); Rankine, L [Department of Radiation Oncology, University of North Carolina in Chapel Hill (United States); Department of Radiation Oncology, Washington University School of Medicine (United States); Adamovics, J [Department of Chemistry and Biology, Rider University, Lawrenceville, NJ (United States); Li, H [Department of Radiation Oncology, Washington University School of Medicine (United States); Oldham, M [Department of Radiation Oncology, Duke University Medical Center (United States)

    2016-06-15

    Purpose: To develop, evaluate and apply a novel high-resolution 3D remote dosimetry protocol for validation of MRI guided radiation therapy treatments (MRIdian by ViewRay™). We demonstrate the first application of the protocol (including two small but required new correction terms) utilizing radiochromic 3D plastic PRESAGE™ with optical-CT readout. Methods: A detailed study of PRESAGE™ dosimeters (2kg) was conducted to investigate the temporal and spatial stability of radiation induced optical density change (ΔOD) over 8 days. Temporal stability was investigated on 3 dosimeters irradiated with four equally-spaced square 6MV fields delivering doses between 10cGy and 300cGy. Doses were imaged (read-out) by optical-CT at multiple intervals. Spatial stability of ΔOD response was investigated on 3 other dosimeters irradiated uniformly with 15MV extended-SSD fields with doses of 15cGy, 30cGy and 60cGy. Temporal and spatial (radial) changes were investigated using CERR and MATLAB’s Curve Fitting Tool-box. A protocol was developed to extrapolate measured ΔOD readings at t=48hr (the typical shipment time in remote dosimetry) to time t=1hr. Results: All dosimeters were observed to gradually darken with time (<5% per day). Consistent intra-batch sensitivity (0.0930±0.002 ΔOD/cm/Gy) and linearity (R2=0.9996) was observed at t=1hr. A small radial effect (<3%) was observed, attributed to curing thermodynamics during manufacture. The refined remote dosimetry protocol (including polynomial correction terms for temporal and spatial effects, CT and CR) was then applied to independent dosimeters irradiated with MR-IGRT treatments. Excellent line profile agreement and 3D-gamma results for 3%/3mm, 10% threshold were observed, with an average passing rate 96.5%± 3.43%. Conclusion: A novel 3D remote dosimetry protocol is presented capable of validation of advanced radiation treatments (including MR-IGRT). The protocol uses 2kg radiochromic plastic dosimeters read-out by

  7. The role of dosimetry audit in lung SBRT multi-centre clinical trials.

    Science.gov (United States)

    Clark, Catharine H; Hurkmans, Coen W; Kry, Stephen F

    2017-12-01

    Stereotactic Body Radiotherapy (SBRT) in the lung is a challenging technique which requires high quality clinical trials to answer the un-resolved clinical questions. Quality assurance of these clinical trials not only ensures the safety of the treatment of the participating patients but also minimises the variation in treatment, thus allowing the lowest number of patient treatments to answer the trial question. This review addresses the role of dosimetry audits in the quality assurance process and considers what can be done to ensure the highest accuracy of dose calculation and delivery and it's assessment in multi-centre trials. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  8. Using generalizability theory to develop clinical assessment protocols.

    Science.gov (United States)

    Preuss, Richard A

    2013-04-01

    Clinical assessment protocols must produce data that are reliable, with a clinically attainable minimal detectable change (MDC). In a reliability study, generalizability theory has 2 advantages over classical test theory. These advantages provide information that allows assessment protocols to be adjusted to match individual patient profiles. First, generalizability theory allows the user to simultaneously consider multiple sources of measurement error variance (facets). Second, it allows the user to generalize the findings of the main study across the different study facets and to recalculate the reliability and MDC based on different combinations of facet conditions. In doing so, clinical assessment protocols can be chosen based on minimizing the number of measures that must be taken to achieve a realistic MDC, using repeated measures to minimize the MDC, or simply based on the combination that best allows the clinician to monitor an individual patient's progress over a specified period of time.

  9. Effects of different photobiomodulation dosimetries on temporomandibular dysfunction: a randomized, double-blind, placebo-controlled clinical trial.

    Science.gov (United States)

    Borges, Rosana Mengue Maggi; Cardoso, Daniela Steffen; Flores, Bianca Chuaste; da Luz, Raquel Dimer; Machado, Catiuci Roberta; Cerveira, Guilherme Pessoa; Daitx, Rodrigo Boff; Dohnert, Marcelo Baptista

    2018-05-30

    Changes involving temporomandibular joint, masticatory musculature, and associated structures characterize temporomandibular dysfunction (TMD). The analgesic and anti-inflammatory effect produced by photobiomodulation has contributed to pain relief and functional improvement. However, the parameters to be used have not yet been well established. The aim of this study is to compare the efficacy of three different photobiomodulation dosimetries in the treatment of patients with TMD. A randomized, double-blind, placebo-controlled clinical trial with 44 subjects divided into the groups 8 J/cm 2 (n = 11), 60 J/cm 2 (n = 11), 105 J/cm 2 (n = 11), and control (n = 11). Pain, symptom severity, and joint mobility were evaluated before and after a ten-session protocol of photobiomodulation with AlGaAs laser (830 nm), at a power density of 30 mW/cm 2 . The mouth opening increased in the 8-J/cm 2 group from 10.49 ± 4.68 to 15.40 ± 6.43 degrees, and in the right protrusion from 9.80 ± 4.2 to 12.56 ± 5.40 degrees after the intervention protocol (p < 0.05). All groups significantly decreased pain (p < 0.05). 830-nm laser photobiomodulation was effective in reducing TMD pain and symptoms at all doses tested. Only the doses of 8 J/cm 2 were effective regarding maximal opening and protrusion of the mandible.

  10. Incorporating ethical principles into clinical research protocols: a tool for protocol writers and ethics committees.

    Science.gov (United States)

    Li, Rebecca H; Wacholtz, Mary C; Barnes, Mark; Boggs, Liam; Callery-D'Amico, Susan; Davis, Amy; Digilova, Alla; Forster, David; Heffernan, Kate; Luthin, Maeve; Lynch, Holly Fernandez; McNair, Lindsay; Miller, Jennifer E; Murphy, Jacquelyn; Van Campen, Luann; Wilenzick, Mark; Wolf, Delia; Woolston, Cris; Aldinger, Carmen; Bierer, Barbara E

    2016-04-01

    A novel Protocol Ethics Tool Kit ('Ethics Tool Kit') has been developed by a multi-stakeholder group of the Multi-Regional Clinical Trials Center of Brigham and Women's Hospital and Harvard. The purpose of the Ethics Tool Kit is to facilitate effective recognition, consideration and deliberation of critical ethical issues in clinical trial protocols. The Ethics Tool Kit may be used by investigators and sponsors to develop a dedicated Ethics Section within a protocol to improve the consistency and transparency between clinical trial protocols and research ethics committee reviews. It may also streamline ethics review and may facilitate and expedite the review process by anticipating the concerns of ethics committee reviewers. Specific attention was given to issues arising in multinational settings. With the use of this Tool Kit, researchers have the opportunity to address critical research ethics issues proactively, potentially speeding the time and easing the process to final protocol approval. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  11. Feasibility studies of using thin entrance window photodiodes for clinical electron beam dosimetry

    International Nuclear Information System (INIS)

    Nascimento, Cristina R.; Asfora, Viviane K.; Barros, Vinicius S.M.; Gonçalves, Josemary A.C.; Andrade, Lucas F.R.; Khoury, Helen J.; Bueno, Carmen C.

    2017-01-01

    The response of the commercial XRA-24 PIN photodiode (5.76 mm 2 active area) for clinical electron beam dosimetry covering the range of 8-12 MeV was investigated. Within this energy range, the charge generated in the diode's sensitive volume is linearly dependent on the absorbed dose up to 320 cGy. However, charge sensitivity coefficients evidenced that the dose response of the diode is slightly dependent on the electron beam energy. Indeed, the diode's energy dependence was within 8.5% for 8-12MeV electron beams. On the other hand, it was also observed an excellent repeatability of these results with a variation coefficient (VC) lower than 0.4%, which is within the 1% tolerance limit recommended by the AAPM TG-62. Furthermore, the agreement between the percentage depth dose profiles (PDD) gathered with the diode and the ionization chamber allowed achieving the electron beam quality within 1% of that obtained with the ionization chamber. Based on these results, the photodiode XRA-24 can be a reliable and inexpensive alternative for electron beams dosimetry. (author)

  12. Feasibility studies of using thin entrance window photodiodes for clinical electron beam dosimetry

    Energy Technology Data Exchange (ETDEWEB)

    Nascimento, Cristina R.; Asfora, Viviane K.; Barros, Vinicius S.M.; Gonçalves, Josemary A.C.; Andrade, Lucas F.R.; Khoury, Helen J.; Bueno, Carmen C., E-mail: vsmdbarros@gmail.com, E-mail: vikhoury@gmail.com, E-mail: hjkhoury@gmail.com, E-mail: cristinaramos@smartsat.com.br, E-mail: josemary@ipen.br, E-mail: ccbueno@ipen.br [Universidade Federal de Pernambuco (UFPE), Recife, PE (Brazil); Instituto Federal de Educação, Ciência e Tecnologia de Pernambuco (IFPE), Recife-PE (Brazil). Departamento de Energia Nuclear; Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil); Santa Casa de Misericórdia de Itabuna, BA (Brazil)

    2017-11-01

    The response of the commercial XRA-24 PIN photodiode (5.76 mm{sup 2} active area) for clinical electron beam dosimetry covering the range of 8-12 MeV was investigated. Within this energy range, the charge generated in the diode's sensitive volume is linearly dependent on the absorbed dose up to 320 cGy. However, charge sensitivity coefficients evidenced that the dose response of the diode is slightly dependent on the electron beam energy. Indeed, the diode's energy dependence was within 8.5% for 8-12MeV electron beams. On the other hand, it was also observed an excellent repeatability of these results with a variation coefficient (VC) lower than 0.4%, which is within the 1% tolerance limit recommended by the AAPM TG-62. Furthermore, the agreement between the percentage depth dose profiles (PDD) gathered with the diode and the ionization chamber allowed achieving the electron beam quality within 1% of that obtained with the ionization chamber. Based on these results, the photodiode XRA-24 can be a reliable and inexpensive alternative for electron beams dosimetry. (author)

  13. Water equivalence of various materials for clinical proton dosimetry by experiment and Monte Carlo simulation

    International Nuclear Information System (INIS)

    Al-Sulaiti, Leena; Shipley, David; Thomas, Russell; Kacperek, Andrzej; Regan, Patrick; Palmans, Hugo

    2010-01-01

    The accurate conversion of dose to various materials used in clinical proton dosimetry to dose-to-water is based on fluence correction factors, accounting for attenuation of primary protons and production of secondary particles due to non-elastic nuclear interactions. This work aims to investigate the depth dose distribution and the fluence correction with respect to water or graphite at water equivalent depths (WED) in different target materials relevant for dosimetry such as polymethyl methacrylate (PMMA), graphite, A-150, aluminium and copper at 60 and 200 MeV. This was done through a comparison between Monte Carlo simulation using MCNPX 2.5.0, analytical model calculations and experimental measurements at Clatterbridge Centre of Oncology (CCO) in a 60 MeV modulated and un-modulated proton beam. MCNPX simulations indicated small fluence corrections for all materials with respect to graphite and water in 60 and 200 MeV except for aluminium. The analytical calculations showed an increase in the fluence correction factor to a few percent for all materials with respect to water at 200 MeV. The experimental measurements for 60 MeV un-modulated beam indicated a good agreement with MCNPX. For the modulated beam the fluence correction factor was found to be decreasing below unity by up to few percent with depth for aluminium and copper but almost constant and unity for A-150.

  14. Conducting Clinically Based Intimate Partner Violence Research: Safety Protocol Recommendations.

    Science.gov (United States)

    Anderson, Jocelyn C; Glass, Nancy E; Campbell, Jacquelyn C

    Maintaining safety is of utmost importance during research involving participants who have experienced intimate partner violence (IPV). Limited guidance on safety protocols to protect participants is available, particularly information related to technology-based approaches to informed consent, data collection, and contacting participants during the course of a study. The purpose of the article is to provide details on the safety protocol developed and utilized with women receiving care at an urban HIV clinic and who were taking part in an observational study of IPV, mental health symptoms, and substance abuse and their relationship to HIV treatment adherence. The protocol presents the technological strategies to promote safety and allow autonomy in participant decision-making throughout the research process, including Voice over Internet Protocol telephone numbers, and tablet-based eligibility screening and data collection. Protocols for management of participants at risk for suicide and/or intimate partner homicide that included automated high-risk messaging to participants and research staff and facilitated disclosure of risk to clinical staff based on participant preferences are discussed. Use of technology and partnership with clinic staff helped to provide an environment where research regarding IPV could be conducted without undue burden or risk to participants. Utilizing tablet-based survey administration provided multiple practical and safety benefits for participants. Most women who screened into high-risk categories for suicide or intimate partner homicide did not choose to have their results shared with their healthcare providers, indicating the importance of allowing participants control over information sharing whenever possible.

  15. Comparison between IAEA/TRS-277 and IAEA/TRS-398 protocols for electron beam dosimetry with cylindrical ionization chambers; Comparacao entre os protocolos IAEA/TRS-277 e IAEA/TRS-398 para dosimetria em feixes de eletrons com camaras de ionizacao cilindricas

    Energy Technology Data Exchange (ETDEWEB)

    Souza, Roberto Salomon de

    2004-07-01

    With the purpose to guarantee an uncertainty in the dosimetry in radiation therapy, the International Atomic Energy Agency (IAEA) published in 1987 the Technical Reports Series (TRS) number 277 - Absorbed Dose Determination in Photon and Electron Beams - An International Code of Practice -, updated in 1997, when was published its second edition. In 2000 was published the TRS number 398 - Absorbed Dose Determination in External Beam Radiotherapy - An International Code of Practice for Dosimetry Based on Standards of Absorbed Dose to Water. The TRS number 398 brings a great conceptual change in relation to the basis of the formalism, before based on calibration factor in terms of air kerma, and now based on calibration factor in terms of absorbed dose in water. Since the TRS number 398 was published, the Secondary Standard Dosimetry Laboratories are calibrating the user's ionization chambers in terms of absorbed dose to water. However, nor all the clinics in Rio de Janeiro and Brazil have its ionization chambers calibrated in terms of absorbed dose to water. The National Cancer Institute, where the measurements were taken, was the first institution in the Rio de Janeiro to have its ionization chambers calibrated in terms of a new formalism. This work describes a comparison between dosimetry done with a cylindrical ionization chamber under electron beams utilizing the TRS number 277 formalism, based on air kerma, and the TRS number 398 formalism, based on absorbed dose to water, reporting the uncertainties variation of the dosimetry associated to each protocol. (author)

  16. Dosimetry; La dosimetrie

    Energy Technology Data Exchange (ETDEWEB)

    Le Couteulx, I.; Apretna, D.; Beaugerie, M.F. [Electricite de France (EDF), 75 - Paris (France)] [and others

    2003-07-01

    Eight articles treat the dosimetry. Two articles evaluate the radiation doses in specific cases, dosimetry of patients in radiodiagnosis, three articles are devoted to detectors (neutrons and x and gamma radiations) and a computer code to build up the dosimetry of an accident due to an external exposure. (N.C.)

  17. SU-E-P-03: The Australian Clinical Dosimetry Service, a Bespoke National Solution

    International Nuclear Information System (INIS)

    Williams, I; Lye, J; Alves, A; Lehmann, J; Kenny, J; Dunn, L; Kron, T

    2015-01-01

    Purpose: The Australian Clinical Dosimetry Service, (ACDS) was a pilot program to enable the Australian Government to determine whether a locally designed audit program was suitable for mitigating dosimetric error risk to radiotherapy patients within Australia. The outcomes from four years of operations will be presented and discussed with a focus why and how the pilot requirements were met. The consequnces of success will be considered, the lessons learnt from the pilot program and how they are impacting the future ACDS design, operation and engagement with stakeholders. Methods: The ACDS was designed over 2010/11 by experts drawn from the three professions in consultation with the national Department of Health. The list of outcomes required over a three year pilot was expressed in a Memorandum of Understanding, (MoU) between Health and the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) which hosted the ACDS. Results: The ACDS has achieved all the MoU requirements. This paper describes how the staff within the ACDS engaged with the professional clinical workforce and provided a successful and functioning audit service. It identifies the strengths and weaknesses within the MoU and the ACDS structure and how the ACDS resolved a number of conflicting issues. It identifies the successes within the ACDS and how these were achieved. It provides details to assist and advise those seeking to design or modify national or regional auditing programs. Finally the paper reviews potential futures for the ACDS. Conclusion: The raw number of audits and outcomes indicate that the ACDS has met the MoU auditing requirements. The reasons for the ACDS’ success are highly dependent on: attracting quality staff who can respond with agility to changing situations, a high level of communication with the professional community, a high level of engagement by the community and an interested and engaged Federal Department. The Australian Clinical Dosimetry Service is a

  18. SU-E-P-03: The Australian Clinical Dosimetry Service, a Bespoke National Solution

    Energy Technology Data Exchange (ETDEWEB)

    Williams, I; Lye, J; Alves, A [Australian Clinical Dosimetry Service, Yallambie, Vic (Australia); Lehmann, J [University of Sydney, Sydney (Australia); Kenny, J [Epworth HealthCare, Richmond, VIC (Australia); Dunn, L [Royal Melbourne Institute of Technology, Melbourne (Australia); Kron, T [Peter MacCallum Cancer Instit., Melbourne (Australia)

    2015-06-15

    Purpose: The Australian Clinical Dosimetry Service, (ACDS) was a pilot program to enable the Australian Government to determine whether a locally designed audit program was suitable for mitigating dosimetric error risk to radiotherapy patients within Australia. The outcomes from four years of operations will be presented and discussed with a focus why and how the pilot requirements were met. The consequnces of success will be considered, the lessons learnt from the pilot program and how they are impacting the future ACDS design, operation and engagement with stakeholders. Methods: The ACDS was designed over 2010/11 by experts drawn from the three professions in consultation with the national Department of Health. The list of outcomes required over a three year pilot was expressed in a Memorandum of Understanding, (MoU) between Health and the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) which hosted the ACDS. Results: The ACDS has achieved all the MoU requirements. This paper describes how the staff within the ACDS engaged with the professional clinical workforce and provided a successful and functioning audit service. It identifies the strengths and weaknesses within the MoU and the ACDS structure and how the ACDS resolved a number of conflicting issues. It identifies the successes within the ACDS and how these were achieved. It provides details to assist and advise those seeking to design or modify national or regional auditing programs. Finally the paper reviews potential futures for the ACDS. Conclusion: The raw number of audits and outcomes indicate that the ACDS has met the MoU auditing requirements. The reasons for the ACDS’ success are highly dependent on: attracting quality staff who can respond with agility to changing situations, a high level of communication with the professional community, a high level of engagement by the community and an interested and engaged Federal Department. The Australian Clinical Dosimetry Service is a

  19. Clinical Simulation: A Protocol for Evaluation of Mobile Technology.

    Science.gov (United States)

    Mather, Carey; Jensen, Sanne; Cummings, Elizabeth

    2017-01-01

    For mobile technology to be accepted at point of care in healthcare environments there is a need to demonstrate benefits whilst ameliorating the risks and challenges. To provide a standardised approach to evaluation of mobile technology a simulation protocol was developed to provide guidance for its use in healthcare environments. Simulated conditions provide the opportunity to assess intended and unintended consequences and identify potential workarounds when using technology. The protocol can also be used to demonstrate the importance of the development of digital professionalism by end-users prior to students entering the clinical practice setting. The mobile technology protocol was adapted from a health information systems protocol developed and used at the ITX Lab, Denmark for use in other simulation laboratories. Use case scenarios were developed to enable evaluation of mobile technology for mobile learning of nurses, nurse supervisors, students and patients. The scenarios can be used in a range of simulated environments including hospital bedside, outpatient clinic or community settings. A case study exemplar of a nurse and patient is included to demonstrate how the mobile technology protocol can be applied.

  20. Blockchain protocols in clinical trials: Transparency and traceability of consent

    Science.gov (United States)

    Benchoufi, Mehdi; Porcher, Raphael; Ravaud, Philippe

    2018-01-01

    Clinical trial consent for protocols and their revisions should be transparent for patients and traceable for stakeholders. Our goal is to implement a process allowing for collection of patients’ informed consent, which is bound to protocol revisions, storing and tracking the consent in a secure, unfalsifiable and publicly verifiable way, and enabling the sharing of this information in real time. For that, we build a consent workflow using a trending technology called Blockchain. This is a distributed technology that brings a built-in layer of transparency and traceability. From a more general and prospective point of view, we believe Blockchain technology brings a paradigmatical shift to the entire clinical research field. We designed a Proof-of-Concept protocol consisting of time-stamping each step of the patient’s consent collection using Blockchain, thus archiving and historicising the consent through cryptographic validation in a securely unfalsifiable and transparent way. For each protocol revision, consent was sought again.  We obtained a single document, in an open format, that accounted for the whole consent collection process: a time-stamped consent status regarding each version of the protocol. This document cannot be corrupted and can be checked on any dedicated public website. It should be considered a robust proof of data. However, in a live clinical trial, the authentication system should be strengthened to remove the need for third parties, here trial stakeholders, and give participative control to the peer users. In the future, the complex data flow of a clinical trial could be tracked by using Blockchain, which core functionality, named Smart Contract, could help prevent clinical trial events not occurring in the correct chronological order, for example including patients before they consented or analysing case report form data before freezing the database. Globally, Blockchain could help with reliability, security, transparency and could be

  1. Blockchain protocols in clinical trials: Transparency and traceability of consent.

    Science.gov (United States)

    Benchoufi, Mehdi; Porcher, Raphael; Ravaud, Philippe

    2017-01-01

    Clinical trial consent for protocols and their revisions should be transparent for patients and traceable for stakeholders. Our goal is to implement a process allowing for collection of patients' informed consent, which is bound to protocol revisions, storing and tracking the consent in a secure, unfalsifiable and publicly verifiable way, and enabling the sharing of this information in real time. For that, we build a consent workflow using a trending technology called Blockchain. This is a distributed technology that brings a built-in layer of transparency and traceability. From a more general and prospective point of view, we believe Blockchain technology brings a paradigmatical shift to the entire clinical research field. We designed a Proof-of-Concept protocol consisting of time-stamping each step of the patient's consent collection using Blockchain, thus archiving and historicising the consent through cryptographic validation in a securely unfalsifiable and transparent way. For each protocol revision, consent was sought again.  We obtained a single document, in an open format, that accounted for the whole consent collection process: a time-stamped consent status regarding each version of the protocol. This document cannot be corrupted and can be checked on any dedicated public website. It should be considered a robust proof of data. However, in a live clinical trial, the authentication system should be strengthened to remove the need for third parties, here trial stakeholders, and give participative control to the peer users. In the future, the complex data flow of a clinical trial could be tracked by using Blockchain, which core functionality, named Smart Contract, could help prevent clinical trial events not occurring in the correct chronological order, for example including patients before they consented or analysing case report form data before freezing the database. Globally, Blockchain could help with reliability, security, transparency and could be a

  2. A virtual dosimetry audit - Towards transferability of gamma index analysis between clinical trial QA groups.

    Science.gov (United States)

    Hussein, Mohammad; Clementel, Enrico; Eaton, David J; Greer, Peter B; Haworth, Annette; Ishikura, Satoshi; Kry, Stephen F; Lehmann, Joerg; Lye, Jessica; Monti, Angelo F; Nakamura, Mitsuhiro; Hurkmans, Coen; Clark, Catharine H

    2017-12-01

    Quality assurance (QA) for clinical trials is important. Lack of compliance can affect trial outcome. Clinical trial QA groups have different methods of dose distribution verification and analysis, all with the ultimate aim of ensuring trial compliance. The aim of this study was to gain a better understanding of different processes to inform future dosimetry audit reciprocity. Six clinical trial QA groups participated. Intensity modulated treatment plans were generated for three different cases. A range of 17 virtual 'measurements' were generated by introducing a variety of simulated perturbations (such as MLC position deviations, dose differences, gantry rotation errors, Gaussian noise) to three different treatment plan cases. Participants were blinded to the 'measured' data details. Each group analysed the datasets using their own gamma index (γ) technique and using standardised parameters for passing criteria, lower dose threshold, γ normalisation and global γ. For the same virtual 'measured' datasets, different results were observed using local techniques. For the standardised γ, differences in the percentage of points passing with γ audit has been an informative step in understanding differences in the verification of measured dose distributions between different clinical trial QA groups. This work lays the foundations for audit reciprocity between groups, particularly with more clinical trials being open to international recruitment. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. MO-B-BRB-00: Three Dimensional Dosimetry

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2016-06-15

    Full three-dimensional (3D) dosimetry using volumetric chemical dosimeters probed by 3D imaging systems has long been a promising technique for the radiation therapy clinic, since it provides a unique methodology for dose measurements in the volume irradiated using complex conformal delivery techniques such as IMRT and VMAT. To date true 3D dosimetry is still not widely practiced in the community; it has been confined to centres of specialized expertise especially for quality assurance or commissioning roles where other dosimetry techniques are difficult to implement. The potential for improved clinical applicability has been advanced considerably in the last decade by the development of improved 3D dosimeters (e.g., radiochromic plastics, radiochromic gel dosimeters and normoxic polymer gel systems) and by improved readout protocols using optical computed tomography or magnetic resonance imaging. In this session, established users of some current 3D chemical dosimeters will briefly review the current status of 3D dosimetry, describe several dosimeters and their appropriate imaging for dose readout, present workflow procedures required for good dosimetry, and analyze some limitations for applications in select settings. We will review the application of 3D dosimetry to various clinical situations describing how 3D approaches can complement other dose delivery validation approaches already available in the clinic. The applications presented will be selected to inform attendees of the unique features provided by full 3D techniques. Learning Objectives: L. John Schreiner: Background and Motivation Understand recent developments enabling clinically practical 3D dosimetry, Appreciate 3D dosimetry workflow and dosimetry procedures, and Observe select examples from the clinic. Sofie Ceberg: Application to dynamic radiotherapy Observe full dosimetry under dynamic radiotherapy during respiratory motion, and Understand how the measurement of high resolution dose data in an

  4. Micro ionization chamber dosimetry in IMRT verification: Clinical implications of dosimetric errors in the PTV

    International Nuclear Information System (INIS)

    Sanchez-Doblado, Francisco; Capote, Roberto; Rosello, Joan V.; Leal, Antonio; Lagares, Juan I.; Arrans, Rafael; Hartmann, Guenther H.

    2005-01-01

    Background and purpose: Absolute dose measurements for Intensity Modulated Radiotherapy (IMRT) beamlets is difficult due to the lack of lateral electron equilibrium. Recently we found that the absolute dosimetry in the penumbra region of the IMRT beamlet, can suffer from significant errors (Capote et al., Med Phys 31 (2004) 2416-2422). This work has the goal to estimate the error made when measuring the Planning Target Volume's (PTV) absolute dose by a micro ion chamber (μIC) in typical IMRT treatment. The dose error comes from the assumption that the dosimetric parameters determining the absolute dose are the same as for the reference conditions. Materials and Methods: Two IMRT treatment plans for common prostate carcinoma case, derived by forward and inverse optimisation, were considered. Detailed geometrical simulation of the μIC and the dose verification set-up was performed. The Monte Carlo (MC) simulation allows us to calculate the delivered dose to water and the dose delivered to the active volume of the ion chamber. However, the measured dose in water is usually derived from chamber readings assuming reference conditions. The MC simulation provides needed correction factors for ion chamber dosimetry in non reference conditions. Results: Dose calculations were carried out for some representative beamlets, a combination of segments and for the delivered IMRT treatments. We observe that the largest dose errors (i.e. the largest correction factors) correspond to the smaller contribution of the corresponding IMRT beamlets to the total dose delivered in the ionization chamber within PTV. Conclusion: The clinical impact of the calculated dose error in PTV measured dose was found to be negligible for studied IMRT treatments

  5. I-124 Imaging and Dosimetry

    Directory of Open Access Journals (Sweden)

    Russ Kuker

    2017-02-01

    Full Text Available Although radioactive iodine imaging and therapy are one of the earliest applications of theranostics, there still remain a number of unresolved clinical questions as to the optimization of diagnostic techniques and dosimetry protocols. I-124 as a positron emission tomography (PET radiotracer has the potential to improve the current clinical practice in the diagnosis and treatment of differentiated thyroid cancer. The higher sensitivity and spatial resolution of PET/computed tomography (CT compared to standard gamma scintigraphy can aid in the detection of recurrent or metastatic disease and provide more accurate measurements of metabolic tumor volumes. However the complex decay schema of I-124 poses challenges to quantitative PET imaging. More prospective studies are needed to define optimal dosimetry protocols and to improve patient-specific treatment planning strategies, taking into account not only the absorbed dose to tumors but also methods to avoid toxicity to normal organs. A historical perspective of I-124 imaging and dosimetry as well as future concepts are discussed.

  6. Which accelerator photon beams are 'clinic-like' for reference dosimetry purposes?

    International Nuclear Information System (INIS)

    Kalach, N.I.; Rogers, D.W.O.

    2003-01-01

    Previous work has demonstrated that, for photon beam dosimetry, TPR 10 20 is not an ideal beam quality specifier for all bremsstrahlung beams, especially for lightly filtered beams in some standards laboratories. This paper addresses the following questions: Is TPR 10 20 an adequate beam quality specifier for all modern clinical therapy accelerators? When can nonclinical beams in standards laboratories be used to calibrate ion chambers or measure k Q factors as a function of TPR 10 20 ? Based on detailed Monte Carlo simulations of Varian, Siemens, Elekta, and GE (Saturn) accelerators one can conclude that TPR 10 20 is an adequate beam quality specifier for all these machines in the sense that for a given value of TPR 10 20 , the value of stopping-power ratios is the same. Agreement between calculations for specific accelerators and measured beam quality specifiers is shown to be good, but agreement with published data for a variety of clinical accelerators is not as good. Possible reasons for the discrepancy are discussed

  7. SU-E-J-214: MR Protocol Development to Visualize Sirius MRI Markers in Prostate Brachytherapy Patients for MR-Based Post-Implant Dosimetry

    Energy Technology Data Exchange (ETDEWEB)

    Lim, T; Wang, J; Frank, S; Stafford, R; Bruno, T; Bathala, T; Mahmood, U; Pugh, T; Ibbott, G; Kudchadker, R [UT MD Anderson Cancer Center, Houston, TX (United States)

    2015-06-15

    Purpose: The current CT-based post-implant dosimetry allows precise seed localization but limited anatomical delineation. Switching to MR-based post-implant dosimetry is confounded by imprecise seed localization. One approach is to place positive-contrast markers (Sirius) adjacent to the negative-contrast seeds. This patient study aims to assess the utility of a 3D fast spoiled gradient-recalled echo (FSPGR) sequence to visualize Sirius markers for post-implant dosimetry. Methods: MRI images were acquired in prostate implant patients (n=10) on Day 0 (day-of-implant) and Day 30. The post-implant MR protocol consisted of 3D T2-weighted fast-spin-echo (FSE), T2-weighted 2D-FSE (axial) and T1-weighted 2D-FSE (axial/sagittal/coronal). We incorporated a 3D-FSPGR sequence into the post-implant MR protocol to visualize the Sirius markers. Patients were scanned with different number-of-excitations (6, 8, 10), field-of-view (10cm, 14cm, 18cm), slice thickness (1mm, 0.8mm), flip angle (14 degrees, 20 degrees), bandwidth (122.070 Hz/pixel, 325.508 Hz/pixel, 390.625 Hz/pixel), phase encoding steps (160, 192, 224, 256), frequency-encoding direction (right/left, anterior/posterior), echo-time type (minimum-full, out-of-phase), field strength (1.5T, 3T), contrast (with, without), scanner vendor (Siemens, GE), coil (endorectal-coil only, endorectal-and-torso-coil, torsocoil only), endorectal-coil filling (30cc, 50cc) and endorectal-coil filling type (air, perfluorocarbon [PFC]). For post-implant dosimetric evaluation with greater anatomical detail, 3D-FSE images were fused with 3D-FSPGR images. For comparison with CT-based post-implant dosimetry, CT images were fused with 3D-FSPGR images. Results: The 3D-FSPGR sequence facilitated visualization of markers in patients. Marker visualization helped distinguish signal voids as seeds versus needle tracks for more definitive MR-based post-implant dosimetry. On the CT-MR fused images, the distance between the seed on CT to MR images was 3

  8. SU-E-J-214: MR Protocol Development to Visualize Sirius MRI Markers in Prostate Brachytherapy Patients for MR-Based Post-Implant Dosimetry

    International Nuclear Information System (INIS)

    Lim, T; Wang, J; Frank, S; Stafford, R; Bruno, T; Bathala, T; Mahmood, U; Pugh, T; Ibbott, G; Kudchadker, R

    2015-01-01

    Purpose: The current CT-based post-implant dosimetry allows precise seed localization but limited anatomical delineation. Switching to MR-based post-implant dosimetry is confounded by imprecise seed localization. One approach is to place positive-contrast markers (Sirius) adjacent to the negative-contrast seeds. This patient study aims to assess the utility of a 3D fast spoiled gradient-recalled echo (FSPGR) sequence to visualize Sirius markers for post-implant dosimetry. Methods: MRI images were acquired in prostate implant patients (n=10) on Day 0 (day-of-implant) and Day 30. The post-implant MR protocol consisted of 3D T2-weighted fast-spin-echo (FSE), T2-weighted 2D-FSE (axial) and T1-weighted 2D-FSE (axial/sagittal/coronal). We incorporated a 3D-FSPGR sequence into the post-implant MR protocol to visualize the Sirius markers. Patients were scanned with different number-of-excitations (6, 8, 10), field-of-view (10cm, 14cm, 18cm), slice thickness (1mm, 0.8mm), flip angle (14 degrees, 20 degrees), bandwidth (122.070 Hz/pixel, 325.508 Hz/pixel, 390.625 Hz/pixel), phase encoding steps (160, 192, 224, 256), frequency-encoding direction (right/left, anterior/posterior), echo-time type (minimum-full, out-of-phase), field strength (1.5T, 3T), contrast (with, without), scanner vendor (Siemens, GE), coil (endorectal-coil only, endorectal-and-torso-coil, torsocoil only), endorectal-coil filling (30cc, 50cc) and endorectal-coil filling type (air, perfluorocarbon [PFC]). For post-implant dosimetric evaluation with greater anatomical detail, 3D-FSE images were fused with 3D-FSPGR images. For comparison with CT-based post-implant dosimetry, CT images were fused with 3D-FSPGR images. Results: The 3D-FSPGR sequence facilitated visualization of markers in patients. Marker visualization helped distinguish signal voids as seeds versus needle tracks for more definitive MR-based post-implant dosimetry. On the CT-MR fused images, the distance between the seed on CT to MR images was 3

  9. BED-Volume histograms calculation for routine clinical dosimetry in brachytherapy

    International Nuclear Information System (INIS)

    Galelli, M.; Feroldi, P.

    1995-01-01

    The consideration of volumes is essential in Brachytherapy clinical dosimetry (I.C.R.U). Indeed, several indices, all based on dose-volume histograms (DVHs), have been designed in order to evaluate: before the therapy the volumetric quality of different possible implant geometries; during the therapy the consistency of the real and the previsional implants. Radiobiological evaluations, considering the dose deposition temporal pattern of treatment, can be usefully added to dosimetric calculations, to compare different treatment schedules. The Linear-Quadratic model is the most used: radiobiological modelisation and Biologically Effective Dose (BED) is principal related dosimetric quantity. Therefore, the consideration of BED-volume histogram (BED-VHs) is a straightforward extension of DVHs. In practice, BED-VHs can help relative comparisons and optimisations in treatment planning when combined to dose-volume histograms. Since 1994 the dosimetric calculations for all the gynecological brachytherapy treatments are performed considering also DVHs and BED-VHs. In this presentation we show the methods of BEDVHs calculation, together with some typical results

  10. Radiotherapy dosimetry audit: three decades of improving standards and accuracy in UK clinical practice and trials

    OpenAIRE

    Clark, Catharine H; Aird, Edwin GA; Bolton, Steve; Miles, Elizabeth A; Nisbet, Andrew; Snaith, Julia AD; Thomas, Russell AS; Venables, Karen; Thwaites, David I

    2015-01-01

    Dosimetry audit plays an important role in the development and safety of radiotherapy. National and large scale audits are able to set, maintain and improve standards, as well as having the potential to identify issues which may cause harm to patients. They can support implementation of complex techniques and can facilitate awareness and understanding of any issues which may exist by benchmarking centres with similar equipment. This review examines the development of dosimetry audit in the UK...

  11. Fall risk screening protocol for older hearing clinic patients.

    Science.gov (United States)

    Criter, Robin E; Honaker, Julie A

    2017-10-01

    The primary purposes of this study were (1) to describe measures that may contrast audiology patients who fall from those who do not fall and (2) to evaluate the clinical performance of measures that could be easily used for fall risk screening in a mainstream audiology hearing clinic. Cross-sectional study Study sample: Thirty-six community-dwelling audiology patient participants and 27 community-dwelling non-audiology patients over 60 years of age. The Hearing Handicap Inventory for the Elderly (HHIE) most accurately identified patients with a recent fall (sensitivity: 76.0%), while the Dizziness Handicap Inventory (DHI) most accurately identified patients without a recent fall (specificity: 90.9%). A combination of measures used in a protocol-including HHIE, DHI, number of medications, and the Timed Up and Go test-resulted in good, accurate identification of patients with or without a recent history of falls (92.0% sensitivity, 100% specificity). This study reports good sensitivity and excellent specificity for identifying patients with and without a recent history of falls when measures were combined into a screening protocol. Despite previously reported barriers, effective fall risk screenings may be performed in hearing clinic settings with measures often readily accessible to audiologists.

  12. Retrospective dosimetry: Preliminary use of the single aliquot regeneration (SAR) protocol for the measurement of quartz dose in young house bricks

    DEFF Research Database (Denmark)

    Banerjee, D.; Bøtter-Jensen, L.; Murray, A.S.

    1999-01-01

    with the expected values based on their known age and confirms the absolute accuracy of the SAR method. It is concluded that a similar to 18 mGy fallout dose component can be detected on a background of similar to 100 mGy; this detection limit is controlled by uncertainties in the natural dose rare measurement......In retrospective dosimetry, the total dose absorbed by some pre-existing dosemeters, such as house bricks or tiles, is used to derive the dose to the population arising from a nuclear accident. This paper uses the newly developed SAR protocol to determine the total dose in young house bricks from...... the vicinity of the Chernobyl reactor site and from Roskilde, Denmark. For these samples, it is shown that high precision (similar to 1%) on the mean estimates of total dose can be achieved with similar to 20 independent measurements. The SAR total dose estimates of two Danish house bricks agree...

  13. A preliminary clinic dosimetry study for synchrotron radiation therapy at SSRF

    International Nuclear Information System (INIS)

    Li Zhaobin; Shi Zeliang; Zhang Qing; Wang Yong; Fu Shen

    2013-01-01

    Synchrotron radiation (SR) represents a unique and innovative anti-cancer treatment due to its unique physical features, including high flux density, and tunable and collimated radiation generation. The aim of this work is to assess the dosimetric properties of SR in Shanghai Synchrotron Radiation Facility (SSRF) for potential applications to clinical radiation oncology. The experiments were performed with 34 and 50 keV X-rays on the BL13W biomedical beamline of SSRF and the 6 MV X-rays from ARTISTE linac for the dosimetry study. The percentage depth dose (PDD) and the surface dose of the SR X-rays and the 6 MV photon beams were performed in solid water phantom with Gafchromic EBT3 films. All curves are normalized to the maximum calculated dose, The depth of full dose buildup is about 10 μm deeper for the monoenergetic X-ray beams of 34 and 50 keV. The beam transmits through the phantom, with a linear attenuation coefficient. The profile in the horizontal plane shows that the dose distribution is uniform within the facula, while the vertical profile shows a Gaussian distribution of the dose. The penumbra is less than 0.2 mm in the horizontal profile. Gafchromic EBT film may be a useful and convenient tool for dose measurement and quality control for the high space and density resolution. It is therefore important to gain a thorough understanding about the physical features of SR before this novel technology can be applied to clinical practice. (authors)

  14. Hematological dosimetry

    International Nuclear Information System (INIS)

    Fluery-Herard, A.

    1991-01-01

    The principles of hematological dosimetry after acute or protracted whole-body irradiation are reviewed. In both cases, over-exposure is never homogeneous and the clinical consequences, viz medullary aplasia, are directly associated with the mean absorbed dose and the seriousness and location of the overexposure. The main hematological data required to assess the seriousness of exposure are the following: repeated blood analysis, blood precursor cultures, as indicators of whole-body exposure; bone marrow puncture, medullary precursor cultures and medullary scintigraphy as indicators of the importance of a local over-exposure and capacity for spontaneous repair. These paraclinical investigations, which are essential for diagnosis and dosimetry, are also used for surveillance and for the main therapeutic issues [fr

  15. PET/CT image registration: Preliminary tests for its application to clinical dosimetry in radiotherapy

    International Nuclear Information System (INIS)

    Banos-Capilla, M. C.; Garcia, M. A.; Bea, J.; Pla, C.; Larrea, L.; Lopez, E.

    2007-01-01

    The quality of dosimetry in radiotherapy treatment requires the accurate delimitation of the gross tumor volume. This can be achieved by complementing the anatomical detail provided by CT images through fusion with other imaging modalities that provide additional metabolic and physiological information. Therefore, use of multiple imaging modalities for radiotherapy treatment planning requires an accurate image registration method. This work describes tests carried out on a Discovery LS positron emission/computed tomography (PET/CT) system by General Electric Medical Systems (GEMS), for its later use to obtain images to delimit the target in radiotherapy treatment. Several phantoms have been used to verify image correlation, in combination with fiducial markers, which were used as a system of external landmarks. We analyzed the geometrical accuracy of two different fusion methods with the images obtained with these phantoms. We first studied the fusion method used by the PET/CT system by GEMS (hardware fusion) on the basis that there is satisfactory coincidence between the reconstruction centers in CT and PET systems; and secondly the fiducial fusion, a registration method, by means of least-squares fitting algorithm of a landmark points system. The study concluded with the verification of the centroid position of some phantom components in both imaging modalities. Centroids were estimated through a calculation similar to center-of-mass, weighted by the value of the CT number and the uptake intensity in PET. The mean deviations found for the hardware fusion method were: vertical bar Δx vertical bar ±σ=3.3 mm±1.0 mm and vertical bar Δy vertical bar ±σ=3.6 mm±1.0 mm. These values were substantially improved upon applying fiducial fusion based on external landmark points: vertical bar Δx vertical bar ±σ=0.7 mm±0.8 mm and vertical bar Δy vertical bar ±σ=0.3 mm±1.7 mm. We also noted that differences found for each of the fusion methods were similar for

  16. Use of computational simulation for evaluation of 3D printed phantoms for application in clinical dosimetry

    International Nuclear Information System (INIS)

    Valeriano, Caio César Santos

    2017-01-01

    The purpose of a phantom is to represent the change in the radiation field caused by absorption and scattering in a given tissue or organ of interest. Its geometrical characteristics and composition should be as close as possible to the values associated with its natural analogue. Anatomical structures can be transformed into 3D virtual objects by medical imaging techniques (e.g. Computed Tomography) and printed by rapid prototyping using materials, for example, polylactic acid. Its production for specific patients requires fulfilling requirements such as geometric accuracy with the individual's anatomy and tissue equivalence, so that usable measurements can be made, and be insensitive to the radiation effects. The objective of this work was to evaluate the behavior of 3D printed materials when exposed to different photon beams, with emphasis on the quality of radiotherapy (6 MV), aiming its application in clinical dosimetry. For this, 30 thermoluminescent dosimeters of LiF:Mg,Ti were used. The equivalence between the PMMA and the printed PLA for the thermoluminescent response of 30 dosimeters of CaSO 4 : Dy was also analyzed. The irradiations with radiotherapy photon beams were simulated using the Eclipse TM treatment planning system,with the Anisotropic Analytical Algorithm and the Acuros ® XB Advanced Dose Calculation algorithm. In addition to the use of Eclipse TM and dosimetric tests, computational simulations were realized using the MCNP5 code. Simulations with the MCNP5 code were performed to calculate the attenuation coefficient of printed plates exposed to different radiodiagnosis X-rays qualities and to develop a computational model of 3D printed plates. (author)

  17. Importance of dosimetry of irradiators for pre-clinical radiobiological experiments

    International Nuclear Information System (INIS)

    Vikram, Bhadrasain

    2014-01-01

    Importance of radiation dose in radiation biology has been increasingly recognized due to translational use of beyond 2Gy dose is in current practice. Hence, accurate dosimetry of biological irradiators is warranted. To address these problems and propose recommendations, the National Cancer Institute (NCI) along with the National Institute of Allergy and Infectious Diseases (NIAID) as well as the National Institute of Standards and Technology (NIST) highlighted a number of recommendations that will be presented in this talk that includes creating dosimetry standard operating procedures (SOPs) for both in-vitro as well as in-vivo experiments. Other recommendations include for journals (as well as to funding agencies) mandating the reporting of dosimetry of biological irradiators. (author)

  18. Experimental 3D dosimetry around a high-dose-rate clinical 192Ir source using a polyacrylamide gel (PAG) dosimeter

    International Nuclear Information System (INIS)

    McJury, M.; Tapper, P.D.; Griffin, S.; Cosgrove, V.P.; Webb, S.; Murphy, P.S.; Leach, M.O.; Oldham, M.

    1999-01-01

    It is well known that the experimental dosimetry of brachytherapy sources presents a challenge. Depending on the particular dosimeter used, measurements can suffer from poor spatial resolution (ion chambers), lack of 3D information (film) or errors due to the presence of the dosimeter itself distorting the radiation flux. To avoid these problems, we have investigated the dosimetry of a clinical 192 Ir source using a polyacrylamide gel (PAG) dosimeter. Experimental measurements of dose versus radial distance from the centre of the source (cross-line plots) were compared with calculations produced with a Nucletron NPS planning system. Good agreement was found between the planning system and gel measurements in planes selected for analysis. Gel dosimeter measurements in a coronal plane through the phantom showed a mean difference between measured absorbed dose and calculated dose of 0.17 Gy with SD=0.13Gy. Spatially, the errors at the reference point remain within one image pixel (1.0 mm). The use of polymer gel dosimetry shows promise for brachytherapy applications, offering complete, three-dimensional dose information, good spatial resolution and small measurement errors. Measurements close to the source, however, are difficult, due to some of the limiting properties of the polyacrylamide gel. (author)

  19. A Typology for Modeling Processes in Clinical Guidelines and Protocols

    Science.gov (United States)

    Tu, Samson W.; Musen, Mark A.

    We analyzed the graphical representations that are used by various guideline-modeling methods to express process information embodied in clinical guidelines and protocols. From this analysis, we distilled four modeling formalisms and the processes they typically model: (1) flowcharts for capturing problem-solving processes, (2) disease-state maps that link decision points in managing patient problems over time, (3) plans that specify sequences of activities that contribute toward a goal, (4) workflow specifications that model care processes in an organization. We characterized the four approaches and showed that each captures some aspect of what a guideline may specify. We believe that a general guideline-modeling system must provide explicit representation for each type of process.

  20. Correction factors for clinical dosemeters used in dosimetry of large fields

    International Nuclear Information System (INIS)

    Campos, L.L.; Caldas, L.V.E.

    1989-01-01

    A method for using by physicist for evaluation of irradiation effect in cables connectors of ionization chambers, and the consequent determination of adequate conection factors, for each measure the geometric system, during the realization of large fields radiation dosimetry are studied. (C.G.C.) [pt

  1. A dosimetry study comparing NCS report-5, IAEA TRS-381, AAPM TG-51 and IAEA TRS-398 in three clinical electron beam energies

    International Nuclear Information System (INIS)

    Palmans, Hugo; Nafaa, Laila; Patoul, Nathalie de; Denis, Jean-Marc; Tomsej, Milan; Vynckier, Stefaan

    2003-01-01

    New codes of practice for reference dosimetry in clinical high-energy photon and electron beams have been published recently, to replace the air kerma based codes of practice that have determined the dosimetry of these beams for the past twenty years. In the present work, we compared dosimetry based on the two most widespread absorbed dose based recommendations (AAPM TG-51 and IAEA TRS-398) with two air kerma based recommendations (NCS report-5 and IAEA TRS-381). Measurements were performed in three clinical electron beam energies using two NE2571-type cylindrical chambers, two Markus-type plane-parallel chambers and two NACP-02-type plane-parallel chambers. Dosimetry based on direct calibrations of all chambers in 60 Co was investigated, as well as dosimetry based on cross-calibrations of plane-parallel chambers against a cylindrical chamber in a high-energy electron beam. Furthermore, 60 Co perturbation factors for plane-parallel chambers were derived. It is shown that the use of 60 Co calibration factors could result in deviations of more than 2% for plane-parallel chambers between the old and new codes of practice, whereas the use of cross-calibration factors, which is the first recommendation in the new codes, reduces the differences to less than 0.8% for all situations investigated here. The results thus show that neither the chamber-to-chamber variations, nor the obtained absolute dose values are significantly altered by changing from air kerma based dosimetry to absorbed dose based dosimetry when using calibration factors obtained from the Laboratory for Standard Dosimetry, Ghent, Belgium. The values of the 60 Co perturbation factor for plane-parallel chambers (k att · k m for the air kerma based and p wall for the absorbed based codes of practice) that are obtained from comparing the results based on 60 Co calibrations and cross-calibrations are within the experimental uncertainties in agreement with the results from other investigators

  2. Development of internal dosimetry protocols using the code MCNPx and voxelized phantoms of Reference of ICRP 110; Desenvolvimento de protocolos de dosimetria interna empregando o codigo MCNPx e fantomas voxelizados de referencia da ICRP 110

    Energy Technology Data Exchange (ETDEWEB)

    Mendes, B.M.; Fonseca, T.C.F., E-mail: bmm@cdtn.br [Centro de esenvolvimento da Tecnologia Nuclear (CDTN/CNEN-MG), Belo Horizonte, MG (Brazil); Trindade, B.M.; Campos, T.P.R. [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Departamento de Engenharia Nuclear

    2017-04-01

    The objective of this work was to perform internal dosimetry calculations for {sup 18}F-FDG employing the MCNPx code and ICRP 110 voxelized reference phantoms (RCP{sub A}F and RCP{sub A}M). The methodologies developed and validated here represent protocols of internal dosimetry holding a better anthropomorphic and anthropometric representation of the human model in which heterogeneous distributions of the emissions can be adopted, useful in the study of new radiopharmaceuticals and internal contamination cases. The reference phantoms were implemented to run on MCNPx. Biodistribution data of {sup 18}F-FDG radiopharmaceutical provided in ICRP 128 were used in the simulations. The organs average absorbed doses and the effective doses were calculated for each model. The values obtained were compared with two reference works available in the literature for validation purposes. The means of the difference of our values and Zankl et al., 2012 reference values were -0.3% for RCP{sub A}M and -0.4% for RCP{sub A}F. Considering Hadid et al., 2013 reference values, the means of the deviation were -2.9% and -2.2% for RCP{sub A}M and RCP{sub A}F respectively. No statistically significant differences were observed (p <0.01) between the reference values and the values calculated by the internal dosimetry protocols developed by our group. Considering the {sup 18}F-FDG validation study performed in this work, the internal dosimetry protocols developed by our group have produced suitable dosimetry data. (author)

  3. 12''th International Conference on Solid State Dosimetry Casa del Cordon. Conference Center (Caja de Burgos), July 5''th-10''th, 1998, Burgos Spain: Programme and Abstracts

    International Nuclear Information System (INIS)

    1998-01-01

    The 12 International Conference on Solid State Dosimetry celebrate in Burgos (Spain) during July on 1998. 1.- Basic Physical Processes 2.- Materials characteristics 3.- Instrumentation 4.- Personal Dosimetry 5.- Clinical Dosimetry 6.- Environmental Dosimetry 7.- Dating retrospective dosimetry 8.- Miscellaneous

  4. Calculation of uncertainties in the protocol of dosimetry for Co 60 beams in Radiotherapy; Calculo de incertidumbres en el protocolo de dosimetria para haces de Co 60 en Radioterapia

    Energy Technology Data Exchange (ETDEWEB)

    Velazquez M, S.; Carrera M, F.; Sanchez S, J. [Hospital Juan Ramon Jimenez, Ronda Norte s/n 21005 Huelva (Spain)

    1998-12-31

    The objective in this work is to show how the uncertainty is possible to know in the determination of the absorbed dose in Co 60 photon beams and to establish in a rational form, tolerance levels for this. It is took as base the spanish protocol of dosimetry in Radiotherapy. We have been centered in a Co 60 beam. We utilized the statistical theory of little samples. We allowed to suggest a new approach about the treatment of the tolerance levels and the uncertainty of the measurement. After two years of experience in the practical hospitable application we have gotten to put around 1 % uncertainty in the absolute dosimetry of the Co 60 beam. The presented protocol allows to execute the accuracy requirements in the determination of absorbed doses. (Author)

  5. PROPOSAL OF GUIDELINE FOR CLINICAL TRIAL PROTOCOLS WITH HERBAL DRUGS

    Directory of Open Access Journals (Sweden)

    Migdacelys Arboláez Estrada.

    2007-04-01

    Full Text Available SUMMARYCuba has extensive experience about herbal drugs, however only a few products get to the clinical phase of drug development. Our objective was to design new guidelines for clinical trials with herbal drugs.A detailed bibliographic search about regulatory aspects about clinical trials in Cuba and the world was done for development of the guideline. The guideline's proposed format includes: 1 Index, including the classification of the content. 2 Summary, 3 Fifteen chapters, related to the clinical trials. The guideline also propose the inclusion of annexes.A new guideline containing 15 chapters allows for writing more clear and detailed clinical trial protocols. The guideline contains the information required to guide the research staff who is interested in the validation of herbal drugs pharmacological activations from the perspective of clinical trials. RESUMEN Cuba tiene experiencia extensa sobre plantas medicinales, aunque solo algunos productos llegan a una fase clínica del desarrollo. Nuestro objetivo fué diseñar una nueva guía para ensayos clínicos con plantas medicinales.Hemos realizado una detallada búsqueda bibliográfica sobre aspectos reguladores de ensayos clínicos en Cuba y el resto del mundo para el desarrollo de la guía. El formato propuesto de la guia incluye: 1 Índice, incluyendo la clasificación de los contenidos. 2 Resumen, 3 Quince capítulos, relacionados con los ensayos clínicos. La guía también propone la inclusión de anexos.La nueva guía que contiene 15 capítulos que orientan la redacción de protocolos de ensayos clínicos más claros y más detallados. La guía contiene la información requerida para orientar al personal investigador interesado en la validación de la actividad farmacológica de las plantas medicinales desde la perspectiva de los ensayos clínicos.

  6. Verification of an algorithm of cono collapsed through the IAEA TECDOC 1583 protocol and dosimetry with radiochromic films

    International Nuclear Information System (INIS)

    Martin-Viera Cueto, J. A.; Benitez Villegas, E. M.; Bodineau Gil, C.; Parra Osorio, V.; Garcia Pareja, S.; Casado Villalon, F. J.

    2013-01-01

    The objective of this study is to verify the characterization of the collapsed cone algorithm of an SP using this Protocol. In addition, given that it only offers details of dose values measured at discrete points, measures are complemented by a gamma test distributions 2D of doses in different cases using film radiochromic. (Author)

  7. Protocol challenges for on-the-job voice dosimetry of teachers in the United States and Finland

    NARCIS (Netherlands)

    Nix, John; Svec, Jan G.; Laukkanen, Anna-Maria; Titze, Ingo R.

    The occupational voice use of teachers has been an important research topic over the last 10 years. However, data collection on vocal loading in teachers at and away from the workplace poses significant challenges to the research protocol. The challenges include recruitment of subjects, voice data

  8. Use of national metrological references of dose absorbed in water and application of the IAEA TRS nr 398 dosimetry protocol to high energy photon beams. BNM-LNHB-LCIE-SFPM working group

    International Nuclear Information System (INIS)

    Chauvenet, B.; Delaunay, F.; Dolo, J.M.; Le Roy, G.; Bridier, A.; Francois, P.; Sabattier, R.

    2003-01-01

    Metrological references of dose absorbed in water for high energy photon beams used in radiotherapy have been elaborated during the past years by national calibration laboratories, and these new references are the basis of recent dosimetry protocols. However, the passage from metrological references of air kerma to dose absorbed in water, as well as the practical application of new calibration opportunities for dosemeters in high energy X ray beams requires a specific attention to maintain the consistency of dose measurement references over the hospital site. In this respect, this guide aims at the application of these metrological references. It proposes recommendations for the application of metrological references in terms of dose absorbed in water on the hospital site with reference to their determination conditions and to the implementation of the new IAEA dosimetry protocol (TRS nr 398). Thus, this guide proposes an overview of metrological references in French calibration laboratories, presents calibration methods (air kerma in a cobalt 60 gamma photon beam, dose absorbed in water) and a comparison with the IAEA TRS 277 dosimetry protocol. It addresses various practical aspects, and discusses uncertainties

  9. Medical reference dosimetry using EPR measurements of alanine: Development of an improved method for clinical dose levels

    International Nuclear Information System (INIS)

    Helt-Hansen, Jakob; Andersen, Claus Erik; Rosendal, Flemming; Kofoed, Inger Matilde

    2009-01-01

    Electron spin resonance (EPR) is used to determine the absorbed dose of alanine dosimeters exposed to clinical photon beams in a solid-water phantom. Alanine is potentially suitable for medical reference dosimetry, because of its near water equivalence over a wide energy spectrum, low signal fading, non-destructive measurement and small dosimeter size. Material and Methods. A Bruker EMX-micro EPR spectrometer with a rectangular cavity and a measurement time of two minutes per dosimeter was used for reading of irradiated alanine dosimeters. Under these conditions a new algorithm based on scaling of known spectra was developed to extract the alanine signal. Results. The dose accuracy, including calibration uncertainty, is less than 2% (k=1) above 4 Gy (n=4). The measurement uncertainty is fairly constant in absolute terms (∼30 mGy) and the relative uncertainty therefore rises for dose measurements below 4 Gy. Typical reproducibility is <1% (k=1) above 10 Gy and <2% between 4 and 10 Gy. Below 4 Gy the uncertainty is higher. A depth dose curve measurement was performed in a solid-water phantom irradiated to a dose of 20 Gy at the maximum dose point (dmax) in 6 and 18 MV photon beams. The typical difference between the dose measured with alanine in solid water and the dose measured with an ion chamber in a water tank was about 1%. A difference of 2% between 6 and 18 MV was found, possibly due to non-water equivalence of the applied phantom. Discussion. Compared to previously published methods the proposed algorithm can be applied without normalisation of phase shifts caused by changes in the g-value of the cavity. The study shows that alanine dosimetry is a suitable candidate for medical reference dosimetry especially for quality control applications

  10. Invited review, recent developments in brachytherapy source dosimetry

    International Nuclear Information System (INIS)

    Meigooni, A.S.

    2004-01-01

    Application of radioactive isotopes is the treatment of choice around the globe for many cancer sites. In this technique, the accuracy of the radiation delivery is highly dependent on the accuracy of radiation dosimetry around individual brachytherapy sources. Moreover, in order to have compatible clinical results, an identical method of source dosimetry must be employed across the world. This problem has been recently addressed by task group 43 from the American Association of Medical Physics with a protocol for dosimetric characterization of brachytherapy sources. This new protocol has been further updated using published data from international sources, by a new Task Group from the American Association of Medical Physics. This has resulted in an updated protocol known as TG43U1 that has been published in March 2004 issue of Medical Physics. The goal of this presentation is to review the original Task Group 43 protocol and associated algorithms for brachytherapy source dosimetry. In addition, the shortcomings of the original protocol that has been resolved in the updated recommendation will be highlighted. I am sure that this is not the end of the line and more work is needed to complete this task. I invite the scientists to join this task and complete the project, with the hope of much better clinical results for cancer patients

  11. SU-F-J-100: Standardized Biodistribution Template for Nuclear Medicine Dosimetry Collection and Reporting

    Energy Technology Data Exchange (ETDEWEB)

    Kesner, A [University of Colorado, Anschutz Medical Campus, Aurora, Colorado (United States); Poli, G [International Atomic Energy Agency, Vienna, Vienna (Austria); Beykan, S; Lassman, M [University of Wuerzburg, Wuerzberg, Wuerzberg (Germany)

    2016-06-15

    Purpose: As the field of Nuclear Medicine moves forward with efforts to integrate radiation dosimetry into clinical practice we can identify the challenge posed by the lack of standardized dose calculation methods and protocols. All personalized internal dosimetry is derived by projecting biodistribution measurements into dosimetry calculations. In an effort to standardize organization of data and its reporting, we have developed, as a sequel to the EANM recommendation of “Good Dosimetry Reporting”, a freely available biodistribution template, which can be used to create a common point of reference for dosimetry data. It can be disseminated, interpreted, and used for method development widely across the field. Methods: A generalized biodistribution template was built in a comma delineated format (.csv) to be completed by users performing biodistribution measurements. The template is available for free download. The download site includes instructions and other usage details on the template. Results: This is a new resource developed for the community. It is our hope that users will consider integrating it into their dosimetry operations. Having biodistribution data available and easily accessible for all patients processed is a strategy for organizing large amounts of information. It may enable users to create their own databases that can be analyzed for multiple aspects of dosimetry operations. Furthermore, it enables population data to easily be reprocessed using different dosimetry methodologies. With respect to dosimetry-related research and publications, the biodistribution template can be included as supplementary material, and will allow others in the community to better compare calculations and results achieved. Conclusion: As dosimetry in nuclear medicine become more routinely applied in clinical applications, we, as a field, need to develop the infrastructure for handling large amounts of data. Our organ level biodistribution template can be used as a

  12. Protocol for adaptation of internal dosimetry techniques for planning of individualized doses of 131I in pediatric patients

    International Nuclear Information System (INIS)

    Biancardi, Rodrigo

    2011-01-01

    The optimization of radiation doses is emphasized in diseases with good prognosis, as differentiated thyroid carcinomas, especially in pediatric patients, since the radiation risk is conversely proportional to age. Aiming to establish individual treatment planning, it has been studied four dosimetry methodologies (external dose monitoring, image quantification, urine and blood bioassay) for four 13.3 ± 1.5-year-old female patients, who received 107 ± 15 MBq (2,9 ± 0,4 mCi) for tracer dose and 5.5 ± 0.3 GBq (149 ± 8 mCi) for thyroid ablation. Effective half-lives, residence times and cumulated activities were estimated in organs and tissues with iodine uptake, through planar images quantification by conjugate-view and attenuation correction, in order to compare biokinetic behavior in tracer dose and ablative dose phases. For external monitoring, two patients had similar whole-body effective half-lives in both phases. For this methodology, despite the uncertainties associated to measurements, equipment used and procedures performed were adequate. For urine bioassay, there were not similarities among the patients whole-body effective half-lives. Through blood bioassay, it was observed that 0.2 % of the administered activity for ablative dose remained in the blood until 76 hours after administration. The external monitoring allowed estimating effective doses in patients mothers by conversion of the environmental equivalent dose. In the ablative dose phase, the effective doses resulted in 1.3 ± 0.3 mSv in the hospital and 0.3 ± 0.1 mSv in patients houses. (author)

  13. An external dosimetry audit programme to credential static and rotational IMRT delivery for clinical trials quality assurance.

    Science.gov (United States)

    Eaton, David J; Tyler, Justine; Backshall, Alex; Bernstein, David; Carver, Antony; Gasnier, Anne; Henderson, Julia; Lee, Jonathan; Patel, Rushil; Tsang, Yatman; Yang, Huiqi; Zotova, Rada; Wells, Emma

    2017-03-01

    External dosimetry audits give confidence in the safe and accurate delivery of radiotherapy. The RTTQA group have performed an on-site audit programme for trial recruiting centres, who have recently implemented static or rotational IMRT, and those with major changes to planning or delivery systems. Measurements of reference beam output were performed by the host centre, and by the auditor using independent equipment. Verification of clinical plans was performed using the ArcCheck helical diode array. A total of 54 measurement sessions were performed between May 2014 and June 2016 at 28 UK institutions, reflecting the different combinations of planning and delivery systems used at each institution. Average ratio of measured output between auditor and host was 1.002±0.006. Average point dose agreement for clinical plans was -0.3±1.8%. Average (and 95% lower confidence intervals) of gamma pass rates at 2%/2mm, 3%/2mm and 3%/3mm respectively were: 92% (80%), 96% (90%) and 98% (94%). Moderately significant differences were seen between fixed gantry angle and rotational IMRT, and between combination of planning systems and linac manufacturer, but not between anatomical treatment site or beam energy. An external audit programme has been implemented for universal and efficient credentialing of IMRT treatments in clinical trials. Good agreement was found between measured and expected doses, with few outliers, leading to a simple table of optimal and mandatory tolerances for approval of dosimetry audit results. Feedback was given to some centres leading to improved clinical practice. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  14. In-vivo dosimetry in external radiotherapy with amorphous silicon Portal Imaging Devices: from method to clinical validation

    International Nuclear Information System (INIS)

    Boissard, Philippe

    2012-01-01

    In vivo dose verification is used to prevent major deviations between the prescribed dose and the dose really delivered to the patient. This quality control was, nationally and internationally, widely recommended by scientific organizations. In France, its implementation and its use are now regulated. To do this, small detectors are fixed on the patient skin at the beginning of the treatment. However, the treatment delay is increased and not all treatment techniques could be assessed, such as IMRT plans (Intensity Modulated Radiation Therapy). In this context, Transit dosimetry performed with Electronic Portal Imaging Devices (EPIDs) appears as an interesting alternative for in vivo dose verification. During the treatment session, a transit dose is measured with the EPID, in two dimensions, and the dose in the patient is estimated from back projection of the portal dose. This work presents a quick and simple alternative method for verification of dose delivered to the patient using photon beams. Verifications in cases of complexes patient shapes and Intensity Modulated Radiation Therapy (IMRT) have been improved by using a Clarkson-Cunningham's integration method. 46 phantom test cases were designed to assess the accuracy of the method for 4, 6, 10 and 20 MV photon beams. For some points of interest the dose reconstructed by the method is compared to the dose measured with an ionization chamber. An additional in vivo uncertainty due to day to day deviations is defined and investigated. In the same time, a clinical study was driven during three years. In vivo dosimetry was performed for 494 patients treated for various tumors sites. Most of the patients were treated for a prostate cancer using IMRT. The in vivo dose is here compared to the dose calculated by the Treatment Planning System, TPS. The results of these two ways of validations are within the accepted tolerance of classical in vivo dosimetry. From the phantom study, we have estimated that the standard

  15. Pre-clinical evaluation of a diode-based In vivo dosimetry system

    International Nuclear Information System (INIS)

    Trujillo, G.

    1998-01-01

    Diode detector systems are routinely used in a number of departments for the quality assurance of the delivered dose in radiation oncology (1,2,3,4,5). The main advantage of diode detectors for in vivo dosimetry (over TLDs, film dosimetry, ionization chambers) is that results are immediately available in real time, do not need external bias voltage and are more sensitive for the same detection volume than ionization chambers thereby allowing a direct and immediate check of the treatment accuracy. Also, is important to mention that is possible to obtain different accuracy levels. For example, in the case of the measurements designed for evaluating the dosimetric accuracy of a new treatment technique for dose escalation studies the action level should be tighter (the order of 2 % to 4 %, 2 standard deviations) than for routine measurements aiming to discover and correct for errors in the treatment of individual patients (± 5 % - 10 % or to avoid mis administrations (10 % - 15 %). This work describes the calibration method adopted and the evaluation of the accuracy and precision of in vivo dosimetry at Co 60 and 23 MV photon energies. Extensive phantoms measurements were made to determine the influence of physical conditions on the diode response. Parameters investigated included diode linearity, leakage, and measurement reproducibility, as well as the field size, SSD, and angular dependence. the practical consequences of these measurements are reported. There is still some controversy as to whether in vivo (diode) dosemeters are required for routine quality assurance purposes. Our work has shown that while care must be taken in choosing and handling diode detector systems they are able to provide an efficient and effective method of ensuring the dose delivered to the patient during treatment is within acceptable limits. (Author)

  16. Dosimetry Service

    CERN Multimedia

    2006-01-01

    Cern Staff and Users can now consult their dose records for an individual or an organizational unit with HRT. Please see more information on our web page: http://cern.ch/rp-dosimetry Dosimetry Service is open every morning from 8.30 - 12.00. Closed in the afternoons. We would like to remind you that dosimeters cannot be sent to customers by internal mail. Short-term dosimeters (VCT's) must always be returned to the Service after the use and must not be left on the racks in the experimental areas or in the secretariats. Dosimetry Service Tel. 7 2155 Dosimetry.service@cern.ch http://cern.ch/rp-dosimetry

  17. Polymer gel dosimetry

    Energy Technology Data Exchange (ETDEWEB)

    Baldock, C [Institute of Medical Physics, School of Physics, University of Sydney (Australia); De Deene, Y [Radiotherapy and Nuclear Medicine, Ghent University Hospital (Belgium); Doran, S [CRUK Clinical Magnetic Resonance Research Group, Institute of Cancer Research, Surrey (United Kingdom); Ibbott, G [Radiation Physics, UT M D Anderson Cancer Center, Houston, TX (United States); Jirasek, A [Department of Physics and Astronomy, University of Victoria, Victoria, BC (Canada); Lepage, M [Centre d' imagerie moleculaire de Sherbrooke, Departement de medecine nucleaire et de radiobiologie, Universite de Sherbrooke, Sherbrooke, QC (Canada); McAuley, K B [Department of Chemical Engineering, Queen' s University, Kingston, ON (Canada); Oldham, M [Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States); Schreiner, L J [Cancer Centre of South Eastern Ontario, Kingston, ON (Canada)], E-mail: c.baldock@physics.usyd.edu.au, E-mail: yves.dedeene@ugent.be

    2010-03-07

    Polymer gel dosimeters are fabricated from radiation sensitive chemicals which, upon irradiation, polymerize as a function of the absorbed radiation dose. These gel dosimeters, with the capacity to uniquely record the radiation dose distribution in three-dimensions (3D), have specific advantages when compared to one-dimensional dosimeters, such as ion chambers, and two-dimensional dosimeters, such as film. These advantages are particularly significant in dosimetry situations where steep dose gradients exist such as in intensity-modulated radiation therapy (IMRT) and stereotactic radiosurgery. Polymer gel dosimeters also have specific advantages for brachytherapy dosimetry. Potential dosimetry applications include those for low-energy x-rays, high-linear energy transfer (LET) and proton therapy, radionuclide and boron capture neutron therapy dosimetries. These 3D dosimeters are radiologically soft-tissue equivalent with properties that may be modified depending on the application. The 3D radiation dose distribution in polymer gel dosimeters may be imaged using magnetic resonance imaging (MRI), optical-computerized tomography (optical-CT), x-ray CT or ultrasound. The fundamental science underpinning polymer gel dosimetry is reviewed along with the various evaluation techniques. Clinical dosimetry applications of polymer gel dosimetry are also presented. (topical review)

  18. Evaluation of aluminum oxide dosimeters using OSL technique in dosimetry of clinical photon beams on volumetric modulated arc treatment

    International Nuclear Information System (INIS)

    Villani, Daniel

    2017-01-01

    Treatment using Volumetric Modulated Arc Radiation Therapy is the most modern modality of conformational radiotherapy so that, with the overlapping of several fields, the dose distributions provide a perfect conformation to the tumor, reducing the probability of complications in adjacent normal tissues. In this sense, many efforts are being invested to improve dose distribution compliance as well as the integration of imaging techniques for tumor screening and correction of inter and intrafraction variations. To this end, an intensive monitoring of the quality of the processes and a quality assurance program are fundamental for patient safety and compliance with current legislation; besides the use of different dosimetry methodologies for intercomparison and validation of the results. The aim of this study is to evaluate and compare the performance of aluminum oxide (Al_2O_3:C) OSL dosimeters manufactured by Landauer Inc. with those produced by Rexon™ in the dosimetry of high energy photon clinical bundles used in Volumetric Modulated Arc Therapy - (VMAT) using different simulating objects. The dosimeters were characterized for gamma radiation of the "6"0Co and for clinical photon beams of 6 MV typical of treatments by VMAT under conditions of electronic equilibrium and maximum dose respectively. Performance tests of the TL and OSL readers used and repeatability of the samples were evaluated. After all tests, the dosimeters were irradiated in the simulation of different radiotherapy treatments by VMAT and their responses compared to the planning system. All types of dosimeters presented satisfactory results in verifying the doses of this type of planning simulation. The Al_2O_3:C dosimeters presented compatible results and validated by the other dosimeters and ionization chamber. Regarding the best technique, the OSL InLight commercial system presents greater practicality and versatility for use and application in the clinical routine. (author)

  19. Radiotherapy dosimetry audit: three decades of improving standards and accuracy in UK clinical practice and trials.

    Science.gov (United States)

    Clark, Catharine H; Aird, Edwin G A; Bolton, Steve; Miles, Elizabeth A; Nisbet, Andrew; Snaith, Julia A D; Thomas, Russell A S; Venables, Karen; Thwaites, David I

    2015-01-01

    Dosimetry audit plays an important role in the development and safety of radiotherapy. National and large scale audits are able to set, maintain and improve standards, as well as having the potential to identify issues which may cause harm to patients. They can support implementation of complex techniques and can facilitate awareness and understanding of any issues which may exist by benchmarking centres with similar equipment. This review examines the development of dosimetry audit in the UK over the past 30 years, including the involvement of the UK in international audits. A summary of audit results is given, with an overview of methodologies employed and lessons learnt. Recent and forthcoming more complex audits are considered, with a focus on future needs including the arrival of proton therapy in the UK and other advanced techniques such as four-dimensional radiotherapy delivery and verification, stereotactic radiotherapy and MR linear accelerators. The work of the main quality assurance and auditing bodies is discussed, including how they are working together to streamline audit and to ensure that all radiotherapy centres are involved. Undertaking regular external audit motivates centres to modernize and develop techniques and provides assurance, not only that radiotherapy is planned and delivered accurately but also that the patient dose delivered is as prescribed.

  20. A clinical implementation of in vivo dosimetry with n-type Isorad semiconductor diodes

    Directory of Open Access Journals (Sweden)

    Rutonjski Laza M.

    2014-01-01

    Full Text Available The study was aimed to check the radiotherapy treatment accuracy and definition of action levels during implementation of in vivo dosimetry as a part of quality assurance program. The calibration and correction factors for in vivo entrance dose measurements for six n-type Isorad semiconductor diodes were determined as recommended by the European Society for Radiotherapy and Oncology Booklet No. 5. The patients for in vivo measurements have been divided in groups, according to the treatment site/techique, in order to investigate and detect the groups where the uncertainty was larger or where a systematic error occurred. The tolerance/action levels for all groups were also defined and checked. In this study, the entrance dose measurements were performed for total of 451 treatment fields, and 338 patients over one year period. The mean value and the standard deviation for different groups were: breast +1.0% ± 2.89%(1 SD, brain, and head and neck - +0.74% ± 2.04%(1 SD, and isocentric pelvis and abdomen - +0.1% ± 2.86%(1 SD. All measurements - +0.72% ± 2.64%(1 SD. In our experience, systematic in vivo dosimetry proved to be a very useful tool for quality assurance of patient's plan and treatment, both in detecting systematic errors and for estimating the accuracy of radiotherapy treatment delivery.

  1. Radiotherapy dosimetry audit: three decades of improving standards and accuracy in UK clinical practice and trials

    Science.gov (United States)

    Aird, Edwin GA; Bolton, Steve; Miles, Elizabeth A; Nisbet, Andrew; Snaith, Julia AD; Thomas, Russell AS; Venables, Karen; Thwaites, David I

    2015-01-01

    Dosimetry audit plays an important role in the development and safety of radiotherapy. National and large scale audits are able to set, maintain and improve standards, as well as having the potential to identify issues which may cause harm to patients. They can support implementation of complex techniques and can facilitate awareness and understanding of any issues which may exist by benchmarking centres with similar equipment. This review examines the development of dosimetry audit in the UK over the past 30 years, including the involvement of the UK in international audits. A summary of audit results is given, with an overview of methodologies employed and lessons learnt. Recent and forthcoming more complex audits are considered, with a focus on future needs including the arrival of proton therapy in the UK and other advanced techniques such as four-dimensional radiotherapy delivery and verification, stereotactic radiotherapy and MR linear accelerators. The work of the main quality assurance and auditing bodies is discussed, including how they are working together to streamline audit and to ensure that all radiotherapy centres are involved. Undertaking regular external audit motivates centres to modernize and develop techniques and provides assurance, not only that radiotherapy is planned and delivered accurately but also that the patient dose delivered is as prescribed. PMID:26329469

  2. Study of the positioning of the films of the MLC by a Test of bands and your influence in the clinic dosimetry in IMRT

    International Nuclear Information System (INIS)

    Serrano Zabaleta, S.; Millan Cebrian, E.; Calvo Carrillo, S.; Alba Escorihuela, V.; Garcia Romero, A.; Ortega Pardina, P.; Canella Anoz, M.; Hernandez Vitoria, A.

    2015-01-01

    We performed a test of adjacent bands inspired by the proposed in AAPM Report No. 72, we provides a parameter characterizing the state of the MLC as to the actual position of its blades. This test has been validated by studying repeatability and reproducibility and has found the correlation between the parameter and creep detected by the ILD. Subsequently it has studied the impact of changes in the positioning of the blades on clinical dosimetry in IMRT patients, reconstructing the patient dose by Matrix Evolution team and Compass software, IBA Dosimetry. (Author)

  3. Characterising an aluminium oxide dosimetry system.

    Science.gov (United States)

    Conheady, Clement F; Gagliardi, Frank M; Ackerly, Trevor

    2015-09-01

    In vivo dosimetry is recommended as a defence-in-depth strategy in radiotherapy treatments and is currently employed by clinics around the world. The characteristics of a new optically stimulated luminescence dosimetry system were investigated for the purpose of replacing an aging thermoluminescence dosimetry system for in vivo dosimetry. The stability of the system was not sufficient to satisfy commissioning requirements and therefore it has not been released into clinical service at this time.

  4. Human-Mouse Dosimetry in Clinical Radioimmunotherapy - Special Emphasis on Pediatric Applications

    International Nuclear Information System (INIS)

    Kairemo, K.J.A.; Pyyry, J.; Heiskanen, T.; Flux, G.; Fisher, D.R.

    2009-01-01

    Monoclonal antibody ('MAB') has been developed for targeting secretory alpha-fetoprotein in hepatic tissue. We have used these MABs for radioimmunotherapy and dose planning of recurrent hepatoblastoma, a rare childhood malignancy This MAB has been labelled with In- 111 and Y-90 for clinical purposes, and can be applied for diagnosis and therapy of liver neoplasms. Physiology based pharmacokinetic (PBPK) modeling and simulation is a useful method for prediction of biodistribution of macromolecules, it can enhance our understanding of the underlying mechanisms and hence may help in rational design of diagnostic and therapeutic agents. Here we also discuss PBPK modeling and simulation of this MAB in mice without tumor and in a pediatric patient. In the clinical study, radiopharmacokinetic parameters for this MAB ( 111 In-DOTA-hAFP31 IgG) were calculated after serial quantitative whole body scans in a child with hepatoblastoma. A 3-D dose planning computer program was used to calculate tumor doses for In-111 and Y-90, the active tumor was delineated on PET/CT images and tumor dose calculation was done based on the In-111-MAB SPECT data using dose point kernel approach both for In-111 and Y-90. The results were compared with MIRD doses obtained for organs in SPECT imaging field, i.e. bone marrow, heart, kidneys, liver, spleen, lungs. The simulated results were fitted to experimental time series data by varying parameters which were not fixed a priori. From quantitative serial imaging based on 8 whole body images at 0-168 hrs using In-111- MAB, the half-lives of spleen, lungs, kidneys and whole body were 502 hrs, 230 hrs, 193 hrs and 490 hrs, respectively. The measured blood half-life was 132 hrs, after a total MAB dose of 50 mg and In-111 activity of 105 MBq. The presumed Y-90 dose based on this kinetic behavior was 43 MBq which should had given 0.3Gy bone marrow dose with assumption of bone marrow: blood ratio 0.4 for IgG. The calculated MIRD Y-90 doses were for

  5. Development of a manualized protocol of massage therapy for clinical trials in osteoarthritis

    Directory of Open Access Journals (Sweden)

    Ali Ather

    2012-10-01

    Full Text Available Abstract Background Clinical trial design of manual therapies may be especially challenging as techniques are often individualized and practitioner-dependent. This paper describes our methods in creating a standardized Swedish massage protocol tailored to subjects with osteoarthritis of the knee while respectful of the individualized nature of massage therapy, as well as implementation of this protocol in two randomized clinical trials. Methods The manualization process involved a collaborative process between methodologic and clinical experts, with the explicit goals of creating a reproducible semi-structured protocol for massage therapy, while allowing some latitude for therapists’ clinical judgment and maintaining consistency with a prior pilot study. Results The manualized protocol addressed identical specified body regions with distinct 30- and 60-min protocols, using standard Swedish strokes. Each protocol specifies the time allocated to each body region. The manualized 30- and 60-min protocols were implemented in a dual-site 24-week randomized dose-finding trial in patients with osteoarthritis of the knee, and is currently being implemented in a three-site 52-week efficacy trial of manualized Swedish massage therapy. In the dose-finding study, therapists adhered to the protocols and significant treatment effects were demonstrated. Conclusions The massage protocol was manualized, using standard techniques, and made flexible for individual practitioner and subject needs. The protocol has been applied in two randomized clinical trials. This manualized Swedish massage protocol has real-world utility and can be readily utilized both in the research and clinical settings. Trial registration Clinicaltrials.gov NCT00970008 (18 August 2009

  6. A quality analysis of clinical anaesthesia study protocols from the Chinese clinical trials registry according to the SPIRIT statement.

    Science.gov (United States)

    Yang, Lei; Chen, Shouming; Yang, Di; Li, Jiajin; Wu, Taixiang; Zuo, Yunxia

    2018-05-15

    To learn about the overall quality of clinical anaesthesia study protocols from the Chinese Clinical Trials Registry and to discuss the way to improve study protocol quality. We defined completeness of each sub-item in SPIRIT as N/A (not applicable) or with a score of 0, 1, or 2. For each protocol, we calculated the proportion of adequately reported items (score = 2 and N/A) and unreported items (score = 0). Protocol quality was determined according to the proportion of reported items, with values >50% indicating high quality. Protocol quality was determined according to the proportion of reported items. For each sub-item in SPIRIT, we calculated the adequately reported rate (percentage of all protocols with score 2 and NA on one sub-item) as well as the unreported rate (percentage of all protocols with score 0 on one sub-item). Total 126 study protocols were available for assessment. Among these, 88.1% were assessed as being of low quality. By comparison, the percentage of low-quality protocols was 88.9% after the publication of the SPIRIT statement. Among the 51 SPIRIT sub-items, 18 sub-items had an unreported rate above 90% while 16 had a higher adequately reported rate than an unreported rate. The overall quality of clinical anaesthesia study protocols registered in the ChiCTR was poor. A mandatory protocol upload and self-check based on the SPIRIT statement during the trial registration process may improve protocol quality in the future.

  7. 11. International conference on solid radiation dosimetry

    International Nuclear Information System (INIS)

    Krylova, I.V.

    1996-01-01

    The main problems discussed during the international conference on solid radiation dosimetry which took place in June 1995 in Budapest are briefly considered. These are the basic physical processes, materials applied for dosimetry, special techniques, personnel monitoring, monitoring of environmental effects, large-dose dosimetry, clinic dosimetry, track detector used for dosimetry, dosimetry in archaeology and geology, equipment and technique for dosimetric measurements. The special attention was paid to superlinearity in the TLD-100 (LiF, Mg, Ti) response function when determining doses of gamma radiation, heavy charged particles, low-energy particle fluxes in particular. New theoretical models were considered

  8. TH-CD-BRA-10: Towards Reference Dosimetry of MR-Linacs Using a Clinical Probe-Format Calorimeter

    Energy Technology Data Exchange (ETDEWEB)

    Renaud, J; Seuntjens, J [McGill University, Montreal, QC (Canada); Sarfehnia, A [McGill University, Montreal, QC (Canada); Sunnybrook Health Sciences Centre, Toronto, ON (Canada); Woodings, S; Kok, J; Asselen, B van; Wolthaus, J; Raaymakers, B [University Medical Center Utrecht, Utrecht (Netherlands)

    2016-06-15

    Purpose: To evaluate the influence of a 1.5 T magnetic field (B-field) on the response of a small-scale graphite calorimeter probe (GPC) developed for use as a novel clinical reference dosimeter. Characterization of the GPC was also assessed in a hybrid MRI-linac (MRL) clinical prototype by performing absolute dosimetry in multiple detector orientations. Methods: B-field influence was characterized using a variable-strength electromagnet system located 280 cm from the source of a clinical linac. The GPC was used to perform a total of 160 absolute dose measurements (6 MV, 920 MU/min) in a water phantom placed between the poles of the electromagnet. The magnitude of the B-field between the poles was varied in the range of 0 – 1.5 T. The relative response of the GPC was determined and compared to that of a thimble type ionization chamber (Exradin A1SL, Standard Imaging). Next, 65 dose measurements were performed using the GPC in a clinical MRL field (7 MV, 620 MU/min) to quantify the rotational dependence of the detector in the presence of a 1.5 T B-field. The GPC was rotated in steps of 90° inside a graphite phantom (SSD 140 cm, depth 2.5 cm) for two detector orientations (parallel and perpendicular to the B field). Results: Relative to the zero B-field condition, the A1SL chamber exhibited an average overresponse of +1.2 % ± 0.03 % at a B-field of 1.5 T, while the GPC under-responded on average by −0.5 % ± 0.9 %. For the MRL measurements, no significant differences were observed between the parallel and perpendicular orientations. In both cases, a rotational dependence of approximately ±1 % was measured. Conclusion: This work suggests that the B-field has minimal influence on the response of the GPC, making it a potentially attractive solution for clinical MRL reference dosimetry. This work has been supported in part by the CREATE Medical Physics Research Training Network NSERC grant RGPIN 432290, as well as NSERC grants RGPIN 298191 & 435608. JR is a

  9. Clinical use of LiF:Mg,Cu,P: Critical evaluation of an ultrasensitive material for thermoluminescence dosimetry

    International Nuclear Information System (INIS)

    Duggan, Lisa

    2002-01-01

    Radiation dosimetry is an essential part of optimization in medical exposures. However there are medical procedures that are particularly challenging for existing dosimetric techniques: neonatal radiography (low dose), mammography (low energy), cardiac catheterization (moving radiation fields), and brachytherapy using implanted radionuclides (steep dose gradients). Hence, the objectives of this thesis were to study the dosimetric characteristics of ultrasensitive LiF:Mg,Cu,P thermoluminescence dosimeters (TLDs) in radiation beams typical for both diagnostics and therapy, and develop procedures to implement this dosimeter into clinical practice for those selected scenarios. GR-200 (SDDML, China) and MCP-N (TLD Poland) TLDs were compared to other TLD materials (LiF:Mg,Ti, Al 2 O 3 :C) and tested for reproducibility, dose response (1 μGy to 500 Gy), photon energy response (10 keV to 18 MVp), light sensitivity (240-800 nm), long-term stability (6 months) using different annealing cycles and glow curve deconvolution. A miniaturized TLD form (MCP-Np) was developed by TLD Poland for the present investigations. Detection limit of GR-200 and MCP-Np was found to be less than 1 and 8 μGy, respectively, with dose response linear up to 18 Gy. To obtain adequate detection limits and precision, accurate temperature calibration of heating cycles and a dual-anneal technique with dose history monitoring was performed. Energy response was similar for both materials within 5% and essentially uniform except for a minimum of 0.82 at 185 keV. LiF:Mg,Cu,P proved to be more suitable than LiF:Mg,Ti for dosimetry in low dose medical applications particularly when kilovoltage photons are to be used. The high sensitivity and resulting scope for miniaturization provided the opportunity to perform unique in vivo measurements within brachytherapy implants and for mammography

  10. A critical analysis of a locally agreed protocol for clinical practice

    International Nuclear Information System (INIS)

    Owen, A.; Hogg, P.; Nightingale, J.

    2004-01-01

    Within the traditional scope of radiographic practice (including advanced practice) there is a need to demonstrate effective patient care and management. Such practice should be set within a context of appropriate evidence and should also reflect peer practice. In order to achieve such practice the use of protocols is encouraged. Effective protocols can maximise care and management by minimising inter- and intra-professional variation; they can also allow for detailed procedural records to be kept in case of legal claims. However, whilst literature exists to encourage the use of protocols there is little published material available to indicate how to create, manage and archive them. This article uses an analytical approach to propose a suitable method for protocol creation and archival, it also offers suggestions on the scope and content of a protocol. To achieve this an existing clinical protocol for radiographer reporting barium enemas is analysed to draw out the general issues. Proposals for protocol creation, management, and archival were identified. The clinical practice described or inferred in the protocol should be drawn from evidence, such evidence could include peer-reviewed material, national standards and peer practice. The protocol should include an explanation of how to proceed when the radiographers reach the limit of their ability. It should refer to the initial training required to undertake the clinical duties as well as the on-going continual professional updating required to maintain competence. Audit of practice should be indicated, including the preferred audit methodology, and associated with this should be a clear statement about standards and what to do if standards are not adequately met. Protocols should be archived, in a paper-based form, for lengthy periods in case of legal claims. On the archived protocol the date it was in clinical use should be included

  11. How to write a surgical clinical research protocol: literature review and practical guide.

    Science.gov (United States)

    Rosenthal, Rachel; Schäfer, Juliane; Briel, Matthias; Bucher, Heiner C; Oertli, Daniel; Dell-Kuster, Salome

    2014-02-01

    The study protocol is the core document of every clinical research project. Clinical research in studies involving surgical interventions presents some specific challenges, which need to be accounted for and described in the study protocol. The aim of this review is to provide a practical guide for developing a clinical study protocol for surgical interventions with a focus on methodologic issues. On the basis of an in-depth literature search of methodologic literature and on some cardinal published surgical trials and observational studies, the authors provides a 10-step guide for developing a clinical study protocol in surgery. This practical guide outlines key methodologic issues important when planning an ethically and scientifically sound research project involving surgical interventions, with the ultimate goal of providing high-level evidence relevant for health care decision making in surgery. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. IAEA/WHO TLD postal dose audit service and high precision measurements for radiotherapy level dosimetry

    International Nuclear Information System (INIS)

    Izewska, J.; Bera, P.; Vatnitsky, S.

    2002-01-01

    Since 1969 the International Atomic Energy Agency, together with the World Health Organization, has performed postal TLD audits to verify calibration of radiotherapy beams in developing countries. The TLD programme also monitors activities of Secondary Standard Dosimetry Laboratories (SSDLs). The programme has checked approximately 4000 clinical beams in over 1100 hospitals, and in many instances significant errors have been detected in the beam calibration. Subsequent follow-up actions help to resolve the discrepancies, thus preventing further mistreatment of patients. The audits for SSDLs check the implementation of the dosimetry protocol in order to assure proper dissemination of dosimetry standards to the end-users. The TLD audit results for SSDLs show good consistency in the basic dosimetry worldwide. New TLD procedures and equipment have recently been introduced by the IAEA that include a modified TLD calibration methodology and computerised tools for automation of dose calculation from TLD readings. (author)

  13. Reviewing three dimensional dosimetry: basics and utilization as presented over 17 Years of DosGel and IC3Ddose

    Science.gov (United States)

    Schreiner, L. J.

    2017-05-01

    For seventeen years a community of basic and clinical scientists and researchers has been meeting bi-annually to promote the clinical advance of techniques to measure radiation dose in three dimensions. The interest in this dosimetry was motivated by its promise as an effective methodology for 3D measurement of the complex conformal dose distributions achieved by modern techniques such as Intensity Modulated and Volumetric Arc Radiation Therapy. Each of the International Conferences on 3D Radiation Dosimetry resulted in the publication of informative proceedings [1-8], the majority openly available on the internet. The proceedings included papers that: i) reviewed the basic science of the radiation sensitive materials used to accumulate the dose information, ii) introduced the science and engineering of the imaging systems required to read the information out, iii) described the work flows and systems required for efficient dosimetry, iv) reported the protocols required for reproducible dosimetry, and v) showed examples of clinical use illustrating advantage and limitations of the dosimetry. This paper is intended to use the framework provided by these proceedings to review the current 3D chemical dosimeters available and to discuss the requirements for their use. The paper describes how 3D dosimetry can complement other dose delivery validation approaches available in the clinic. It closes with some personal reflections of how the motivation for, and practice of, 3D dosimetry have changed (or not) over the years.

  14. Reviewing three dimensional dosimetry: basics and utilization as presented over 17 Years of DosGel and IC3Ddose

    International Nuclear Information System (INIS)

    Schreiner, L J

    2017-01-01

    For seventeen years a community of basic and clinical scientists and researchers has been meeting bi-annually to promote the clinical advance of techniques to measure radiation dose in three dimensions. The interest in this dosimetry was motivated by its promise as an effective methodology for 3D measurement of the complex conformal dose distributions achieved by modern techniques such as Intensity Modulated and Volumetric Arc Radiation Therapy. Each of the International Conferences on 3D Radiation Dosimetry resulted in the publication of informative proceedings [1-8], the majority openly available on the internet. The proceedings included papers that: i) reviewed the basic science of the radiation sensitive materials used to accumulate the dose information, ii) introduced the science and engineering of the imaging systems required to read the information out, iii) described the work flows and systems required for efficient dosimetry, iv) reported the protocols required for reproducible dosimetry, and v) showed examples of clinical use illustrating advantage and limitations of the dosimetry. This paper is intended to use the framework provided by these proceedings to review the current 3D chemical dosimeters available and to discuss the requirements for their use. The paper describes how 3D dosimetry can complement other dose delivery validation approaches available in the clinic. It closes with some personal reflections of how the motivation for, and practice of, 3D dosimetry have changed (or not) over the years. (paper)

  15. Importance of the effective atomic number (Zeff) of TL materials for radiation dosimetry in clinical applications

    International Nuclear Information System (INIS)

    Gonzalez M, P.R.

    2008-01-01

    The electric power generation, it has been one of the radiation applications of bigger weight, mainly in developed countries. Another sector of more impact is without a doubt that of the medicine. However, for a sure operation with radiations, those international organisms of radiological safety, exist every time more precise detection systems. The thermoluminescent dosimetry is one of the more reliable methods for this purpose, for that several groups of investigators from different parts of the world, they have guided its investigations in the development of new TL materials. However, to avoid underestimate or overestimation of the measured dose with the use of these materials, it should take into account it effective atomic number (Z eff ) it is well known that some TL materials considered as equivalent to the tissue, presents smaller TL intensity when being irradiated with low energy photons, while the TL material known as not equivalent to the tissue, they present the supra sensitivity effect for this radiation type. Nowadays, the estimate of the Z eff has not been clear, in this work the Z eff is determined by means of the traditional methods and an own method is presented for its determination. The results of the TL signal of different materials, when being irradiated with photons of effective energy between 24 keV and 1.25 MeV and their relationship with their calculated Z eff are also presented. (Author)

  16. Dosimetry applications in GATE Monte Carlo toolkit.

    Science.gov (United States)

    Papadimitroulas, Panagiotis

    2017-09-01

    Monte Carlo (MC) simulations are a well-established method for studying physical processes in medical physics. The purpose of this review is to present GATE dosimetry applications on diagnostic and therapeutic simulated protocols. There is a significant need for accurate quantification of the absorbed dose in several specific applications such as preclinical and pediatric studies. GATE is an open-source MC toolkit for simulating imaging, radiotherapy (RT) and dosimetry applications in a user-friendly environment, which is well validated and widely accepted by the scientific community. In RT applications, during treatment planning, it is essential to accurately assess the deposited energy and the absorbed dose per tissue/organ of interest, as well as the local statistical uncertainty. Several types of realistic dosimetric applications are described including: molecular imaging, radio-immunotherapy, radiotherapy and brachytherapy. GATE has been efficiently used in several applications, such as Dose Point Kernels, S-values, Brachytherapy parameters, and has been compared against various MC codes which are considered as standard tools for decades. Furthermore, the presented studies show reliable modeling of particle beams when comparing experimental with simulated data. Examples of different dosimetric protocols are reported for individualized dosimetry and simulations combining imaging and therapy dose monitoring, with the use of modern computational phantoms. Personalization of medical protocols can be achieved by combining GATE MC simulations with anthropomorphic computational models and clinical anatomical data. This is a review study, covering several dosimetric applications of GATE, and the different tools used for modeling realistic clinical acquisitions with accurate dose assessment. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  17. ESR Dosimetry

    International Nuclear Information System (INIS)

    Baffa, Oswaldo; Rossi, Bruno; Graeff, Carlos; Kinoshita, Angela; Chen Abrego, Felipe; Santos, Adevailton Bernardo dos

    2004-01-01

    ESR dosimetry is widely used for several applications such as dose assessment in accidents, medical applications and sterilization of food and other materials. In this work the dosimetric properties of natural and synthetic Hydroxyapatite, Alanine, and 2-Methylalanine are presented. Recent results on the use of a K-Band (24 GHz) ESR spectrometer in dosimetry are also presented

  18. Dosimetry Service

    CERN Multimedia

    2005-01-01

    Please remember to read your dosimeter at least once a month. Regular read-outs are vital to ensure that your personal dose is periodically monitored. Dosimeters should be read even if you have not visited the controlled areas. Dosimetry Service - Tel. 7 2155 http://cern.ch/rp-dosimetry

  19. Dosimetry Service

    CERN Multimedia

    Dosimetry Service

    2005-01-01

    Please remember to read your dosimeter at least once a month. Regular read-outs are vital to ensure that your personal dose is periodically monitored. Dosimeters should be read even if you have not visited the controlled areas. Dosimetry Service Tel. 7 2155 http://cern.ch/rp-dosimetry

  20. Dosimetry Service

    CERN Multimedia

    2005-01-01

    Please remember to read your dosimeter at least once a month. Regular read-outs are vital to ensure that your personal dose is periodically monitored. Dosimeters should be read even if you have not visited the controlled areas. Dosimetry Service - Tel. 72155 http://cern.ch/rp-dosimetry

  1. Dosimetry in Diagnostic Radiology for Paediatric Patients

    International Nuclear Information System (INIS)

    2013-01-01

    Concern about the radiation dose to children from diagnostic radiology examinations has recently been popularly expressed, particularly as related to computed tomography (CT) procedures. This involves the observation that children can receive doses far in excess of those delivered to adults, in part due to the digital nature of the image receptors that may give no warning to the operator of the dose to the patient. Concern for CT examinations should be extended to the broad range of paediatric diagnostic radiological procedures responsible for radiation doses in children, especially as factors, such as increased radiosensitivity and the longer life expectancy of children, increase the associated radiation risk. In all cases, owing to the added paediatric radiological examination factor of patient size and its associated impact on equipment selection, clinical examination protocol and dosimetric audit, the determination of paediatric dose requires a distinct approach from adult dosimetry associated with diagnostic radiological examinations. In response to this, there is a need to inform health professionals about standardized methodologies used to determine paediatric dose for all major modalities such as general radiography, fluoroscopy and CT. Methodologies for standardizing the conduct of dose audits and their use for the derivation and application of diagnostic reference levels for patient populations, that vary in size, are also required. In addition, a review is needed of the current knowledge on risks specific to non-adults from radiation, and also an analysis of the management of factors contributing to dose from paediatric radiological examinations. In 2007, the IAEA published a code of practice, Dosimetry in Diagnostic Radiology: An International Code of Practice, as Technical Reports Series No. 457 (TRS 457). TRS 457 recommends procedures for dosimetric measurement and calibration for the attainment of standardized dosimetry, and addresses requirements

  2. CT head-scan dosimetry in an anthropomorphic phantom and associated measurement of ACR accreditation-phantom imaging metrics under clinically representative scan conditions

    Energy Technology Data Exchange (ETDEWEB)

    Brunner, Claudia C.; Stern, Stanley H.; Chakrabarti, Kish [U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, Maryland 20993 (United States); Minniti, Ronaldo [National Institute of Standards and Technology, 100 Bureau Drive, Gaithersburg, Maryland 20899 (United States); Parry, Marie I. [Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, Maryland 20889 (United States); Skopec, Marlene [National Institutes of Health, 9000 Rockville Pike, Bethesda, Maryland 20892 (United States)

    2013-08-15

    Purpose: To measure radiation absorbed dose and its distribution in an anthropomorphic head phantom under clinically representative scan conditions in three widely used computed tomography (CT) scanners, and to relate those dose values to metrics such as high-contrast resolution, noise, and contrast-to-noise ratio (CNR) in the American College of Radiology CT accreditation phantom.Methods: By inserting optically stimulated luminescence dosimeters (OSLDs) in the head of an anthropomorphic phantom specially developed for CT dosimetry (University of Florida, Gainesville), we measured dose with three commonly used scanners (GE Discovery CT750 HD, Siemens Definition, Philips Brilliance 64) at two different clinical sites (Walter Reed National Military Medical Center, National Institutes of Health). The scanners were set to operate with the same data-acquisition and image-reconstruction protocols as used clinically for typical head scans, respective of the practices of each facility for each scanner. We also analyzed images of the ACR CT accreditation phantom with the corresponding protocols. While the Siemens Definition and the Philips Brilliance protocols utilized only conventional, filtered back-projection (FBP) image-reconstruction methods, the GE Discovery also employed its particular version of an adaptive statistical iterative reconstruction (ASIR) algorithm that can be blended in desired proportions with the FBP algorithm. We did an objective image-metrics analysis evaluating the modulation transfer function (MTF), noise power spectrum (NPS), and CNR for images reconstructed with FBP. For images reconstructed with ASIR, we only analyzed the CNR, since MTF and NPS results are expected to depend on the object for iterative reconstruction algorithms.Results: The OSLD measurements showed that the Siemens Definition and the Philips Brilliance scanners (located at two different clinical facilities) yield average absorbed doses in tissue of 42.6 and 43.1 m

  3. Retrospective Dosimetry and Clinical Follow-up Programme of Chernobyl Accident Clean-up Workers in Latvia

    International Nuclear Information System (INIS)

    Mironova-Ulmane, N.; Pavlenko, A.; Zvagule, T.; Karner, T.; Bruvere, R.; Volrate, A.

    2001-01-01

    Full text: About 6500 Latvian inhabitants were recruited for clean-up works at Chernobyl Nuclear Power Plant during 1986-1991. Absorbed doses for them are usually unknown, because only less then half of the clean-up workers cohort had officially documented external exposure. Clinical investigations show high morbidity rate of clean-up workers compared with general population. The results of Electronic Spin Resonance (ESR) dose reconstruction (doses absorbed in the tooth enamel) for the clean-up workers were always higher as documented of exposure doses of physical measurements. In many cases more than half of total absorbed dose is due to 90 Sr accumulated in teeth. Most of the clean-up workers have poli-symptomatic sicknesses that exhibit tendency to progress, and their morbidity exceeds that observed in general population. ESR dosimetry programs and clinical follow-up improved existing knowledge in the field of radiation medicine. These data will help to develop and apply the proper treatment and rehabilitation procedures for clean-up workers. (author)

  4. A contribution to the study of the biological dosimetry in clinical radiopathology

    International Nuclear Information System (INIS)

    Eston, T.E. de.

    1983-01-01

    The effects of total body irradiation with different radiation doses from a 4MeV linear accelerator on organs and tissues of adult male rabbits were studied. Doses of 0.50, 2.00, 6.00 and 8.00 Gy were applied. Different organic parameters were evaluated before and after various periods of the post-irradiation time. Mortality did not occured for 0.50 or 2.00 Gy, but morbility was greater in comparison with the control; sexual potency was maintained. 'Impotentia colundi' occured with 6 Gy. A small loss of weight occured with 2.00 Gy and a higher loss for 6.00 Gy, with later recovery. Blood parameters varied even for lowest dose. Alterations were evident in the bone marrow activity for 2.00 and 6.00 Gy. Spermatides, spermatocytes and mature spermatozoids were affect even by low doses, the laters loosing motility. Significant difference was observed in the relation DNA/RNA for irradiated-and control animals. The results showed that T3 asssay could serve as 'biological indicator' of irradiation in a period of at least 7 hours and for doses of 4Gy or more. Using the kinetic method, an increase of glutamic oxalacetic transaminase (GOT) seric levels was observed for 6.00 Gy after 7 hours and a decrease for the glutamic pyruvic transaminase (GPT). Fasting glycemy and catecolamines urinary extraction were not statiscally significants. The study of chromosomal aberrations that occur in lymphocytes after 'in vitro' irradiation showed that this is at the present moment the most efficient method for biological dosimetry. (M.A.) [pt

  5. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials.

    Science.gov (United States)

    Chan, An-Wen; Tetzlaff, Jennifer M; Gøtzsche, Peter C; Altman, Douglas G; Mann, Howard; Berlin, Jesse A; Dickersin, Kay; Hróbjartsson, Asbjørn; Schulz, Kenneth F; Parulekar, Wendy R; Krleza-Jeric, Karmela; Laupacis, Andreas; Moher, David

    2013-01-08

    High quality protocols facilitate proper conduct, reporting, and external review of clinical trials. However, the completeness of trial protocols is often inadequate. To help improve the content and quality of protocols, an international group of stakeholders developed the SPIRIT 2013 Statement (Standard Protocol Items: Recommendations for Interventional Trials). The SPIRIT Statement provides guidance in the form of a checklist of recommended items to include in a clinical trial protocol. This SPIRIT 2013 Explanation and Elaboration paper provides important information to promote full understanding of the checklist recommendations. For each checklist item, we provide a rationale and detailed description; a model example from an actual protocol; and relevant references supporting its importance. We strongly recommend that this explanatory paper be used in conjunction with the SPIRIT Statement. A website of resources is also available (www.spirit-statement.org). The SPIRIT 2013 Explanation and Elaboration paper, together with the Statement, should help with the drafting of trial protocols. Complete documentation of key trial elements can facilitate transparency and protocol review for the benefit of all stakeholders.

  6. Evaluating Protocol Lifecycle Time Intervals in HIV/AIDS Clinical Trials

    Science.gov (United States)

    Schouten, Jeffrey T.; Dixon, Dennis; Varghese, Suresh; Cope, Marie T.; Marci, Joe; Kagan, Jonathan M.

    2014-01-01

    Background Identifying efficacious interventions for the prevention and treatment of human diseases depends on the efficient development and implementation of controlled clinical trials. Essential to reducing the time and burden of completing the clinical trial lifecycle is determining which aspects take the longest, delay other stages, and may lead to better resource utilization without diminishing scientific quality, safety, or the protection of human subjects. Purpose In this study we modeled time-to-event data to explore relationships between clinical trial protocol development and implementation times, as well as identify potential correlates of prolonged development and implementation. Methods We obtained time interval and participant accrual data from 111 interventional clinical trials initiated between 2006 and 2011 by NIH’s HIV/AIDS Clinical Trials Networks. We determined the time (in days) required to complete defined phases of clinical trial protocol development and implementation. Kaplan-Meier estimates were used to assess the rates at which protocols reached specified terminal events, stratified by study purpose (therapeutic, prevention) and phase group (pilot/phase I, phase II, and phase III/ IV). We also examined several potential correlates to prolonged development and implementation intervals. Results Even though phase grouping did not determine development or implementation times of either therapeutic or prevention studies, overall we observed wide variation in protocol development times. Moreover, we detected a trend toward phase III/IV therapeutic protocols exhibiting longer developmental (median 2 ½ years) and implementation times (>3years). We also found that protocols exceeding the median number of days for completing the development interval had significantly longer implementation. Limitations The use of a relatively small set of protocols may have limited our ability to detect differences across phase groupings. Some timing effects

  7. Feasibility of Automatic Extraction of Electronic Health Data to Evaluate a Status Epilepticus Clinical Protocol.

    Science.gov (United States)

    Hafeez, Baria; Paolicchi, Juliann; Pon, Steven; Howell, Joy D; Grinspan, Zachary M

    2016-05-01

    Status epilepticus is a common neurologic emergency in children. Pediatric medical centers often develop protocols to standardize care. Widespread adoption of electronic health records by hospitals affords the opportunity for clinicians to rapidly, and electronically evaluate protocol adherence. We reviewed the clinical data of a small sample of 7 children with status epilepticus, in order to (1) qualitatively determine the feasibility of automated data extraction and (2) demonstrate a timeline-style visualization of each patient's first 24 hours of care. Qualitatively, our observations indicate that most clinical data are well labeled in structured fields within the electronic health record, though some important information, particularly electroencephalography (EEG) data, may require manual abstraction. We conclude that a visualization that clarifies a patient's clinical course can be automatically created using the patient's electronic clinical data, supplemented with some manually abstracted data. Future work could use this timeline to evaluate adherence to status epilepticus clinical protocols. © The Author(s) 2015.

  8. A comparison of national and international megavoltage calibration protocols

    International Nuclear Information System (INIS)

    Almond, P.R.

    1985-01-01

    Almond lists, describes and compares the following radiation therapy dosimetry protocols and standards of the following groups: Deutsches Institut fuer Normung (DIN), Nordic Association of Clinical Physics (NACP), National Council on Radiation Protection and Measurements (NCRP), Hospital Physicists Association (HPA), American Association of Physics in Medicine (AAPM), Bureau National de Metrologie (BNM), and the Sociedad Espanola de fisica Medica (SEFM)

  9. Dosimetry methods

    DEFF Research Database (Denmark)

    McLaughlin, W.L.; Miller, A.; Kovacs, A.

    2003-01-01

    Chemical and physical radiation dosimetry methods, used for the measurement of absorbed dose mainly during the practical use of ionizing radiation, are discussed with respect to their characteristics and fields of application....

  10. Dosimetry of pion beams

    International Nuclear Information System (INIS)

    Dicello, J.F.

    1975-01-01

    Negative pion beams are probably the most esoteric and most complicated type of radiation which has been suggested for use in clinical radiotherapy. Because of the limited availability of pion beams in the past, even to nuclear physicists, there exist relatively fewer basic data for this modality. Pion dosimetry is discussed

  11. Review of the correlation between results of cytogenetic dosimetry from blood lymphocytes and EPR dosimetry from tooth enamel for victims of radiation accidents

    International Nuclear Information System (INIS)

    Khvostunov, I.K.; Ivannikov, A.I.; Skvortsov, V.G.; Golub, E.V.; Nugis, V. Yu.

    2015-01-01

    The goal of this study was to compare dose estimates from electron paramagnetic resonance (EPR) dosimetry with teeth and cytogenetic dosimetry with blood lymphocytes for 30 victims of radiation accidents. The whole-body exposures estimated by tooth enamel EPR dosimetry were ranging from 0.01 to 9.3 Gy. Study group comprised victims exposed to acute and prolonged irradiation at high and low dose rate in different accidents. Blood samples were taken from each of them for cytogenetic analysis. Aberrations were scored and analysed according to International Atomic Energy Agency (IAEA) guidelines for conventional and FISH analysis. Tooth samples were collected in dental clinics after they had been extracted during ordinary practice. EPR dosimetry was performed according to the IAEA protocol. EPR dosimetry showed good correlation with dosimetry based on chromosomal analysis. All estimations of cytogenetic dose below detection limit coincide with EPR dose estimates within the ranges of uncertainty. The differences between cytogenetic and EPR assays may occur in a case of previous unaccounted exposure, non-homogeneous irradiation and due to contribution to absorbed dose from neutron irradiation. (authors)

  12. Combining dosimetry and toxicity: analysis of two UK phase III clinical trials

    International Nuclear Information System (INIS)

    Gulliford, Sarah L

    2014-01-01

    There are many advantages to performing a clinical trial when implementing a novel radiotherapy technique. The clinical trials framework enables the safety and efficacy of the 'experimental arm' to be tested and ensures practical support, rigorous quality control and data monitoring for participating centres. In addition to the clinical and follow-up data collected from patients within the trial, it is also possible to collect 3-D dosimetric information from the corresponding radiotherapy treatment plans. Analysing the combination of dosimetric, clinical and follow-up data enhances the understanding of the relationship between the dose delivered to both the target and normal tissue structures and reported outcomes and toxicity. Aspects of the collection, collation and analysis of data from two UK multicentre Phase III radiotherapy trials are presented here. MRC-RT01 dose-escalation prostate radiotherapy trial ISRCTN47772397 was one of the first UK multi-centre radiotherapy trials to collect 3-D dosimetric data. A number of different analysis methodologies were implemented to investigate the relationship between the dose distribution to the rectum and specific rectal toxicities. More recently data was collected from the PARSPORT trial (Parotid Sparing IMRT vs conventional head and neck radiotherapy) ISRCTN48243537. In addition to the planned analysis, dosimetric analysis was employed to investigate an unexpected finding that acute fatigue was more prevalent in the IMRT arm of the trial. It can be challenging to collect 3-D dosimetric information from multicentre radiotherapy trials. However, analysing the relationship between dosimetric and toxicity data provides invaluable information which can influence the next generation of radiotherapy techniques.

  13. How to design and write a clinical research protocol in Cosmetic Dermatology*

    Science.gov (United States)

    Bagatin, Ediléia; Miot, Helio A.

    2013-01-01

    Cosmetic Dermatology is a growing subspecialty. High-quality basic science studies have been published; however, few double-blind, randomized controlled clinical trials, which are the major instrument for evidence-based medicine, have been conducted in this area. Clinical research is essential for the discovery of new knowledge, improvement of scientific basis, resolution of challenges, and good clinical practice. Some basic principles for a successful researcher include interest, availability, persistence, and honesty. It is essential to learn how to write a protocol research and to know the international and national regulatory rules. A complete clinical trial protocol should include question, background, objectives, methodology (design, variable description, sample size, randomization, inclusion and exclusion criteria, intervention, efficacy and safety measures, and statistical analysis), consent form, clinical research form, and references. Institutional ethical review board approval and financial support disclosure are necessary. Publication of positive or negative results should be an authors' commitment. PMID:23539006

  14. SU-F-P-15: Report On AAPM TG 178 Gamma Knife Dosimetry and Quality Assurance

    Energy Technology Data Exchange (ETDEWEB)

    Goetsch, S [San Diego Medical Physics, Solana Beach, CA (United States)

    2016-06-15

    Purpose: AAPM Task Group 178 Gamma Stereotactic Radiosurgery Dosimetry and Quality Assurance was formed in August, 2008. The Task Group has 12 medical physicists, two physicians and two consultants. Methods: A round robin dosimetry intercomparison of proposed ionization chambers, electrometer and dosimetry phantoms was conducted over a 15 month period in 2011 and 2012 (Med Phys 42, 11, Nov, 2015). The data obtained at 9 institutions (with ten different Elekta Gamma Knife units) was analyzed by the lead author using several protocols. Results: The most consistent results were obtained using the Elekta ABS 16cm diameter phantom, with the TG-51 protocol modified as recommended by Alfonso et al (Med Phys 35, 11, Nov 2008). A key white paper (Med Phys, in press) sponsored by Elekta Corporation, was used to obtain correction factors for the ionization chambers and phantoms used in this intercomparison. Consistent results were obtained for both Elekta Gamma Knife Model 4C and Gamma Knife Perfexion units as measured with each of two miniature ionization chambers Conclusion: The full TG 178 report gives clinical history and background of gamma stereotactic radiosurgery, clinical examples and history, quality assurance recommendations and outline of possible dosimetry protocols. The report will be reviewed by the AAPM Working Group on Recommendations for Radiotherapy External Beam Quality Assurance and then by the AAPM Science Council before publication in Medical Physics. Consultant to Elekta, Inc.

  15. SU-F-P-15: Report On AAPM TG 178 Gamma Knife Dosimetry and Quality Assurance

    International Nuclear Information System (INIS)

    Goetsch, S

    2016-01-01

    Purpose: AAPM Task Group 178 Gamma Stereotactic Radiosurgery Dosimetry and Quality Assurance was formed in August, 2008. The Task Group has 12 medical physicists, two physicians and two consultants. Methods: A round robin dosimetry intercomparison of proposed ionization chambers, electrometer and dosimetry phantoms was conducted over a 15 month period in 2011 and 2012 (Med Phys 42, 11, Nov, 2015). The data obtained at 9 institutions (with ten different Elekta Gamma Knife units) was analyzed by the lead author using several protocols. Results: The most consistent results were obtained using the Elekta ABS 16cm diameter phantom, with the TG-51 protocol modified as recommended by Alfonso et al (Med Phys 35, 11, Nov 2008). A key white paper (Med Phys, in press) sponsored by Elekta Corporation, was used to obtain correction factors for the ionization chambers and phantoms used in this intercomparison. Consistent results were obtained for both Elekta Gamma Knife Model 4C and Gamma Knife Perfexion units as measured with each of two miniature ionization chambers Conclusion: The full TG 178 report gives clinical history and background of gamma stereotactic radiosurgery, clinical examples and history, quality assurance recommendations and outline of possible dosimetry protocols. The report will be reviewed by the AAPM Working Group on Recommendations for Radiotherapy External Beam Quality Assurance and then by the AAPM Science Council before publication in Medical Physics. Consultant to Elekta, Inc

  16. Implementation of nuclear magnetic resonance polymer-gel dosimetry into clinical practice

    International Nuclear Information System (INIS)

    Novotny, Josef Jr.

    2003-01-01

    The aim of this thesis research was to evaluate some basic properties of the polymer-gel dosimeter and test it in clinical practice. Dependence of polymer-gel dosimeter sensitivity on different photon and electron energies as well as on different mean dose rates of standard clinically used linear accelerator was studied. A physical/mathematical description of the effect of temperature on the polymer-gel dosimeter, able to correct a dosimeter 1/T2 response for different temperatures during the NMR measurement, was developed. The polymer-gel dosimeter was tested for the verification of stereotactic radiosurgery techniques with the Leksell Gamma Knife. There was an observed trend in polymer-gel dosimeter sensitivity dependence on quality index for the high-energy x ray beams. Similarly, there was an observed trend in dosimeter sensitivity dependence on mean electron energy. It was demonstrated that these trends were statistically significant. Polymer-gel dosimeter sensitivity was decreased with increased photon or electron energy. There was observed no trend in polymer-gel dosimeter sensitivity dependence on mean dose rates for both photon and electron beams within experimental errors. It was demonstrated in this study that the NMR 1/T2-dose response is increased for lower temperatures of the evaluated polymer-gel samples. The relaxation rate response can be expressed as a function consisting of two terms, one denoted for the temperature dependence and the other one for the dose dependence. Two clinical applications of the polymer-gel dosimeter were demonstrated in this study. The first experiment allowed a check of the entire stereotactic procedure with the Leksell gamma knife including target stereotactic localization on NMR, treatment planning, and irradiation. The second experiment evaluated dosimetric and geometric inaccuracies associated with the stereotactic irradiation of the experimental rat brain. It was demonstrated that polymer-gel can be effectively used

  17. Biological and clinical dosimetry. Progress report July 1, 1964-June 30, 1979

    International Nuclear Information System (INIS)

    Laughlin, J.S.; McDonald, J.C.

    1979-01-01

    The dosimetric studies at this laboratory were initiated with the primary goal of developing systems for the determination of absorbed dose in biological research and clinical applications. The primary method under study is the local absorbed dose calorimeter, a concept initiated and developed by J. S. Laughlin. In addition, secondary dosimetric systems such as ionization chambers, chemical dosimeters and thermoluminescent dosimeters (TLD) are being developed and applied to provide an absolute basis for the evaluation and comparison of experiments, treatments, and other procedures using radiation

  18. Monte Carlo study of LDR seed dosimetry with an application in a clinical brachytherapy breast implant.

    Science.gov (United States)

    Furstoss, C; Reniers, B; Bertrand, M J; Poon, E; Carrier, J-F; Keller, B M; Pignol, J P; Beaulieu, L; Verhaegen, F

    2009-05-01

    A Monte Carlo (MC) study was carried out to evaluate the effects of the interseed attenuation and the tissue composition for two models of 125I low dose rate (LDR) brachytherapy seeds (Medi-Physics 6711, IBt InterSource) in a permanent breast implant. The effect of the tissue composition was investigated because the breast localization presents heterogeneities such as glandular and adipose tissue surrounded by air, lungs, and ribs. The absolute MC dose calculations were benchmarked by comparison to the absolute dose obtained from experimental results. Before modeling a clinical case of an implant in heterogeneous breast, the effects of the tissue composition and the interseed attenuation were studied in homogeneous phantoms. To investigate the tissue composition effect, the dose along the transverse axis of the two seed models were calculated and compared in different materials. For each seed model, three seeds sharing the same transverse axis were simulated to evaluate the interseed effect in water as a function of the distance from the seed. A clinical study of a permanent breast 125I implant for a single patient was carried out using four dose calculation techniques: (1) A TG-43 based calculation, (2) a full MC simulation with realistic tissues and seed models, (3) a MC simulation in water and modeled seeds, and (4) a MC simulation without modeling the seed geometry but with realistic tissues. In the latter, a phase space file corresponding to the particles emitted from the external surface of the seed is used at each seed location. The results were compared by calculating the relevant clinical metrics V85, V100, and V200 for this kind of treatment in the target. D90 and D50 were also determined to evaluate the differences in dose and compare the results to the studies published for permanent prostate seed implants in literature. The experimental results are in agreement with the MC absolute doses (within 5% for EBT Gafchromic film and within 7% for TLD-100

  19. Foundations of ionizing radiation dosimetry

    International Nuclear Information System (INIS)

    Denisenko, O.N.; Pereslegin, I.A.

    1985-01-01

    Foundations of dosimetry in application to radiotherapy are presented. General characteristics of ionizing radiations and main characteristics of ionizing radiation sources, mostly used in radiotherapy, are given. Values and units for measuring ionizing radiation (activity of a radioactive substance, absorbed dose, exposure dose, integral dose and dose equivalent are considered. Different methods and instruments for ionizing radiation dosimetry are discussed. The attention is paid to the foundations of clinical dosimetry (representation of anatomo-topographic information, choice of radiation conditions, realization of radiation methods, corrections for a configuration and inhomogeneity of a patient's body, account of biological factors of radiation effects, instruments of dose field formation, control of irradiation procedure chosen)

  20. Water equivalence of some plastic-water phantom materials for clinical proton beam dosimetry

    International Nuclear Information System (INIS)

    Al-Sulaiti, L.; Shipley, D.; Thomas, R.; Owen, P.; Kacperek, A.; Regan, P.H.; Palmans, H.

    2012-01-01

    Plastic-water phantom materials are not exactly water equivalent since they have a different elemental composition and different interaction cross sections for protons than water. Several studies of the water equivalence of plastic-water phantom materials have been reported for photon and electron beams, but none for clinical proton beams. In proton beams, the difference between non-elastic nuclear interactions in plastic-water phantom materials compared to those in water should be considered. In this work, the water equivalence of Plastic Water ® (PW) 1 , Plastic Water ® Diagnostic Therapy (PWDT) 1 and solid water (WT1) 2 phantoms was studied for clinical proton energies of 60 MeV and 200 MeV. This was done by evaluating the fluence correction factor at equivalent depths; first with respect to water and then with respect to graphite by experiment and Monte Carlo (MC) simulations using FLUKA. MC simulations showed that the fluence correction with respect to water was less than 0.5% up to the entire penetration depth of the protons at 60 MeV and less than 1% at 200 MeV up to 20 cm depth for PWDT, PW and WT1. With respect to graphite the fluence correction was about 0.5% for 60 MeV and about 4% for 200 MeV. The experimental results for modulated and un-modulated 60 MeV proton beams showed good agreement with the MC simulated fluence correction factors with respect to graphite deviating less than 1% from unity for the three plastic-water phantoms. - Highlights: ► We study plastic-water in clinical proton beams by experiment and Monte Carlo. ► We obtain fluence correction factors for water and graphite. ► The correction factor for water was close to 1 at 60 MeV and <0.990 at 200 MeV. ► The correction factor for graphite was ∼0.5% at 60 MeV and up to 4% at 200 MeV.

  1. Building a protocol expressway: the case of Mayo Clinic Cancer Center.

    Science.gov (United States)

    McJoynt, Terre A; Hirzallah, Muhanad A; Satele, Daniel V; Pitzen, Jason H; Alberts, Steven R; Rajkumar, S Vincent

    2009-08-10

    Inconsistencies and errors resulting from nonstandard processes, together with redundancies, rework, and excess workload, lead to extended time frames for clinical trial protocol development. This results in dissatisfaction among sponsors, investigators, and staff and restricts the availability of novel treatment options for patients. A team of experts from Mayo Clinic formed, including Protocol Development Unit staff and management from the three Mayo Clinic campuses (Florida, Minnesota, and Arizona), a systems and procedures analyst, a quality office analyst, and two physician members to address the identified deficiencies. The current-state process was intensively reviewed, and improvement steps were taken to accelerate the development and approval of cancer-related clinical trials. The primary goal was to decrease the time from receipt of a new protocol through submission to an approving authority, such as the National Cancer Institute or institutional review board. Using the Define, Measure, Analyze, Improve, Control (DMAIC) framework infused with Lean waste-reduction methodologies, areas were identified for improvement, including enhancing first-time quality and processing new studies on a first-in/first-out basis. The project was successful in improving the mean turnaround time for internally authored protocols (P Lean methodologies is an effective tool to structure the definition, planning, analysis, and implementation of significant process changes.

  2. Advantages and disadvantages of luminescence dosimetry

    Energy Technology Data Exchange (ETDEWEB)

    Olko, Pawel, E-mail: Pawel.Olko@ifj.edu.p [Institute of Nuclear Physics Polish Academy of Science (IFJ PAN), Krakow (Poland)

    2010-03-15

    Owing to their excellent dosimetric properties, luminescence detectors of ionizing radiation are now extensively applied in individual dosimetry services. The most frequently used personal dosemeters are based on Optically Stimulated Luminescence (OSL), radiophotoluminescence (RPL) or thermoluminescence (TL). Luminescence detectors have also found several applications in clinical dosimetry, especially around new radiation modalities in radiotherapy, such as Intensity Modulated Radiotherapy (IMRT) or ion beam radiotherapy. Requirements of luminescence detectors applied in individual and clinical dosimetry and some recent developments in luminescence of detectors and techniques leading to significant improvements of the functionality and accuracy of dosimetry systems are reviewed and discussed.

  3. Economic evaluation of a clinical protocol for diagnosing emergency patients with suspected pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Wolfe Rory

    2006-06-01

    Full Text Available Abstract Background The objective of this paper is to estimate the amount of cost-savings to the Australian health care system from implementing an evidence-based clinical protocol for diagnosing emergency patients with suspected pulmonary embolism (PE at the Emergency department of a Victorian public hospital with 50,000 presentations in 2001–2002. Methods A cost-minimisation study used the data collected in a controlled clinical trial of a clinical protocol for diagnosing patients with suspected PE. Thenumber and type of diagnostic tests in a historic cohort of 185 randomly selected patients, who presented to the emergency department with suspectedPE during an eight month period prior to the clinical trial (January 2002 -August 2002 were compared with the number and type of diagnostic tests in745 patients, who presented to the emergency department with suspected PE from November 2002 to August 2003. Current Medicare fees per test were usedas unit costs to calculate the mean aggregated cost of diagnostic investigation per patient in both study groups. A t-test was used to estimate the statistical significance of the difference in the cost of resources used for diagnosing PE in the control and in the intervention group. Results The trial demonstrated that diagnosing PE using an evidence-based clinical protocol was as effective as the existing clinical practice. The clinical protocol offers the advantage of reducing the use of diagnostic imaging, resulting in an average cost savings of at least $59.30 per patient. Conclusion Extrapolating the observed cost-savings of $59.30 per patient to the wholeof Australia could potentially result in annual savings between $3.1 million to $3.7 million.

  4. Environmental dosimetry

    International Nuclear Information System (INIS)

    Gold, R.

    1977-01-01

    For more than 60 years, natural radiation has offered broad opportunities for basic research as evidenced by many fundamental discoveries. Within the last decade, however, dramatic changes have occurred in the motivation and direction of this research. The urgent need for economical energy sources entailing acceptably low levels of environmental impact has compelled the applied aspects of our radiation environment to become overriding considerations. It is within this general framework that state-of-the-art environmental dosimetry techniques are reviewed. Although applied motivation and relevance underscores the current milieu for both reactor and environmental dosimetry, a perhaps even more unifying force is the broad similarity of reactor and environmental radiation fields. In this review, a comparison of these two mixed radiation fields is presented stressing the underlying similarities that exist. On this basis, the evolution of a strong inner bond between dosimetry methods for both reactor and environmental radiation fields is described. The existence of this bond will be illustrated using representative examples of observed spectra. Dosimetry methods of particularly high applicability for both of these fields are described. Special emphasis is placed on techniques of high sensitivity and absolute accuracy which are capable of resolving the components of these mixed radiation fields

  5. Development of a dynamic quality assurance testing protocol for multisite clinical trial DCE-CT accreditation

    Energy Technology Data Exchange (ETDEWEB)

    Driscoll, B. [Department of Radiation Physics, Princess Margaret Cancer Center, 610 University Avenue, Toronto, Ontario M5G 2M9 (Canada); Keller, H. [Department of Radiation Physics, Princess Margaret Cancer Center, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada and Department of Radiation Oncology, University of Toronto, 150 College Street, Toronto, Ontario M5S 3E2 (Canada); Jaffray, D.; Coolens, C. [Department of Radiation Physics, Princess Margaret Cancer Center, 610 University Avenue, Toronto, Ontario M5G 2M9 (Canada); Department of Radiation Oncology, University of Toronto, 150 College Street, Toronto, Ontario M5S 3E2 (Canada); Techna Institute, University Health Network, 124-100 College Street, Toronto, Ontario M5G 1L5 (Canada)

    2013-08-15

    Purpose: Credentialing can have an impact on whether or not a clinical trial produces useful quality data that is comparable between various institutions and scanners. With the recent increase of dynamic contrast enhanced-computed tomography (DCE-CT) usage as a companion biomarker in clinical trials, effective quality assurance, and control methods are required to ensure there is minimal deviation in the results between different scanners and protocols at various institutions. This paper attempts to address this problem by utilizing a dynamic flow imaging phantom to develop and evaluate a DCE-CT quality assurance (QA) protocol.Methods: A previously designed flow phantom, capable of producing predictable and reproducible time concentration curves from contrast injection was fully validated and then utilized to design a DCE-CT QA protocol. The QA protocol involved a set of quantitative metrics including injected and total mass error, as well as goodness of fit comparison to the known truth concentration curves. An additional region of interest (ROI) sensitivity analysis was also developed to provide additional details on intrascanner variability and determine appropriate ROI sizes for quantitative analysis. Both the QA protocol and ROI sensitivity analysis were utilized to test variations in DCE-CT results using different imaging parameters (tube voltage and current) as well as alternate reconstruction methods and imaging techniques. The developed QA protocol and ROI sensitivity analysis was then applied at three institutions that were part of clinical trial involving DCE-CT and results were compared.Results: The inherent specificity of robustness of the phantom was determined through calculation of the total intraday variability and determined to be less than 2.2 ± 1.1% (total calculated output contrast mass error) with a goodness of fit (R{sup 2}) of greater than 0.99 ± 0.0035 (n= 10). The DCE-CT QA protocol was capable of detecting significant deviations from

  6. Fate of clinical research studies after ethical approval--follow-up of study protocols until publication.

    Directory of Open Access Journals (Sweden)

    Anette Blümle

    Full Text Available Many clinical studies are ultimately not fully published in peer-reviewed journals. Underreporting of clinical research is wasteful and can result in biased estimates of treatment effect or harm, leading to recommendations that are inappropriate or even dangerous.We assembled a cohort of clinical studies approved 2000-2002 by the Research Ethics Committee of the University of Freiburg, Germany. Published full articles were searched in electronic databases and investigators contacted. Data on study characteristics were extracted from protocols and corresponding publications. We characterized the cohort, quantified its publication outcome and compared protocols and publications for selected aspects.Of 917 approved studies, 807 were started and 110 were not, either locally or as a whole. Of the started studies, 576 (71% were completed according to protocol, 128 (16% discontinued and 42 (5% are still ongoing; for 61 (8% there was no information about their course. We identified 782 full publications corresponding to 419 of the 807 initiated studies; the publication proportion was 52% (95% CI: 0.48-0.55. Study design was not significantly associated with subsequent publication. Multicentre status, international collaboration, large sample size and commercial or non-commercial funding were positively associated with subsequent publication. Commercial funding was mentioned in 203 (48% protocols and in 205 (49% of the publications. In most published studies (339; 81% this information corresponded between protocol and publication. Most studies were published in English (367; 88%; some in German (25; 6% or both languages (27; 6%. The local investigators were listed as (co-authors in the publications corresponding to 259 (62% studies.Half of the clinical research conducted at a large German university medical centre remains unpublished; future research is built on an incomplete database. Research resources are likely wasted as neither health care

  7. Assessment of national dosimetry quality audits results for teletherapy machines from 1989 to 2015.

    Science.gov (United States)

    Muhammad, Wazir; Ullah, Asad; Mahmood, Khalid; Matiullah

    2016-01-01

    The purpose of this study was to ensure accuracy in radiation dose delivery, external dosimetry quality audit has an equal importance with routine dosimetry performed at clinics. To do so, dosimetry quality audit was organized by the Secondary Standard Dosimetry Laboratory (SSDL) of Pakistan Institute of Nuclear Science and Technology (PINSTECH) at the national level to investigate and minimize uncertainties involved in the measurement of absorbed dose, and to improve the accuracy of dose measurement at different radiotherapy hospitals. A total of 181 dosimetry quality audits (i.e., 102 of Co-60 and 79 of linear accelerators) for teletherapy units installed at 22 different sites were performed from 1989 to 2015. The percent deviation between users’ calculated/stated dose and evaluated dose (in the result of on-site dosimetry visits) were calculated and the results were analyzed with respect to the limits of ± 2.5% (ICRU "optimal model") ± 3.0% (IAEA on-site dosimetry visits limit) and ± 5.0% (ICRU minimal or "lowest acceptable" model). The results showed that out of 181 total on-site dosimetry visits, 20.44%, 16.02%, and 4.42% were out of acceptable limits of ± 2.5% ± 3.0%, and ± 5.0%, respectively. The importance of a proper ongoing quality assurance program, recommendations of the followed protocols, and properly calibrated thermometers, pressure gauges, and humidity meters at radiotherapy hospitals are essential in maintaining consistency and uniformity of absorbed dose measurements for precision in dose delivery.

  8. TU-FG-201-06: Remote Dosimetric Auditing for Clinical Trials Using EPID Dosimetry: A Pilot Study

    Energy Technology Data Exchange (ETDEWEB)

    Miri, N; Legge, K; Greer, P [Newcastle University, Newcastle, NSW (Australia); Lehmann, J [Calvary Mater Newcastle, Newcastle, NSW (Australia); Vial, P [Liverpool Hospital, Sydney, NSW (Australia)

    2016-06-15

    Purpose: To perform a pilot study for remote dosimetric credentialing of intensity modulated radiation therapy (IMRT) based clinical trials. The study introduces a novel, time efficient and inexpensive dosimetry audit method for multi-center credentialing. The method employs electronic portal imaging device (EPID) to reconstruct delivered dose inside a virtual flat/cylindrical water phantom. Methods: Five centers, including different accelerator types and treatment planning systems (TPS), were asked to download two CT data sets of a Head and Neck (H&N) and Postprostatectomy (P-P) patients to produce benchmark plans. These were then transferred to virtual flat and cylindrical phantom data sets that were also provided. In-air EPID images of the plans were then acquired, and the data sent to the central site for analysis. At the central site, these were converted to DICOM format, all images were used to reconstruct 2D and 3D dose distributions inside respectively the flat and cylindrical phantoms using inhouse EPID to dose conversion software. 2D dose was calculated for individual fields and 3D dose for the combined fields. The results were compared to corresponding TPS doses. Three gamma criteria were used, 3%3mm-3%/2mm–2%/2mm with a 10% dose threshold, to compare the calculated and prescribed dose. Results: All centers had a high pass rate for the criteria of 3%/3 mm. For 2D dose, the average of centers mean pass rate was 99.6% (SD: 0.3%) and 99.8% (SD: 0.3%) for respectively H&N and PP patients. For 3D dose, 3D gamma was used to compare the model dose with TPS combined dose. The mean pass rate was 97.7% (SD: 2.8%) and 98.3% (SD: 1.6%). Conclusion: Successful performance of the method for the pilot centers establishes the method for dosimetric multi-center credentialing. The results are promising and show a high level of gamma agreement and, the procedure is efficient, consistent and inexpensive. Funding has been provided from Department of Radiation Oncology

  9. Dosimetry in radioiodine therapy of benign thyroid diseases. Background and practice; Dosimetrie bei Radioiodtherapie benigner Schilddruesenerkrankungen. Hintergrund und Durchfuehrung

    Energy Technology Data Exchange (ETDEWEB)

    Bockisch, A.; Sonnenschein, W.; Jentzen, W.; Hartung, V.; Goerges, R. [Universitaetsklinikum Essen (Germany). Klinik fuer Nuklearmedizin

    2008-09-15

    Radioiodine therapy of benign thyroid diseases (focal = [toxic adenoma], multifocal, disseminated autonomy, Grave's disease or clinical relevant goitre) needs to be and can be performed individually for each patient. Most frequently a radioiodine test is performed applying a small activity of iodine-131 ({sup 131}I). The paper discusses some protocols for pre- or posttherapeutic dosimetry and discusses their advantages and disadvantages. All are based on the volumetry of the target tissue as well as the radioiodine kinetics in the target volume what may be represented by maximum uptake and half life of iodine retention in the thyroid. Possible disturbances and measuring uncertainties of these parameters are presented and discussed. In spite of the discussed uncertainties in dosimetry, due to its high therapeutic width radioiodine therapy is a very successful procedure to cure hyperthyroidism or to reduce goitre volume with only little side effects. (orig.)

  10. Neutron personnel dosimetry

    International Nuclear Information System (INIS)

    Griffith, R.V.

    1981-01-01

    The current state-of-the-art in neutron personnel dosimetry is reviewed. Topics covered include dosimetry needs and alternatives, current dosimetry approaches, personnel monitoring devices, calibration strategies, and future developments

  11. An experimental and Monte Carlo investigation of the energy dependence of alanine/EPR dosimetry: I. Clinical x-ray beams

    International Nuclear Information System (INIS)

    Zeng, G G; McEwen, M R; Rogers, D W O; Klassen, N V

    2004-01-01

    The energy dependence of alanine/EPR dosimetry, in terms of absorbed dose-to-water for clinical 6, 10, 25 MV x-rays and 60 Co rays was investigated by measurements and Monte Carlo (MC) calculations. The dose rates were traceable to the NRC primary standard for absorbed dose, a sealed water calorimetry. The electron paramagnetic resonance (EPR) spectra of irradiated pellets were measured using a Bruker EMX 081 EPR spectrometer. The DOSRZnrc Monte Carlo code of the EGSnrc system was used to simulate the experimental conditions with BEAM code calculated input spectra of x-rays and γ-rays. Within the experimental uncertainty of 0.5%, the alanine EPR response to absorbed dose-to-water for x-rays was not dependent on beam quality from 6 MV to 25 MV, but on average, it was about 0.6% lower than its response to 60 Co gamma rays. Combining experimental data with Monte Carlo calculations, it is found that the alanine/EPR response per unit absorbed dose-to-alanine is the same for clinical x-rays and 60 Co gamma rays within the uncertainty of 0.6%. Monte Carlo simulations showed that neither the presence of PMMA holder nor varying the dosimeter thickness between 1 mm and 5 mm has significant effect on the energy dependence of alanine/EPR dosimetry within the calculation uncertainty of 0.3%

  12. Dosimetry, clinical factors and medication intake influencing urinary symptoms after prostate radiotherapy: An analysis of data from the RADAR prostate radiotherapy trial

    International Nuclear Information System (INIS)

    Yahya, Noorazrul; Ebert, Martin A.; Bulsara, Max; Haworth, Annette; Kennedy, Angel; Joseph, David J.; Denham, Jim W.

    2015-01-01

    Purpose/objective: To identify dosimetry, clinical factors and medication intake impacting urinary symptoms after prostate radiotherapy. Material and methods: Data describing clinical factors and bladder dosimetry (reduced with principal component (PC) analysis) for 754 patients treated with external beam radiotherapy accrued by TROG 03.04 RADAR prostate radiotherapy trial were available for analysis. Urinary symptoms (frequency, incontinence, dysuria and haematuria) were prospectively assessed using LENT-SOMA to a median of 72 months. The endpoints assessed were prevalence (grade ⩾1) at the end of radiotherapy (representing acute symptoms), at 18-, 36- and 54-month follow-ups (representing late symptoms) and peak late incidence including only grade ⩾2. Impact of factors was assessed using multivariate logistic regression models with correction for over-optimism. Results: Baseline symptoms, non-insulin dependent diabetes mellitus, age and PC1 (correlated to the mean dose) impact symptoms at >1 timepoints. Associations at a single timepoint were found for cerebrovascular condition, ECOG status and non-steroidal anti-inflammatory drug intake. Peak incidence analysis shows the impact of baseline, bowel and cerebrovascular condition and smoking status. Conclusions: The prevalence and incidence analysis provide a complementary view for urinary symptom prediction. Sustained impacts across time points were found for several factors while some associations were not repeated at different time points suggesting poorer or transient impact

  13. Adoption of the children's obesity clinic's treatment (TCOCT) protocol into another Danish pediatric obesity treatment clinic

    DEFF Research Database (Denmark)

    Most, Sebastian W; Højgaard, Birgitte; Teilmann, Grete Katrine

    2015-01-01

    BACKGROUND: Treating severe childhood obesity has proven difficult with inconsistent treatment results. This study reports the results of the implementation of a childhood obesity chronic care treatment protocol. METHODS: Patients aged 5 to 18 years with a body mass index (BMI) above the 99th......, but independent of baseline BMI SDS, age, co-morbidity, SES, pubertal stage, place of referral, hours of treatment per year, and mean visit interval time. CONCLUSIONS: The systematic use of the TCOCT protocol reduced the degree of childhood obesity with acceptable retention rates with a modest time...... percentile for sex and age were eligible for inclusion. At baseline patients' height, weight, and tanner stages were measured, as well as parents' socioeconomic status (SES) and family structure. Parental weight and height were self-reported. An individualised treatment plan including numerous advices...

  14. Hearing screening procedures and protocols in use at immunisation clinics in South Africa

    Directory of Open Access Journals (Sweden)

    Luisa Petrocchi-Bartal

    2014-12-01

    Full Text Available Background: There exists a need for context-relevant research aimed at facilitating the efficacious provision of early hearing detection and intervention services in South Africa. Objectives: This study aimed to determine the hearing screening procedures and protocols as well as referral protocols in use at maternal child woman’s health (MCWH immunisation clinics in South Africa. Method: Thirty primary health care immunisation clinic managers or acting managers were interviewed in two South African sample groups. An exploratory, non-experimental,qualitative research design was employed incorporating both quantitative and qualitative information. An interview using a questionnaire was administered with all participants. The questionnaire encompassed areas such as work contexts, hearing screening contexts and information management systems, as well as quality control measures in place at these clinics.Content analysis was then used to code emergent themes into specific categories. Frequency calculations of these themes were calculated and results described qualitatively. Results: No primary health care (PHC clinics placed within the identified sites provided formalised new-born/infant hearing screening and none of these facilities had equipment to do so. Most sites attributed the lack of formalised hearing screening to budgetary and human resource issues, staff training in particular. Non-formalised hearing screening protocols in place demonstrated inconsistencies in application across districts and none complied with Health Professions Council of South Africa (HPCSA clinic guidelines or any international guidelines. Conclusion: Results from the current study have assisted in identifying procedural and logistical assets and barriers to implementation of HPCSA clinic guidelines for early hearing detection and intervention (EHDI at immunisation clinics in South Africa.

  15. P-02: Echocardiography Has Low Clinical Efficacy of Libyan Screening Protocol in Athletes

    Directory of Open Access Journals (Sweden)

    Salaheddin Sharif

    2017-03-01

    Full Text Available INTRODUCTIONPre-participation screening has been largely accepted as a means to identify those athletes at risk of cardiovascular diseases which are responsible for sudden cardiac death. The objectives of athlete screening are to reduce injuries and prevent sudden. However, there is no single commonly adopted protocol to screen athletes. Although the European Society of Cardiology and the American Heart Association recommend the routine screening of athletes to prevent sudden death, there is significant disagreement regarding use 12 lead ECG. FIFA has recommend the inclusion of an Echocardiography (ECHO in screening protocol.PURPOSEExplore the debate regarding differences between European and the USA pre-participation screening protocol for sudden death while also considering pre-competition medical assessment protocol used by the Libyan Football Federation. To provide evidence based recommendations on the best protocol to be used for pre-participation screening, and thus to standardize the screening method.MATERIALS and METHOD1236 male athletic received a medical history, general physical examination, cardiovascular and musculoskeletal examination, 12 lead ECG, blood laboratory test, and echocardiography.FINDINGS1235 athletics were found to be eligible to participate in sport and were given a full medical clearance. One athletic was diagnosed with second degree heart block by ECG while his medical history, physical examination, echocardiograph, and blood test were normal.DISCUSSIONEchocardiography alone do did not identify pathological condition and using echocardiography is still controversial and clinically not effective in young athletesCONCLUSIONThe Screening protocol should include a combination of medical history, physical examination and ECG due to the high sensitivity found, and thus it was able to identify all athletes at risk for the disease.

  16. Clinical impact of 99mTc-MAA SPECT/CT-based dosimetry in the radioembolization of liver malignancies with 90Y-loaded microspheres

    International Nuclear Information System (INIS)

    Garin, Etienne; Rolland, Yan; Laffont, Sophie; Edeline, Julien

    2016-01-01

    Radioembolization with 90 Y-loaded microspheres is increasingly used in the treatment of primary and secondary liver cancer. Technetium-99 m macroaggregated albumin (MAA) scintigraphy is used as a surrogate of microsphere distribution to assess lung or digestive shunting prior to therapy, based on tumoral targeting and dosimetry. To date, this has been the sole pre-therapeutic tool available for such evaluation. Several dosimetric approaches have been described using both glass and resin microspheres in hepatocellular carcinoma (HCC) and liver metastasis. Given that each product offers different specific activities and numbers of spheres injected, their radiobiological properties are believed to lightly differ. This paper summarizes and discusses the available studies focused on MAA-based dosimetry, particularly concentrating on potential confounding factors like clinical context, tumor size, cirrhosis, previous or concomitant therapy, and product used. In terms of the impact of tumoral dose in HCC, the results were concordant and a response relationship and tumoral threshold dose was clearly identified, especially in studies using glass microspheres. Tumoral dose has also been found to influence survival. The concept of treatment intensification has recently been introduced, yet despite several studies publishing interesting findings on the tumor dose-metastasis relationship, no consensus has been reached, and further clarification is thus required. Nor has the maximal tolerated dose to the liver been well documented, requiring more accurate evaluation. Lung dose was well described, despite recently identified factors influencing its evaluation, requiring further assessment. MAA SPECT/CT dosimetry is accurate in HCC and can now be used in order to achieve a fully customized approach, including treatment intensification. Yet further studies are warranted for the metastasis setting and evaluating the maximal tolerated liver dose. (orig.)

  17. Clinical impact of {sup 99m}Tc-MAA SPECT/CT-based dosimetry in the radioembolization of liver malignancies with {sup 90}Y-loaded microspheres

    Energy Technology Data Exchange (ETDEWEB)

    Garin, Etienne [Cancer Institute Eugene Marquis, Department of Nuclear Medicine, Rennes (France); University of Rennes 1, Rennes (France); INSERM, U-991, Liver Metabolisms and Cancer, Rennes (France); Rolland, Yan [Cancer Institute Eugene Marquis, Department of Medical Imaging, Rennes (France); Laffont, Sophie [University of Rennes 1, Rennes (France); Edeline, Julien [University of Rennes 1, Rennes (France); INSERM, U-991, Liver Metabolisms and Cancer, Rennes (France); Cancer Institute Eugene Marquis, Department of Medical Oncology, Rennes (France)

    2016-03-15

    Radioembolization with {sup 90}Y-loaded microspheres is increasingly used in the treatment of primary and secondary liver cancer. Technetium-99 m macroaggregated albumin (MAA) scintigraphy is used as a surrogate of microsphere distribution to assess lung or digestive shunting prior to therapy, based on tumoral targeting and dosimetry. To date, this has been the sole pre-therapeutic tool available for such evaluation. Several dosimetric approaches have been described using both glass and resin microspheres in hepatocellular carcinoma (HCC) and liver metastasis. Given that each product offers different specific activities and numbers of spheres injected, their radiobiological properties are believed to lightly differ. This paper summarizes and discusses the available studies focused on MAA-based dosimetry, particularly concentrating on potential confounding factors like clinical context, tumor size, cirrhosis, previous or concomitant therapy, and product used. In terms of the impact of tumoral dose in HCC, the results were concordant and a response relationship and tumoral threshold dose was clearly identified, especially in studies using glass microspheres. Tumoral dose has also been found to influence survival. The concept of treatment intensification has recently been introduced, yet despite several studies publishing interesting findings on the tumor dose-metastasis relationship, no consensus has been reached, and further clarification is thus required. Nor has the maximal tolerated dose to the liver been well documented, requiring more accurate evaluation. Lung dose was well described, despite recently identified factors influencing its evaluation, requiring further assessment. MAA SPECT/CT dosimetry is accurate in HCC and can now be used in order to achieve a fully customized approach, including treatment intensification. Yet further studies are warranted for the metastasis setting and evaluating the maximal tolerated liver dose. (orig.)

  18. Defining robustness protocols: a method to include and evaluate robustness in clinical plans

    International Nuclear Information System (INIS)

    McGowan, S E; Albertini, F; Lomax, A J; Thomas, S J

    2015-01-01

    We aim to define a site-specific robustness protocol to be used during the clinical plan evaluation process. Plan robustness of 16 skull base IMPT plans to systematic range and random set-up errors have been retrospectively and systematically analysed. This was determined by calculating the error-bar dose distribution (ebDD) for all the plans and by defining some metrics used to define protocols aiding the plan assessment. Additionally, an example of how to clinically use the defined robustness database is given whereby a plan with sub-optimal brainstem robustness was identified. The advantage of using different beam arrangements to improve the plan robustness was analysed. Using the ebDD it was found range errors had a smaller effect on dose distribution than the corresponding set-up error in a single fraction, and that organs at risk were most robust to the range errors, whereas the target was more robust to set-up errors. A database was created to aid planners in terms of plan robustness aims in these volumes. This resulted in the definition of site-specific robustness protocols. The use of robustness constraints allowed for the identification of a specific patient that may have benefited from a treatment of greater individuality. A new beam arrangement showed to be preferential when balancing conformality and robustness for this case. The ebDD and error-bar volume histogram proved effective in analysing plan robustness. The process of retrospective analysis could be used to establish site-specific robustness planning protocols in proton therapy. These protocols allow the planner to determine plans that, although delivering a dosimetrically adequate dose distribution, have resulted in sub-optimal robustness to these uncertainties. For these cases the use of different beam start conditions may improve the plan robustness to set-up and range uncertainties. (paper)

  19. Defining robustness protocols: a method to include and evaluate robustness in clinical plans

    Science.gov (United States)

    McGowan, S. E.; Albertini, F.; Thomas, S. J.; Lomax, A. J.

    2015-04-01

    We aim to define a site-specific robustness protocol to be used during the clinical plan evaluation process. Plan robustness of 16 skull base IMPT plans to systematic range and random set-up errors have been retrospectively and systematically analysed. This was determined by calculating the error-bar dose distribution (ebDD) for all the plans and by defining some metrics used to define protocols aiding the plan assessment. Additionally, an example of how to clinically use the defined robustness database is given whereby a plan with sub-optimal brainstem robustness was identified. The advantage of using different beam arrangements to improve the plan robustness was analysed. Using the ebDD it was found range errors had a smaller effect on dose distribution than the corresponding set-up error in a single fraction, and that organs at risk were most robust to the range errors, whereas the target was more robust to set-up errors. A database was created to aid planners in terms of plan robustness aims in these volumes. This resulted in the definition of site-specific robustness protocols. The use of robustness constraints allowed for the identification of a specific patient that may have benefited from a treatment of greater individuality. A new beam arrangement showed to be preferential when balancing conformality and robustness for this case. The ebDD and error-bar volume histogram proved effective in analysing plan robustness. The process of retrospective analysis could be used to establish site-specific robustness planning protocols in proton therapy. These protocols allow the planner to determine plans that, although delivering a dosimetrically adequate dose distribution, have resulted in sub-optimal robustness to these uncertainties. For these cases the use of different beam start conditions may improve the plan robustness to set-up and range uncertainties.

  20. Dosimetry in life sciences

    International Nuclear Information System (INIS)

    1975-01-01

    The uses of radiation in medicine and biology have grown in scope and diversity to make the Radiological Sciences a significant factor in both research and medical practice. Of critical importance in the applications and development of biomedical and radiological techniques is the precision with which the dose may be determined at all points of interest in the absorbing medium. This has developed as a result of efficacy of investigations in clinical radiation therapy, concern for patient safety and diagnostic accuracy in diagnostic radiology and the advent of clinical trials and research into the use of heavily ionizing radiations in biology and medicine. Since the last IAEA Symposium on Dosimetry Techniques applied to Agriculture, Industry, Biology and Medicine, held in Vienna in 1972, it has become increasingly clear that advances in the techniques and hardware of biomedical dosimetry have been rapid. It is for these reasons that this symposium was organized in a concerted effort to focus on the problems, developments and areas of further research in dosimetry in the Life Sciences. (author)

  1. Dosimetry in life sciences

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1975-06-15

    The uses of radiation in medicine and biology have grown in scope and diversity to make the Radiological Sciences a significant factor in both research and medical practice. Of critical importance in the applications and development of biomedical and radiological techniques is the precision with which the dose may be determined at all points of interest in the absorbing medium. This has developed as a result of efficacy of investigations in clinical radiation therapy, concern for patient safety and diagnostic accuracy in diagnostic radiology and the advent of clinical trials and research into the use of heavily ionizing radiations in biology and medicine. Since the last IAEA Symposium on Dosimetry Techniques applied to Agriculture, Industry, Biology and Medicine, held in Vienna in 1972, it has become increasingly clear that advances in the techniques and hardware of biomedical dosimetry have been rapid. It is for these reasons that this symposium was organized in a concerted effort to focus on the problems, developments and areas of further research in dosimetry in the Life Sciences. (author)

  2. Pregnancy outcome of “delayed start” GnRH antagonist protocol versus GnRH antagonist protocol in poor responders: A clinical trial study

    Directory of Open Access Journals (Sweden)

    Abbas Aflatoonian

    2017-08-01

    Full Text Available Background: Management of poor-responding patients is still major challenge in assisted reproductive techniques (ART. Delayed-start GnRH antagonist protocol is recommended to these patients, but little is known in this regards. Objective: The goal of this study was assessment of delayed-start GnRH antagonist protocol in poor responders, and in vitro fertilization (IVF outcomes. Materials and Methods: This randomized clinical trial included sixty infertile women with Bologna criteria for ovarian poor responders who were candidate for IVF. In case group (n=30, delayed-start GnRH antagonist protocol administered estrogen priming followed by early follicular-phase GnRH antagonist treatment for 7 days before ovarian stimulation with gonadotropin. Control group (n=30 treated with estrogen priming antagonist protocol. Finally, endometrial thickness, the rates of oocytes maturation, , embryo formation, and pregnancy were compared between two groups. Results: Rates of implantation, chemical, clinical, and ongoing pregnancy in delayed-start cycles were higher although was not statistically significant. Endometrial thickness was significantly higher in case group. There were no statistically significant differences in the rates of oocyte maturation, embryo formation, and IVF outcomes between two groups. Conclusion: There is no significant difference between delayed-start GnRH antagonist protocol versus GnRH antagonist protocol.

  3. Neutron beam measurement dosimetry

    International Nuclear Information System (INIS)

    Amaro, C.R.

    1995-01-01

    This report describes animal dosimetry studies and phantom measurements. During 1994, 12 dogs were irradiated at BMRR as part of a 4 fraction dose tolerance study. The animals were first infused with BSH and irradiated daily for 4 consecutive days. BNL irradiated 2 beagles as part of their dose tolerance study using BPA fructose. In addition, a dog at WSU was irradiated at BMRR after an infusion of BPA fructose. During 1994, the INEL BNCT dosimetry team measured neutron flux and gamma dose profiles in two phantoms exposed to the epithermal neutron beam at the BMRR. These measurements were performed as a preparatory step to the commencement of human clinical trials in progress at the BMRR

  4. Development and implementation of intranasal naloxone opioid overdose response protocol at a homeless health clinic.

    Science.gov (United States)

    Dahlem, Chin Hwa Y; Horstman, Molly J; Williams, Brent C

    2016-01-01

    To describe the development, implementation, and preliminary evaluation of Opioid Overdose Response Protocol using intranasal (IN) naloxone in a homeless shelter. Opioid Overdose Response Protocol and training curriculum were developed using the Massachusetts Department of Public Health Opioid Overdose Education and Naloxone Distribution (OEND) flow chart, the American Heart Association (AHA) simplified adult basic life support algorithm, and resources through Harms Reduction Coalition. Intranasal naloxone offers a safe and effective method for opioid reversal. To combat the rising incidence of opioid overdose, IN naloxone should be made available at homeless shelters and other facilities with high frequency of opioid overdose, including the training of appropriate staff. This project has demonstrated the effective training and implementation of an Opioid Overdose Response Protocol, based on feedback received from cardiopulmonary resuscitation (CPR) trained nonhealthcare staff. Nurse practitioners (NPs), with our focus on patient care, prevention, and education, are well suited to the deployment of this life-saving protocol. NPs are in critical positions to integrate opioid overdose prevention education and provide naloxone rescue kits in clinical practices. ©2015 American Association of Nurse Practitioners.

  5. The Interface of Clinical Decision-Making With Study Protocols for Knowledge Translation From a Walking Recovery Trial.

    Science.gov (United States)

    Hershberg, Julie A; Rose, Dorian K; Tilson, Julie K; Brutsch, Bettina; Correa, Anita; Gallichio, Joann; McLeod, Molly; Moore, Craig; Wu, Sam; Duncan, Pamela W; Behrman, Andrea L

    2017-01-01

    Despite efforts to translate knowledge into clinical practice, barriers often arise in adapting the strict protocols of a randomized, controlled trial (RCT) to the individual patient. The Locomotor Experience Applied Post-Stroke (LEAPS) RCT demonstrated equal effectiveness of 2 intervention protocols for walking recovery poststroke; both protocols were more effective than usual care physical therapy. The purpose of this article was to provide knowledge-translation tools to facilitate implementation of the LEAPS RCT protocols into clinical practice. Participants from 2 of the trial's intervention arms: (1) early Locomotor Training Program (LTP) and (2) Home Exercise Program (HEP) were chosen for case presentation. The two cases illustrate how the protocols are used in synergy with individual patient presentations and clinical expertise. Decision algorithms and guidelines for progression represent the interface between implementation of an RCT standardized intervention protocol and clinical decision-making. In each case, the participant presents with a distinct clinical challenge that the therapist addresses by integrating the participant's unique presentation with the therapist's expertise while maintaining fidelity to the LEAPS protocol. Both participants progressed through an increasingly challenging intervention despite their own unique presentation. Decision algorithms and exercise progression for the LTP and HEP protocols facilitate translation of the RCT protocol to the real world of clinical practice. The two case examples to facilitate translation of the LEAPS RCT into clinical practice by enhancing understanding of the protocols, their progression, and their application to individual participants.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A147).

  6. Proton therapy posterior beam approach with pencil beam scanning for esophageal cancer. Clinical outcome, dosimetry, and feasibility

    Energy Technology Data Exchange (ETDEWEB)

    Zeng, Yue-Can [Shengjing Hospital of China Medical University, Department of Medical Oncology, Cancer Center, Shenyang (China); University of Washington Medical Center, Department of Radiation Oncology, 1959 NE Pacific Street, Campus Box 356043, Seattle, WA (United States); Vyas, Shilpa; Apisarnthanarax, Smith; Zeng, Jing [University of Washington Medical Center, Department of Radiation Oncology, 1959 NE Pacific Street, Campus Box 356043, Seattle, WA (United States); Dang, Quang; Schultz, Lindsay [Seattle Cancer Care Alliance Proton Therapy Center, Seattle, WA (United States); Bowen, Stephen R. [University of Washington Medical Center, Department of Radiation Oncology, 1959 NE Pacific Street, Campus Box 356043, Seattle, WA (United States); University of Washington Medical Center, Department of Radiology, Seattle, WA (United States); Shankaran, Veena [University of Washington Medical Center, Department of Medical Oncology, Seattle, WA (United States); Farjah, Farhood [University of Washington Medical Center, Department of Surgery, Division of Cardiothoracic Surgery, Seattle, WA (United States); University of Washington Medical Center, Department of Surgery, Surgical Outcomes Research Center, Seattle, WA (United States); Oelschlager, Brant K. [University of Washington Medical Center, Department of Surgery, Seattle, WA (United States)

    2016-12-15

    The aim of this study is to present the dosimetry, feasibility, and preliminary clinical results of a novel pencil beam scanning (PBS) posterior beam technique of proton treatment for esophageal cancer in the setting of trimodality therapy. From February 2014 to June 2015, 13 patients with locally advanced esophageal cancer (T3-4N0-2M0; 11 adenocarcinoma, 2 squamous cell carcinoma) were treated with trimodality therapy (neoadjuvant chemoradiation followed by esophagectomy). Eight patients were treated with uniform scanning (US) and 5 patients were treated with a single posterior-anterior (PA) beam PBS technique with volumetric rescanning for motion mitigation. Comparison planning with PBS was performed using three plans: AP/PA beam arrangement; PA plus left posterior oblique (LPO) beams, and a single PA beam. Patient outcomes, including pathologic response and toxicity, were evaluated. All 13 patients completed chemoradiation to 50.4 Gy (relative biological effectiveness, RBE) and 12 patients underwent surgery. All 12 surgical patients had an R0 resection and pathologic complete response was seen in 25 %. Compared with AP/PA plans, PA plans have a lower mean heart (14.10 vs. 24.49 Gy, P < 0.01), mean stomach (22.95 vs. 31.33 Gy, P = 0.038), and mean liver dose (3.79 vs. 5.75 Gy, P = 0.004). Compared to the PA/LPO plan, the PA plan reduced the lung dose: mean lung dose (4.96 vs. 7.15 Gy, P = 0.020) and percentage volume of lung receiving 20 Gy (V{sub 20}; 10 vs. 17 %, P < 0.01). Proton therapy with a single PA beam PBS technique for preoperative treatment of esophageal cancer appears safe and feasible. (orig.) [German] Wir stellen die Vergleichsdosimetrie, Realisierbarkeit und die vorlaeufigen klinischen Ergebnisse einer neuen Pencil-Beam-Scanning(-PBS)/Posterior-Beam-Methode innerhalb der Protonentherapie fuer Speiseroehrenkrebs im Setting einer trimodalen Therapie vor. Von Februar 2014 bis Juni 2015 erhielten 13 Patienten mit lokal fortgeschrittenem

  7. A proposed protocol for hand and table sanitizing in chiropractic clinics and education institutions

    Science.gov (United States)

    Evans, Marion Willard; Ramcharan, Michael; Floyd, Rod; Globe, Gary; Ndetan, Harrison; Williams, Ronald; Ivie, Ronald

    2009-01-01

    Abstract Objective By nature, chiropractic is a hands-on profession using manipulation applied to the joints with direct skin-to-skin contacts. Chiropractic tables are designed with a face piece to accommodate the prone patient's head in a neutral position and hand rests to allow for relaxed shoulders and upper spine so treatment is facilitated. The purpose of this article is to present a proposed guideline for hand and treatment table surface sanitizing for the chiropractic profession that is evidence-based and can easily be adopted by teaching institutions and doctors in the field. Methods A review of the chiropractic literature demonstrated that pathogenic microbes are present on treatment tables in teaching clinics at multiple facilities, yet no standardized protocols exist in the United States regarding table sanitizing and hand hygiene in chiropractic clinics or education institutions. This article reviews the scientific literature on the subject by using several search engines, databases, and specific reviews of documents pertaining to the topic including existing general guidelines. Results The literature has several existing guidelines that the authors used to develop a proposed protocol for hand and table sanitizing specific to the chiropractic profession. Recommendations were developed and are presented on hand hygiene and table sanitizing procedures that could lower the risk of infection for both clinical personnel and patients in chiropractic facilities. Conclusion This article offers a protocol for hand and table sanitizing in chiropractic clinics and education institutions. The chiropractic profession should consider adoption of these or similar measures and disseminate them to teaching clinics, institutions, and private practitioners. PMID:19646384

  8. Integrating usability testing and think-aloud protocol analysis with "near-live" clinical simulations in evaluating clinical decision support.

    Science.gov (United States)

    Li, Alice C; Kannry, Joseph L; Kushniruk, Andre; Chrimes, Dillon; McGinn, Thomas G; Edonyabo, Daniel; Mann, Devin M

    2012-11-01

    Usability evaluations can improve the usability and workflow integration of clinical decision support (CDS). Traditional usability testing using scripted scenarios with think-aloud protocol analysis provide a useful but incomplete assessment of how new CDS tools interact with users and clinical workflow. "Near-live" clinical simulations are a newer usability evaluation tool that more closely mimics clinical workflow and that allows for a complementary evaluation of CDS usability as well as impact on workflow. This study employed two phases of testing a new CDS tool that embedded clinical prediction rules (an evidence-based medicine tool) into primary care workflow within a commercial electronic health record. Phase I applied usability testing involving "think-aloud" protocol analysis of 8 primary care providers encountering several scripted clinical scenarios. Phase II used "near-live" clinical simulations of 8 providers interacting with video clips of standardized trained patient actors enacting the clinical scenario. In both phases, all sessions were audiotaped and had screen-capture software activated for onscreen recordings. Transcripts were coded using qualitative analysis methods. In Phase I, the impact of the CDS on navigation and workflow were associated with the largest volume of negative comments (accounting for over 90% of user raised issues) while the overall usability and the content of the CDS were associated with the most positive comments. However, usability had a positive-to-negative comment ratio of only 0.93 reflecting mixed perceptions about the usability of the CDS. In Phase II, the duration of encounters with simulated patients was approximately 12 min with 71% of the clinical prediction rules being activated after half of the visit had already elapsed. Upon activation, providers accepted the CDS tool pathway 82% of times offered and completed all of its elements in 53% of all simulation cases. Only 12.2% of encounter time was spent using the

  9. Assessment of CaSO4:Dy and LiF:Mg,Ti thermoluminescent dosimeters performance in the dosimetry of clinical electron beams

    International Nuclear Information System (INIS)

    Nunes, Maira Goes

    2008-01-01

    The assessment of the performance of CaS0 4 :Dy thermoluminescent detectors produced by IPEN in the dosimetry of clinical electron beams aims to propose an alternative to the LiF:Mg,Ti commercial dosimeters (TLD-100) largely applied in radiation therapy. The two types of thermoluminescent dosimeters were characterised with the use of PMMA, RMI-457 type solid water and water phantoms in radiation fields of 4, 6, 9, 12 and 16 MeV electrons of nominal energies in which the dose-response curves were obtained and the surface and depth doses were determined. The thermoluminescent response dependency with the electron nominal energies and the applied phantom were studied. The CaS0 4 :Dy presented the same behaviour than the LiF:Mg,Ti in such a way that its application as an alternative to the TLD-100 pellets in the radiation therapy dosimetry of electron beams is viable and presents the significantly higher sensitivity to the electron radiation as its main advantage. (author)

  10. Clinical development of a failure detection-based online repositioning strategy for prostate IMRT--Experiments, simulation, and dosimetry study

    International Nuclear Information System (INIS)

    Liu Wu; Qian Jianguo; Hancock, Steven L.; Xing, Lei; Luxton, Gary

    2010-01-01

    Purpose: To implement and evaluate clinic-ready adaptive imaging protocols for online patient repositioning (motion tracking) during prostate IMRT using treatment beam imaging supplemented by minimal, as-needed use of on-board kV. Methods: The authors examine the two-step decision-making strategy: (1) Use cine-MV imaging and online-updated characterization of prostate motion to detect target motion that is potentially beyond a predefined threshold and (2) use paired MV-kV 3D localization to determine overthreshold displacement and, if needed, reposition the patient. Two levels of clinical implementation were evaluated: (1) Field-by-field based motion correction for present-day linacs and (2) instantaneous repositioning for new-generation linacs with capabilities of simultaneous MV-kV imaging and remote automatic couch control during treatment delivery. Experiments were performed on a Varian Trilogy linac in clinical mode using a 4D motion phantom programed with prostate motion trajectories taken from patient data. Dosimetric impact was examined using a 2D ion chamber array. Simulations were done for 536 trajectories from 17 patients. Results: Despite the loss of marker detection efficiency caused by the MLC leaves sometimes obscuring the field at the marker's projected position on the MV imager, the field-by-field correction halved (from 23% to 10%) the mean percentage of time that target displacement exceeded a 3 mm threshold, as compared to no intervention. This was achieved at minimal cost in additional imaging (average of one MV-kV pair per two to three treatment fractions) and with a very small number of repositionings (once every four to five fractions). Also with low kV usage (∼2/fraction), the instantaneous repositioning approach reduced overthreshold time by more than 75% (23% to 5%) even with severe MLC blockage as often encountered in current IMRT and could reduce the overthreshold time tenfold (to <2%) if the MLC blockage problem were relieved. The

  11. Clinical development of a failure detection-based online repositioning strategy for prostate IMRT--experiments, simulation, and dosimetry study.

    Science.gov (United States)

    Liu, Wu; Qian, Jianguo; Hancock, Steven L; Xing, Lei; Luxton, Gary

    2010-10-01

    To implement and evaluate clinic-ready adaptive imaging protocols for online patient repositioning (motion tracking) during prostate IMRT using treatment beam imaging supplemented by minimal, as-needed use of on-board kV. The authors examine the two-step decision-making strategy: (1) Use cine-MV imaging and online-updated characterization of prostate motion to detect target motion that is potentially beyond a predefined threshold and (2) use paired MV-kV 3D localization to determine overthreshold displacement and, if needed, reposition the patient. Two levels of clinical implementation were evaluated: (1) Field-by-field based motion correction for present-day linacs and (2) instantaneous repositioning for new-generation linacs with capabilities of simultaneous MV-kV imaging and remote automatic couch control during treatment delivery. Experiments were performed on a Varian Trilogy linac in clinical mode using a 4D motion phantom programed with prostate motion trajectories taken from patient data. Dosimetric impact was examined using a 2D ion chamber array. Simulations were done for 536 trajectories from 17 patients. Despite the loss of marker detection efficiency caused by the MLC leaves sometimes obscuring the field at the marker's projected position on the MV imager, the field-by-field correction halved (from 23% to 10%) the mean percentage of time that target displacement exceeded a 3 mm threshold, as compared to no intervention. This was achieved at minimal cost in additional imaging (average of one MV-kV pair per two to three treatment fractions) and with a very small number of repositionings (once every four to five fractions). Also with low kV usage (approximation 2/fraction), the instantaneous repositioning approach reduced overthreshold time by more than 75% (23% to 5%) even with severe MLC blockage as often encountered in current IMRT and could reduce the overthreshold time tenfold (to < 2%) if the MLC blockage problem were relieved. The information

  12. Clinical development of a failure detection-based online repositioning strategy for prostate IMRT--Experiments, simulation, and dosimetry study

    Energy Technology Data Exchange (ETDEWEB)

    Liu Wu; Qian Jianguo; Hancock, Steven L.; Xing, Lei; Luxton, Gary [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California 94305-5847 (United States) and Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut 06510 (United States); Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California 94305-5847 (United States)

    2010-10-15

    Purpose: To implement and evaluate clinic-ready adaptive imaging protocols for online patient repositioning (motion tracking) during prostate IMRT using treatment beam imaging supplemented by minimal, as-needed use of on-board kV. Methods: The authors examine the two-step decision-making strategy: (1) Use cine-MV imaging and online-updated characterization of prostate motion to detect target motion that is potentially beyond a predefined threshold and (2) use paired MV-kV 3D localization to determine overthreshold displacement and, if needed, reposition the patient. Two levels of clinical implementation were evaluated: (1) Field-by-field based motion correction for present-day linacs and (2) instantaneous repositioning for new-generation linacs with capabilities of simultaneous MV-kV imaging and remote automatic couch control during treatment delivery. Experiments were performed on a Varian Trilogy linac in clinical mode using a 4D motion phantom programed with prostate motion trajectories taken from patient data. Dosimetric impact was examined using a 2D ion chamber array. Simulations were done for 536 trajectories from 17 patients. Results: Despite the loss of marker detection efficiency caused by the MLC leaves sometimes obscuring the field at the marker's projected position on the MV imager, the field-by-field correction halved (from 23% to 10%) the mean percentage of time that target displacement exceeded a 3 mm threshold, as compared to no intervention. This was achieved at minimal cost in additional imaging (average of one MV-kV pair per two to three treatment fractions) and with a very small number of repositionings (once every four to five fractions). Also with low kV usage ({approx}2/fraction), the instantaneous repositioning approach reduced overthreshold time by more than 75% (23% to 5%) even with severe MLC blockage as often encountered in current IMRT and could reduce the overthreshold time tenfold (to <2%) if the MLC blockage problem were

  13. DIRECT PULP CAPPING IN TREATMENT OF REVERSIBLE PULPITIS IN PRIMARY TEETH- CLINICAL PROTOCOL

    Directory of Open Access Journals (Sweden)

    Nina Milcheva

    2016-10-01

    Full Text Available The pulp of primary teeth is identical morphologically and physiologically to that of permanent teeth and it is capable to answer to pathological stimuli by producing tertiary dentin. When the inflammation of the pulp is in its reversible stage vital methods of treatment are indicated in order to stimulate the healing processes in it and protect its vitality. In Bulgaria the most popular method of treatment of inflammation diseases of the pulp in primary dentition is the mortal amputation. The biological way of treatment is not very common even in cases where there are indications for it. Purpose: The aim of this paper is to present the approbated by us protocol for application of direct pulp capping for treatment of reversible pulpitis in primary teeth. Material and methods: On the base of world experience and our contemporary meta- analysis of the researches published in the last 15 years concerning the problems of diagnostics. We determined clinical and radiographic diagnostic criteria for reversible pulpitis in primary teeth and indications for application of direct pulp capping as a method of treatment. We give clinical steps for application of the method and summarized the clinical and radiographic criteria for success after treatment. Results/conclusion: We gather all the information for applying direct pulp cappingfor treatment of reversible pulpitis in primary dentition. We offer the method of direct pulp capping as a clinical protocol “step by step” and illustrated by scheme which can be useful for students and dentists in their everyday practice.

  14. Neutron Dosimetry

    International Nuclear Information System (INIS)

    Vanhavere, F.

    2001-01-01

    The objective of SCK-CEN's R and D programme on neutron dosimetry is to improve the determination of neutron doses by studying neutron spectra, neutron dosemeters and shielding adaptations. In 2000, R and D focused on the contiued investigation of the bubble detectors type BD-PND and BDT, in particular their sensitivity and temperature dependence; the updating of SCK-CEN's criticality dosemeter, the investigation of the characteristics of new thermoluminescent materials and their use in neutron dosemetry; and the investigation of neutron shielding

  15. Neutron Dosimetry

    Energy Technology Data Exchange (ETDEWEB)

    Vanhavere, F

    2001-04-01

    The objective of SCK-CEN's R and D programme on neutron dosimetry is to improve the determination of neutron doses by studying neutron spectra, neutron dosemeters and shielding adaptations. In 2000, R and D focused on the contiued investigation of the bubble detectors type BD-PND and BDT, in particular their sensitivity and temperature dependence; the updating of SCK-CEN's criticality dosemeter, the investigation of the characteristics of new thermoluminescent materials and their use in neutron dosemetry; and the investigation of neutron shielding.

  16. Hypofractionated Prostate Radiotherapy with or without Conventionally Fractionated Nodal Irradiation: Clinical Toxicity Observations and Retrospective Daily Dosimetry.

    Science.gov (United States)

    McDonald, Andrew M; Bishop, Justin M; Jacob, Rojymon; Dobelbower, Michael C; Kim, Robert Y; Yang, Eddy S; Smith, Heather; Wu, Xingen; Fiveash, John B

    2012-01-01

    Purpose. To evaluate toxicity associated with the addition of elective nodal irradiation (ENI) to a hypofractionated regimen for the treatment of prostate cancer. Methods and Materials. Fifty-seven patients received pelvic image-guided IMRT to 50.4 Gy in 28 fractions with a hypofractionated simultaneous boost to the prostate to 70 Gy. Thirty-one patients received prostate-only treatment to 70 Gy in 28 fractions. Results. Median followup was 41.1 months. Early grade ≥2 urinary toxicity rates were 49% (28 of 57) for patients receiving ENI and 58% (18 of 31) for those not (P = 0.61). Early grade ≥2 rectal toxicity rates were 40% (23 of 57) and 23% (7 of 31), respectively (P = 0.09). The addition of ENI resulted in a 21% actuarial rate of late grade ≥2 rectal toxicity at 4 years, compared to 0% for patients treated to the prostate only (P = 0.02). Retrospective daily dosimetry of patients experiencing late rectal toxicity revealed an average increase of 2.67% of the rectal volume receiving 70 Gy compared to the original plan. Conclusions. The addition of ENI resulted in an increased risk of late rectal toxicity. Grade ≥2 late rectal toxicity was associated with worse daily rectal dosimetry compared to the treatment plan.

  17. Topics in radiation dosimetry radiation dosimetry

    CERN Document Server

    1972-01-01

    Radiation Dosimetry, Supplement 1: Topics in Radiation Dosimetry covers instruments and techniques in dealing with special dosimetry problems. The book discusses thermoluminescence dosimetry in archeological dating; dosimetric applications of track etching; vacuum chambers of radiation measurement. The text also describes wall-less detectors in microdosimetry; dosimetry of low-energy X-rays; and the theory and general applicability of the gamma-ray theory of track effects to various systems. Dose equivalent determinations in neutron fields by means of moderator techniques; as well as developm

  18. Influence of the curve density relative electron in dosimetry clinic in treatments stereo tactics; Influencia de la curva de densidad electronica relativa en la dosimetria clinica en tratamientos estereotaxicos

    Energy Technology Data Exchange (ETDEWEB)

    Moreno Saiz, C.; Benitez Villegas, E. M.; Casado Villalon, F. J.; Parra Osorio, V.; Bodineau Gil, C.; Garcia Pareja, S.

    2013-07-01

    The objective of this study is to analyze the difference between clinical dosimetry in the treatments with radiosurgery and stereotactic radiotherapy fractional obtained from the relative Electron density curve (Schneider 1996) tabulated and provided with the scanner's radiation therapy. (Author)

  19. Understanding implementation processes of clinical pathways and clinical practice guidelines in pediatric contexts: a study protocol

    Directory of Open Access Journals (Sweden)

    Scott Shannon D

    2011-12-01

    Full Text Available Abstract Background Canada is among the most prosperous nations in the world, yet the health and wellness outcomes of Canadian children are surprisingly poor. There is some evidence to suggest that these poor health outcomes are partly due to clinical practice variation, which can stem from failure to apply the best available research evidence in clinical practice, otherwise known as knowledge translation (KT. Surprisingly, clinical practice variation, even for common acute paediatric conditions, is pervasive. Clinical practice variation results in unnecessary medical treatments, increased suffering, and increased healthcare costs. This study focuses on improving health outcomes for common paediatric acute health concerns by evaluating strategies that improve KT and reduce clinical practice variation. Design/Methods Using a multiple case study design, qualitative and quantitative data will be collected from four emergency departments in western Canada. Data sources will include: pre- and post-implementation focus group data from multidisciplinary healthcare professionals; individual interviews with the local champions, KT intervention providers, and unit/site leaders/managers; Alberta Context Tool (ACT survey data; and aggregated patient outcome data. Qualitative and quantitative data will be systematically triangulated, and matrices will be built to do cross-case comparison. Explanations will be built about the success or lack of success of the clinical practice guidelines (CPG and clinical pathways (CPs uptake based upon the cross-case comparisons. Significance This study will generate new knowledge about the potential causal mechanisms and factors which shape implementation. Future studies will track the impact of the CPG/CPs implementation on children's health outcome, and healthcare costs.

  20. Dosimetry in diagnostic and interventional radiology - ICRU and IAEA activities

    International Nuclear Information System (INIS)

    Zoetelief, J.; Pernicka, F.

    2002-01-01

    Full text: Main aims of patient dosimetry in diagnostic and interventional radiology are to determine dosimetric quantities for establishment and use of guidance levels or diagnostic reference levels and for comparative risk assessment. In the latter case, the average doses to the organs and tissues at risk should be assessed. Only limited number of measurements serve to potential risk assessment of the examination and intervention. An additional objective of dosimetry in diagnostic and interventional radiology is the assessment of equipment performance. Ionization chambers are the main devices used for dosimetric measurements in diagnostic and interventional radiology but other devices with special properties are also used. Important examples are thermoluminescent detectors (TLDs) and semiconductor detectors. For most dosemeters used in x-ray medical imaging the desired quantity for calibration of dosemeters is the air kerma free-in-air. Calibrations should be made at appropriate radiation qualities, for which recommendations are available for conventional radiology. It is important that the calibrations are traceable to the international measurement system. The uncertainty of dose measurements in medical x-ray imaging, for comparative risk assessments as well as for quality assurance, should not exceed about 7 per cent in terms of the expanded uncertainty using a coverage factor of 2. The dosimetric approaches in general diagnostic radiology, mammography and computed tomography are slightly different, resulting in application specific dosimetric quantities. Consequently, different protocols for patient dosimetry are available for these different purposes. In general diagnostic radiology, various quantities and terminologies have been used for the specification of dose on the central beam axis at the point where the x-ray beam enters the patient (or a phantom representing the patient). These include the exposure at skin entrance (ESE), the input radiation exposure

  1. Assessment of Adverse Events in Protocols, Clinical Study Reports, and Published Papers of Trials of Orlistat

    DEFF Research Database (Denmark)

    Schroll, Jeppe Bennekou; Penninga, Elisabeth I; Gøtzsche, Peter C

    2016-01-01

    BACKGROUND: Little is known about how adverse events are summarised and reported in trials, as detailed information is usually considered confidential. We have acquired clinical study reports (CSRs) from the European Medicines Agency through the Freedom of Information Act. The CSRs describe......Med and adverse event data were extracted from this source as well. All three sources were compared. Individual adverse events from one trial were summed and compared to the totals in the summary report. None of the protocols or CSRs contained instructions for investigators on how to question participants about...

  2. Standardized terminology for clinical trial protocols based on top-level ontological categories.

    Science.gov (United States)

    Heller, B; Herre, H; Lippoldt, K; Loeffler, M

    2004-01-01

    This paper describes a new method for the ontologically based standardization of concepts with regard to the quality assurance of clinical trial protocols. We developed a data dictionary for medical and trial-specific terms in which concepts and relations are defined context-dependently. The data dictionary is provided to different medical research networks by means of the software tool Onto-Builder via the internet. The data dictionary is based on domain-specific ontologies and the top-level ontology of GOL. The concepts and relations described in the data dictionary are represented in natural language, semi-formally or formally according to their use.

  3. A clinical protocol to increase chewing and assess mastication in children with feeding disorders.

    Science.gov (United States)

    Volkert, Valerie M; Peterson, Kathryn M; Zeleny, Jason R; Piazza, Cathleen C

    2014-09-01

    Children with feeding disorders often cannot or do not chew when presented with table food. Children with chewing deficits also often swallow the bite before masticating it appropriately, which we will refer to as early swallowing. In the current study, we evaluated a clinical protocol to increase chews per bite, assess mastication, and eliminate early swallowing with three children with feeding disorders. The current study adds to a small body of literature on chewing and mastication of children with feeding disorders. Suggestions for future research are also discussed. © The Author(s) 2014.

  4. Sensitivity Analysis of Per-Protocol Time-to-Event Treatment Efficacy in Randomized Clinical Trials

    Science.gov (United States)

    Gilbert, Peter B.; Shepherd, Bryan E.; Hudgens, Michael G.

    2013-01-01

    Summary Assessing per-protocol treatment effcacy on a time-to-event endpoint is a common objective of randomized clinical trials. The typical analysis uses the same method employed for the intention-to-treat analysis (e.g., standard survival analysis) applied to the subgroup meeting protocol adherence criteria. However, due to potential post-randomization selection bias, this analysis may mislead about treatment efficacy. Moreover, while there is extensive literature on methods for assessing causal treatment effects in compliers, these methods do not apply to a common class of trials where a) the primary objective compares survival curves, b) it is inconceivable to assign participants to be adherent and event-free before adherence is measured, and c) the exclusion restriction assumption fails to hold. HIV vaccine efficacy trials including the recent RV144 trial exemplify this class, because many primary endpoints (e.g., HIV infections) occur before adherence is measured, and nonadherent subjects who receive some of the planned immunizations may be partially protected. Therefore, we develop methods for assessing per-protocol treatment efficacy for this problem class, considering three causal estimands of interest. Because these estimands are not identifiable from the observable data, we develop nonparametric bounds and semiparametric sensitivity analysis methods that yield estimated ignorance and uncertainty intervals. The methods are applied to RV144. PMID:24187408

  5. Registered nurses' clinical reasoning in home healthcare clinical practice: A think-aloud study with protocol analysis.

    Science.gov (United States)

    Johnsen, Hege Mari; Slettebø, Åshild; Fossum, Mariann

    2016-05-01

    The home healthcare context can be unpredictable and complex, and requires registered nurses with a high level of clinical reasoning skills and professional autonomy. Thus, additional knowledge about registered nurses' clinical reasoning performance during patient home care is required. The aim of this study is to describe the cognitive processes and thinking strategies used by recently graduated registered nurses while caring for patients in home healthcare clinical practice. An exploratory qualitative think-aloud design with protocol analysis was used. Home healthcare visits to patients with stroke, diabetes, and chronic obstructive pulmonary disease in seven healthcare districts in southern Norway. A purposeful sample of eight registered nurses with one year of experience. Each nurse was interviewed using the concurrent think-aloud technique in three different patient home healthcare clinical practice visits. A total of 24 home healthcare visits occurred. Follow-up interviews were conducted with each participant. The think-aloud sessions were transcribed and analysed using three-step protocol analysis. Recently graduated registered nurses focused on both general nursing concepts and concepts specific to the domains required and tasks provided in home healthcare services as well as for different patient groups. Additionally, participants used several assertion types, cognitive processes, and thinking strategies. Our results showed that recently graduated registered nurses used both simple and complex cognitive processes involving both inductive and deductive reasoning. However, their reasoning was more reactive than proactive. The results may contribute to nursing practice in terms of developing effective nursing education programmes. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. SU-G-TeP3-08: Pre-Clinical Radionuclide Therapy Dosimetry in Several Pediatric Cancer Xenografts

    Energy Technology Data Exchange (ETDEWEB)

    Marsh, I; Otto, M; Weichert, J; Baiu, D; Bednarz, B [University of Wisconsin, Madison, WI (United States)

    2016-06-15

    Purpose: The focus of this work is to perform Monte Carlo-based dosimetry for several pediatric cancer xenografts in mice treated with a novel radiopharmaceutical {sup 131}I-CLR1404. Methods: Four mice for each tumor cell line were injected with 8–13 µCi/g of the {sup 124}124I-CLR1404. PET/CT images of each individual mouse were acquired at 5–6 time points over the span of 96–170 hours post-injection. Following acquisition, the images were co-registered, resampled, rescaled, corrected for partial volume effects (PVE), and masked. For this work the pre-treatment PET images of {sup 124}I-CLR1404 were used to predict therapeutic doses from {sup 131}I-CLR1404 at each time point by assuming the same injection activity and accounting for the difference in physical decay rates. Tumors and normal tissues were manually contoured using anatomical and functional images. The CT and the PET images were used in the Geant4 (v9.6) Monte Carlo simulation to define the geometry and source distribution, respectively. The total cumulated absorbed dose was calculated by numerically integrating the dose-rate at each time point over all time on a voxel-by-voxel basis. Results: Spatial distributions of the absorbed dose rates and dose volume histograms as well as mean, minimum, maximum, and total dose values for each ROI were generated for each time point. Conclusion: This work demonstrates how mouse-specific MC-based dosimetry could potentially provide more accurate characterization of efficacy of novel radiopharmaceuticals in radionuclide therapy. This work is partially funded by NIH grant CA198392.

  7. The Bad Berka dose protocol: comparative results of dosimetry in peptide receptor radionuclide therapy using (177)Lu-DOTATATE, (177)Lu-DOTANOC, and (177)Lu-DOTATOC.

    Science.gov (United States)

    Schuchardt, Christiane; Kulkarni, Harshad R; Prasad, Vikas; Zachert, Carolin; Müller, Dirk; Baum, Richard P

    2013-01-01

    The objective of this study is to analyze the in vivo behavior of the (177)Lu-labeled peptides DOTATATE, DOTANOC, and DOTATOC used for peptide receptor radionuclide therapy (PRRNT) of neuroendocrine tumors (NETs), by measuring organ and tumor kinetics and by performing dosimetric calculations. Two hundred fifty-three patients (group 1) with metastasized NET who underwent PRRNT were examined. Out of these, 185 patients received (177)Lu-DOTATATE, 9 were treated with (177)Lu-DOTANOC, and 59 with (177)Lu-DOTATOC. Additionally, 25 patients receiving, in consecutive PRRNT cycles, DOTATATE followed by DOTATOC (group 2) and 3 patients receiving DOTATATE and DOTANOC (group 3) were analyzed. Dosimetric calculations (according to MIRD scheme) were performed using OLINDA software. In group 1, DOTATOC exhibited the lowest and DOTANOC the highest uptake and therefore mean absorbed dose in normal organs (whole body, kidney, and spleen). In group 2, there was a significant difference between DOTATATE and DOTATOC concerning kinetics and normal organ doses. (177)Lu-DOTATOC had the lowest uptake/dose delivered to normal organs and highest tumor-to-kidney ratio. There were no significant differences between the three peptides concerning tumor kinetics and mean absorbed tumor dose. The study demonstrates a correlation between high affinity of DOTANOC in vitro and high uptake in normal organs/whole body in vivo, resulting in a higher whole-body dose. DOTATOC exhibited the lowest uptake and dose delivered to normal tissues and the best tumor-to-kidney ratio. Due to large interpatient variability, individual dosimetry should be performed for each therapy cycle.

  8. Alcohol handrubbing and chlorhexidine handwashing protocols for routine hospital practice: A randomized clinical trial of protocol efficacy and time effectiveness

    NARCIS (Netherlands)

    Chow, Angela; Arah, Onyebuchi A.; Chan, Siew-Pang; Poh, Bee-Fong; Krishnan, Prabha; Ng, Woei-Kian; Choudhury, Saugata; Chan, Joey; Ang, Brenda

    2012-01-01

    Background: The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) recommend the use of alcohol handrubs to prevent health care-associated infections. However, the efficacy and time effectiveness of different alcohol handrubbing protocols have yet to be

  9. Dynamic whole body PET parametric imaging: I. Concept, acquisition protocol optimization and clinical application

    Science.gov (United States)

    Karakatsanis, Nicolas A.; Lodge, Martin A.; Tahari, Abdel K.; Zhou, Y.; Wahl, Richard L.; Rahmim, Arman

    2013-01-01

    Static whole body PET/CT, employing the standardized uptake value (SUV), is considered the standard clinical approach to diagnosis and treatment response monitoring for a wide range of oncologic malignancies. Alternative PET protocols involving dynamic acquisition of temporal images have been implemented in the research setting, allowing quantification of tracer dynamics, an important capability for tumor characterization and treatment response monitoring. Nonetheless, dynamic protocols have been confined to single bed-coverage limiting the axial field-of-view to ~15–20 cm, and have not been translated to the routine clinical context of whole-body PET imaging for the inspection of disseminated disease. Here, we pursue a transition to dynamic whole body PET parametric imaging, by presenting, within a unified framework, clinically feasible multi-bed dynamic PET acquisition protocols and parametric imaging methods. We investigate solutions to address the challenges of: (i) long acquisitions, (ii) small number of dynamic frames per bed, and (iii) non-invasive quantification of kinetics in the plasma. In the present study, a novel dynamic (4D) whole body PET acquisition protocol of ~45min total length is presented, composed of (i) an initial 6-min dynamic PET scan (24 frames) over the heart, followed by (ii) a sequence of multi-pass multi-bed PET scans (6 passes x 7 bed positions, each scanned for 45sec). Standard Patlak linear graphical analysis modeling was employed, coupled with image-derived plasma input function measurements. Ordinary least squares (OLS) Patlak estimation was used as the baseline regression method to quantify the physiological parameters of tracer uptake rate Ki and total blood distribution volume V on an individual voxel basis. Extensive Monte Carlo simulation studies, using a wide set of published kinetic FDG parameters and GATE and XCAT platforms, were conducted to optimize the acquisition protocol from a range of 10 different clinically

  10. Dynamic whole-body PET parametric imaging: I. Concept, acquisition protocol optimization and clinical application.

    Science.gov (United States)

    Karakatsanis, Nicolas A; Lodge, Martin A; Tahari, Abdel K; Zhou, Y; Wahl, Richard L; Rahmim, Arman

    2013-10-21

    Static whole-body PET/CT, employing the standardized uptake value (SUV), is considered the standard clinical approach to diagnosis and treatment response monitoring for a wide range of oncologic malignancies. Alternative PET protocols involving dynamic acquisition of temporal images have been implemented in the research setting, allowing quantification of tracer dynamics, an important capability for tumor characterization and treatment response monitoring. Nonetheless, dynamic protocols have been confined to single-bed-coverage limiting the axial field-of-view to ~15-20 cm, and have not been translated to the routine clinical context of whole-body PET imaging for the inspection of disseminated disease. Here, we pursue a transition to dynamic whole-body PET parametric imaging, by presenting, within a unified framework, clinically feasible multi-bed dynamic PET acquisition protocols and parametric imaging methods. We investigate solutions to address the challenges of: (i) long acquisitions, (ii) small number of dynamic frames per bed, and (iii) non-invasive quantification of kinetics in the plasma. In the present study, a novel dynamic (4D) whole-body PET acquisition protocol of ~45 min total length is presented, composed of (i) an initial 6 min dynamic PET scan (24 frames) over the heart, followed by (ii) a sequence of multi-pass multi-bed PET scans (six passes × seven bed positions, each scanned for 45 s). Standard Patlak linear graphical analysis modeling was employed, coupled with image-derived plasma input function measurements. Ordinary least squares Patlak estimation was used as the baseline regression method to quantify the physiological parameters of tracer uptake rate Ki and total blood distribution volume V on an individual voxel basis. Extensive Monte Carlo simulation studies, using a wide set of published kinetic FDG parameters and GATE and XCAT platforms, were conducted to optimize the acquisition protocol from a range of ten different clinically

  11. Dynamic whole-body PET parametric imaging: I. Concept, acquisition protocol optimization and clinical application

    International Nuclear Information System (INIS)

    Karakatsanis, Nicolas A; Lodge, Martin A; Tahari, Abdel K; Zhou, Y; Wahl, Richard L; Rahmim, Arman

    2013-01-01

    Static whole-body PET/CT, employing the standardized uptake value (SUV), is considered the standard clinical approach to diagnosis and treatment response monitoring for a wide range of oncologic malignancies. Alternative PET protocols involving dynamic acquisition of temporal images have been implemented in the research setting, allowing quantification of tracer dynamics, an important capability for tumor characterization and treatment response monitoring. Nonetheless, dynamic protocols have been confined to single-bed-coverage limiting the axial field-of-view to ∼15–20 cm, and have not been translated to the routine clinical context of whole-body PET imaging for the inspection of disseminated disease. Here, we pursue a transition to dynamic whole-body PET parametric imaging, by presenting, within a unified framework, clinically feasible multi-bed dynamic PET acquisition protocols and parametric imaging methods. We investigate solutions to address the challenges of: (i) long acquisitions, (ii) small number of dynamic frames per bed, and (iii) non-invasive quantification of kinetics in the plasma. In the present study, a novel dynamic (4D) whole-body PET acquisition protocol of ∼45 min total length is presented, composed of (i) an initial 6 min dynamic PET scan (24 frames) over the heart, followed by (ii) a sequence of multi-pass multi-bed PET scans (six passes × seven bed positions, each scanned for 45 s). Standard Patlak linear graphical analysis modeling was employed, coupled with image-derived plasma input function measurements. Ordinary least squares Patlak estimation was used as the baseline regression method to quantify the physiological parameters of tracer uptake rate K i and total blood distribution volume V on an individual voxel basis. Extensive Monte Carlo simulation studies, using a wide set of published kinetic FDG parameters and GATE and XCAT platforms, were conducted to optimize the acquisition protocol from a range of ten different

  12. Dynamic whole-body PET parametric imaging: I. Concept, acquisition protocol optimization and clinical application

    Science.gov (United States)

    Karakatsanis, Nicolas A.; Lodge, Martin A.; Tahari, Abdel K.; Zhou, Y.; Wahl, Richard L.; Rahmim, Arman

    2013-10-01

    Static whole-body PET/CT, employing the standardized uptake value (SUV), is considered the standard clinical approach to diagnosis and treatment response monitoring for a wide range of oncologic malignancies. Alternative PET protocols involving dynamic acquisition of temporal images have been implemented in the research setting, allowing quantification of tracer dynamics, an important capability for tumor characterization and treatment response monitoring. Nonetheless, dynamic protocols have been confined to single-bed-coverage limiting the axial field-of-view to ˜15-20 cm, and have not been translated to the routine clinical context of whole-body PET imaging for the inspection of disseminated disease. Here, we pursue a transition to dynamic whole-body PET parametric imaging, by presenting, within a unified framework, clinically feasible multi-bed dynamic PET acquisition protocols and parametric imaging methods. We investigate solutions to address the challenges of: (i) long acquisitions, (ii) small number of dynamic frames per bed, and (iii) non-invasive quantification of kinetics in the plasma. In the present study, a novel dynamic (4D) whole-body PET acquisition protocol of ˜45 min total length is presented, composed of (i) an initial 6 min dynamic PET scan (24 frames) over the heart, followed by (ii) a sequence of multi-pass multi-bed PET scans (six passes × seven bed positions, each scanned for 45 s). Standard Patlak linear graphical analysis modeling was employed, coupled with image-derived plasma input function measurements. Ordinary least squares Patlak estimation was used as the baseline regression method to quantify the physiological parameters of tracer uptake rate Ki and total blood distribution volume V on an individual voxel basis. Extensive Monte Carlo simulation studies, using a wide set of published kinetic FDG parameters and GATE and XCAT platforms, were conducted to optimize the acquisition protocol from a range of ten different clinically

  13. Radiation dosimetry

    International Nuclear Information System (INIS)

    Harper, M.W.; Thomas, B.; Conway, J.

    1977-01-01

    A dosemeter is described that is based on the TSCD principle (thermally stimulated current dosimetry). Basically this involves irradiating a responsive material and then heating it,whereby an electric current is produced. If the material is heated in an electric field the peak value of the thermally stimulated current or alternatively the total charge released by heating, can be related to the radiation dose received. The instrument described utilises a sheet coated with a thermoplastic polymer, such as a poly4-methylpent-l-ene. The polymer should have a softening point not lower than 150 0 C with an electrical resistivity of at least 10 16 chms/cm at 150 0 C. The polymer may also be PTFE. Heating should be in the range 150 0 C to 200 0 C and the electric field in the range 50 to 10,000V/mm. (U.K.)

  14. Organ dosimetry

    International Nuclear Information System (INIS)

    Kaul, Dean C.; Egbert, Stephen D.; Otis, Mark D.; Kuhn, Thomas; Kerr, George D.; Eckerman, Keith F.; Cristy, Mark; Ryman, Jeffrey C.; Tang, Jabo S.; Maruyama, Takashi

    1987-01-01

    This chapter describes the technical approach, complicating factors, and sensitivities and uncertainties of calculations of doses to the organs of the A-bomb survivors. It is the object of the effort so described to provide data that enables the dosimetry system to determine the fluence, kerma, absorbed dose, and similar quantities in 14 organs and the fetus, specified as being of radiobiological interest. This object was accomplished through the use of adjoint Monte Carlo computations, which use a number of random particle histories to determine the relationship of incident neutrons and gamma rays to those transported to a target organ. The system uses these histories to correlate externally-incident energy- and angle-differential fluences with the fluence spectrum (energy differential only) within the target organ. In order for the system to work in the most efficient manner possible, two levels of data were provided. The first level, represented by approximately 6,000 random adjoint-particle histories, enables the computation of the fluence spectrum with sufficient precision to provide statistically reliable (± 6 %) mean doses within any given organ. With this limited history inventory, the system can be run rapidly for all survivors. Mean organ dose and dose uncertainty are obtainable in this mode. The second mode of operation enables the system to produce a good approximation to fluence spectrum within any organ or to produce the dose in each of an array of organ subvolumes. To be statistically reliable, this level of detail requires far more random histories, approximately 40,000 per organ. Thus, operation of the dosimetry system in this mode (i.e., with this data set) is intended to be on an as-needed, organ-specific basis, since the system run time is eight times that in the mean dose mode. (author)

  15. Protocol Adherence for Severe Sepsis and Septic Shock Management in the Emergency Department; a Clinical Audit

    Directory of Open Access Journals (Sweden)

    Mostafa Alavi-Moghaddam

    2016-12-01

    Full Text Available Introduction: Although significant development in the field of medicine is achieved, sepsis is still a major issue threatening humans’ lives. This study was aimed to audit the management of severe sepsis and septic shock patients in emergency department (ED according to the present standard guidelines.Method: This is a prospective audit on approaching adult septic patients who were admitted to ED. The audit checklist was created based on the protocols of Surviving Sepsis Campaign and British Royal College recommendations. The mean knowledge score and the compliance rate of studied measures regarding standard protocols were calculated using SPSS version 21.Results: 30 emergency medicine residents were audited (63.3% male. The mean knowledge score of studied residents regarding standard guidelines were 5.07 ± 1.78 (IQR = 2 in pre education and 8.17 ± 1.31 (IQR = 85 in post education phase (p < 0.001. There was excellent compliance with standard in 4 (22% studied measures, good in 2 (11%, fair in 1 (6%, weak in 2 (11%, and poor in 9 (50%. 64% of poor compliance measures correlated to therapeutic factors. After training, score of 5 measures including checking vital signs in < 20 minute, central vein pressure measurement in < 1 hour, blood culture request, administration of vasopressor agents, and high flow O2 therapy were improved clinically, but not statistically.Conclusion: The protocol adherence in management of severe sepsis and septic shock for urine output measurement, central venous pressure monitoring, administration of inotrope agents, blood transfusion, intravenous antibiotic and hydration therapy, and high flow O2 delivery were disappointingly low. It seems training workshops and implementation of Clinical audit can improve residents’ adherence to current standard guidelines regarding severe sepsis and septic shock.

  16. TestDose: A nuclear medicine software based on Monte Carlo modeling for generating gamma camera acquisitions and dosimetry

    Energy Technology Data Exchange (ETDEWEB)

    Garcia, Marie-Paule, E-mail: marie-paule.garcia@univ-brest.fr; Villoing, Daphnée [UMR 1037 INSERM/UPS, CRCT, 133 Route de Narbonne, 31062 Toulouse (France); McKay, Erin [St George Hospital, Gray Street, Kogarah, New South Wales 2217 (Australia); Ferrer, Ludovic [ICO René Gauducheau, Boulevard Jacques Monod, St Herblain 44805 (France); Cremonesi, Marta; Botta, Francesca; Ferrari, Mahila [European Institute of Oncology, Via Ripamonti 435, Milano 20141 (Italy); Bardiès, Manuel [UMR 1037 INSERM/UPS, CRCT, 133 Route de Narbonne, Toulouse 31062 (France)

    2015-12-15

    Purpose: The TestDose platform was developed to generate scintigraphic imaging protocols and associated dosimetry by Monte Carlo modeling. TestDose is part of a broader project (www.dositest.com) whose aim is to identify the biases induced by different clinical dosimetry protocols. Methods: The TestDose software allows handling the whole pipeline from virtual patient generation to resulting planar and SPECT images and dosimetry calculations. The originality of their approach relies on the implementation of functional segmentation for the anthropomorphic model representing a virtual patient. Two anthropomorphic models are currently available: 4D XCAT and ICRP 110. A pharmacokinetic model describes the biodistribution of a given radiopharmaceutical in each defined compartment at various time-points. The Monte Carlo simulation toolkit GATE offers the possibility to accurately simulate scintigraphic images and absorbed doses in volumes of interest. The TestDose platform relies on GATE to reproduce precisely any imaging protocol and to provide reference dosimetry. For image generation, TestDose stores user’s imaging requirements and generates automatically command files used as input for GATE. Each compartment is simulated only once and the resulting output is weighted using pharmacokinetic data. Resulting compartment projections are aggregated to obtain the final image. For dosimetry computation, emission data are stored in the platform database and relevant GATE input files are generated for the virtual patient model and associated pharmacokinetics. Results: Two samples of software runs are given to demonstrate the potential of TestDose. A clinical imaging protocol for the Octreoscan™ therapeutical treatment was implemented using the 4D XCAT model. Whole-body “step and shoot” acquisitions at different times postinjection and one SPECT acquisition were generated within reasonable computation times. Based on the same Octreoscan™ kinetics, a dosimetry

  17. Agreements between Industry and Academia on Publication Rights: A Retrospective Study of Protocols and Publications of Randomized Clinical Trials.

    Directory of Open Access Journals (Sweden)

    Benjamin Kasenda

    2016-06-01

    Full Text Available Little is known about publication agreements between industry and academic investigators in trial protocols and the consistency of these agreements with corresponding statements in publications. We aimed to investigate (i the existence and types of publication agreements in trial protocols, (ii the completeness and consistency of the reporting of these agreements in subsequent publications, and (iii the frequency of co-authorship by industry employees.We used a retrospective cohort of randomized clinical trials (RCTs based on archived protocols approved by six research ethics committees between 13 January 2000 and 25 November 2003. Only RCTs with industry involvement were eligible. We investigated the documentation of publication agreements in RCT protocols and statements in corresponding journal publications. Of 647 eligible RCT protocols, 456 (70.5% mentioned an agreement regarding publication of results. Of these 456, 393 (86.2% documented an industry partner's right to disapprove or at least review proposed manuscripts; 39 (8.6% agreements were without constraints of publication. The remaining 24 (5.3% protocols referred to separate agreement documents not accessible to us. Of those 432 protocols with an accessible publication agreement, 268 (62.0% trials were published. Most agreements documented in the protocol were not reported in the subsequent publication (197/268 [73.5%]. Of 71 agreements reported in publications, 52 (73.2% were concordant with those documented in the protocol. In 14 of 37 (37.8% publications in which statements suggested unrestricted publication rights, at least one co-author was an industry employee. In 25 protocol-publication pairs, author statements in publications suggested no constraints, but 18 corresponding protocols documented restricting agreements.Publication agreements constraining academic authors' independence are common. Journal articles seldom report on publication agreements, and, if they do

  18. Agreements between Industry and Academia on Publication Rights: A Retrospective Study of Protocols and Publications of Randomized Clinical Trials

    Science.gov (United States)

    Kasenda, Benjamin; von Elm, Erik; You, John J.; Tomonaga, Yuki; Saccilotto, Ramon; Amstutz, Alain; Bengough, Theresa; Meerpohl, Joerg J.; Stegert, Mihaela; Olu, Kelechi K.; Tikkinen, Kari A. O.; Neumann, Ignacio; Carrasco-Labra, Alonso; Faulhaber, Markus; Mulla, Sohail M.; Mertz, Dominik; Akl, Elie A.; Bassler, Dirk; Busse, Jason W.; Nordmann, Alain; Gloy, Viktoria; Ebrahim, Shanil; Schandelmaier, Stefan; Sun, Xin; Vandvik, Per O.; Johnston, Bradley C.; Walter, Martin A.; Burnand, Bernard; Hemkens, Lars G.; Bucher, Heiner C.; Guyatt, Gordon H.; Briel, Matthias

    2016-01-01

    Background Little is known about publication agreements between industry and academic investigators in trial protocols and the consistency of these agreements with corresponding statements in publications. We aimed to investigate (i) the existence and types of publication agreements in trial protocols, (ii) the completeness and consistency of the reporting of these agreements in subsequent publications, and (iii) the frequency of co-authorship by industry employees. Methods and Findings We used a retrospective cohort of randomized clinical trials (RCTs) based on archived protocols approved by six research ethics committees between 13 January 2000 and 25 November 2003. Only RCTs with industry involvement were eligible. We investigated the documentation of publication agreements in RCT protocols and statements in corresponding journal publications. Of 647 eligible RCT protocols, 456 (70.5%) mentioned an agreement regarding publication of results. Of these 456, 393 (86.2%) documented an industry partner’s right to disapprove or at least review proposed manuscripts; 39 (8.6%) agreements were without constraints of publication. The remaining 24 (5.3%) protocols referred to separate agreement documents not accessible to us. Of those 432 protocols with an accessible publication agreement, 268 (62.0%) trials were published. Most agreements documented in the protocol were not reported in the subsequent publication (197/268 [73.5%]). Of 71 agreements reported in publications, 52 (73.2%) were concordant with those documented in the protocol. In 14 of 37 (37.8%) publications in which statements suggested unrestricted publication rights, at least one co-author was an industry employee. In 25 protocol-publication pairs, author statements in publications suggested no constraints, but 18 corresponding protocols documented restricting agreements. Conclusions Publication agreements constraining academic authors’ independence are common. Journal articles seldom report on

  19. Barriers and strategies for the clinical translation of advanced orthopaedic tissue engineering protocols.

    Science.gov (United States)

    Madry, H; Alini, M; Stoddart, M J; Evans, C; Miclau, T; Steiner, S

    2014-05-06

    Research in orthopaedic tissue engineering has intensified over the last decade and new protocols continue to emerge. The clinical translation of these new applications, however, remains associated with a number of obstacles. This report highlights the major issues that impede the clinical translation of advanced tissue engineering concepts, discusses strategies to overcome these barriers, and examines the need to increase incentives for translational strategies. The statements are based on presentations and discussions held at the AO Foundation-sponsored symposium "Where Science meets Clinics 2013" held at the Congress Center in Davos, Switzerland, in September, 2013. The event organisers convened a diverse group of over one hundred stakeholders involved in clinical translation of orthopaedic tissue engineering, including scientists, clinicians, healthcare industry professionals and regulatory agency representatives. A major point that emerged from the discussions was that there continues to be a critical need for early trans-disciplinary communication and collaboration in the development and execution of research approaches. Equally importantly was the need to address the shortage of sustained funding programs for multidisciplinary teams conducting translational research. Such detailed discussions between experts contribute towards the development of a roadmap to more successfully advance the clinical translation of novel tissue engineering concepts and ultimately improve patient care in orthopaedic and trauma surgery.

  20. Barriers and strategies for the clinical translation of advanced orthopaedic tissue engineering protocols

    Directory of Open Access Journals (Sweden)

    H Madry

    2014-05-01

    Full Text Available Research in orthopaedic tissue engineering has intensified over the last decade and new protocols continue to emerge. The clinical translation of these new applications, however, remains associated with a number of obstacles. This report highlights the major issues that impede the clinical translation of advanced tissue engineering concepts, discusses strategies to overcome these barriers, and examines the need to increase incentives for translational strategies. The statements are based on presentations and discussions held at the AO Foundation-sponsored symposium "Where Science meets Clinics 2013" held at the Congress Center in Davos, Switzerland, in September, 2013. The event organisers convened a diverse group of over one hundred stakeholders involved in clinical translation of orthopaedic tissue engineering, including scientists, clinicians, healthcare industry professionals and regulatory agency representatives. A major point that emerged from the discussions was that there continues to be a critical need for early trans-disciplinary communication and collaboration in the development and execution of research approaches. Equally importantly was the need to address the shortage of sustained funding programs for multidisciplinary teams conducting translational research. Such detailed discussions between experts contribute towards the development of a roadmap to more successfully advance the clinical translation of novel tissue engineering concepts and ultimately improve patient care in orthopaedic and trauma surgery.

  1. Validation and dosimetric evaluation employing the techniques of TL and OSL of thermoluminescent materials for application in the dosimetry of clinical beams of electrons used in total irradiation of the skin - TSI

    International Nuclear Information System (INIS)

    Almeida, Shirlane Barbosa de

    2017-01-01

    In vivo dosimetry has become an important role for the treatment of total skin irradiation within a rigorous quality assurance program that should be an integral part of the radiotherapy departments. TSI dosimetry is difficult because of the complexity of the treatment in assessing dose uniformity and measuring the dose absorbed at shallow depths throughout the skin surface extent, resulting in a wide variation in dose distribution. The TLDs have proven to be very useful for the distribution and verification of the dose prescribed for the patient as the dose may differ from place to place due to patient body geometry, overlapping of structures and asymmetries of the radiation field. The use of TLDs in vivo can identify variations in the prescribed dose because its measurement accuracy and great precision. Several types of dosimeters have been used in the radiotherapy sectors, the most commonly used are Lithium Fluride (TLD-100), where it obtains a long history in this type of application. New dosimetric materials have gained great importance in the dosimetry of clinical electron beams, such as Dysprosium-doped Calcium Sulphate (TL) and Carbon doped (OSL) based Aluminum Oxide, This work evaluates the performance of the respective thermoluminescent dosimeters and the optically stimulated luminescence in the dosimetry of clinical electron beams used in total irradiation of the skin. (author)

  2. Relative dosimetry by Ebt-3

    International Nuclear Information System (INIS)

    De Leon A, M. A.; Rivera M, T.; Hernandez O, J. O.

    2015-10-01

    In the present work relative dosimetry in two linear accelerator for radiation therapy was studied. Both Varian Oncology systems named Varian Clinac 2100-Cd and MLC Varian Clinac i X were used. Gaf Chromic Ebt-3 film was used. Measurements have been performed in a water equivalent phantom, using 6 MV and 18 MV photon beams on both Linacs. Both calibration and Electron irradiations were carried out with the ionization chamber placed at the isocenter, below a stack of solid water slabs, at the depth of dose maximum (D max), with a Source-to-Surface Distance (SSD) of 100 cm and a field size of 10 cm x 10 cm. Calibration and dosimetric measurements photons were carried out under IAEA-TRS 398 protocol. Results of relative dosimetry in the present work are discussed. (Author)

  3. Comprehensive brachytherapy physical and clinical aspects

    CERN Document Server

    Baltas, Dimos; Meigooni, Ali S; Hoskin, Peter J

    2013-01-01

    Modern brachytherapy is one of the most important oncological treatment modalities requiring an integrated approach that utilizes new technologies, advanced clinical imaging facilities, and a thorough understanding of the radiobiological effects on different tissues, the principles of physics, dosimetry techniques and protocols, and clinical expertise. A complete overview of the field, Comprehensive Brachytherapy: Physical and Clinical Aspects is a landmark publication, presenting a detailed account of the underlying physics, design, and implementation of the techniques, along with practical guidance for practitioners. Bridging the gap between research and application, this single source brings together the technological basis, radiation dosimetry, quality assurance, and fundamentals of brachytherapy. In addition, it presents discussion of the most recent clinical practice in brachytherapy including prostate, gynecology, breast, and other clinical treatment sites. Along with exploring new clinical protocols, ...

  4. Clinical characterization of OSL dosimeters for use in dosimetry of teletherapy beams in conventional fractionation; Caracterizacion clinica de dosimetros OSL para su uso en dosimetria de haces de teleterapia en fraccionamiento convencional

    Energy Technology Data Exchange (ETDEWEB)

    Lopez V, A.; Gutierrez M, J. G.; Rivera M, T. [IPN, Centro de Investigacion en Ciencia Aplicada y Tecnologia Avanzada, Av. Legaria No. 694, Col. Irrigacion, 11500 Mexico D. F. (Mexico); Velazquez T, J. J., E-mail: jggm25@yahoo.com.mx [Centro Medico Nacional Siglo XXI, Hospital de Oncologia, Departamento de Fisica Medica, Av. Cuauhtemoc No. 330, Col. Doctores, 06720 Mexico D. F. (Mexico)

    2015-10-15

    Optically stimulated materials are increasingly used for dosimetry in clinical settings; to be sure of the obtained reading their proper clinical characterization is necessary. Is important to know the homogeneity of a batch, reproducibility, be exposed to the same conditions of irradiation repeatedly and other dependences that could present such as energy, angular, the type of radiation which are exposed and the dose deposited in them. For characterization they were designed and implemented tests for each of the factors of interest, taking into account the need for them (calculations, manufacture of mannequins, conditions, practicality, etc.) It was shown that we can apply this dosimetry in clinical practice within a radiotherapy center, relying on the readings and practicality. (Author)

  5. EPID-based in vivo dosimetry for stereotactic body radiotherapy of non-small cell lung tumors: Initial clinical experience.

    Science.gov (United States)

    Consorti, R; Fidanzio, A; Brainovich, V; Mangiacotti, F; De Spirito, M; Mirri, M A; Petrucci, A

    2017-10-01

    EPID-based in vivo dosimetry (IVD) has been implemented for stereotactic body radiotherapy treatments of non-small cell lung cancer to check both isocenter dose and the treatment reproducibility comparing EPID portal images. 15 patients with lung tumors of small dimensions and treated with volumetric modulated arc therapy were enrolled for this initial experience. IVD tests supplied ratios R between in vivo reconstructed and planned isocenter doses. Moreover a γ-like analysis between daily EPID portal images and a reference one, in terms of percentage of points with γ-value smaller than 1, P γlevels of 5% for R ratio, P γlevel, and an average P γ90%. Paradigmatic discrepancies were observed in three patients: a set-up error and a patient morphological change were identified thanks to CBCT image analysis whereas the third discrepancy was not fully justified. This procedure can provide improved patient safety as well as a first step to integrate IVD and CBCT dose recalculation. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  6. Clinical results of entrance dose in vivo dosimetry for high energy photons in external beam radiotherapy using MOSFETs

    International Nuclear Information System (INIS)

    Morton, J. P.; Bhat, M.; Williams, T.; Kovendy, A.

    2007-01-01

    Full text: Thomson and Nielsen T N -502 R D MOSFETs were used for entrance dose in vivo dosimetry for 6 and 10 MV photons. A total of 24 patients were tested, 10 breast. 8 prostate, 5 lung and 1 head and neck. For prostates three fields were checked. For all other plans all fields were checked. An action threshold of 8% was set for any one field and 5% for all fields combined. The total number of fields tested was 56, with a mean discrepancy of 1.4% and S.D. of 2.6%. Breasts had a mean discrepancy of 1.8% and S.D. of 2.8%. Prostates had a mean discrepancy of 1.3% and S.D. of 2.9%. For 3 fields combined, prostates had a mean of 1.3% and S.D. of 1.8%. These results are similar to results obtained with diodes and TLDs for the same techniques.

  7. Personnel neutron dosimetry

    International Nuclear Information System (INIS)

    Hankins, D.

    1982-04-01

    This edited transcript of a presentation on personnel neutron discusses the accuracy of present dosimetry practices, requirements, calibration, dosemeter types, quality factors, operational problems, and dosimetry for a criticality accident. 32 figs

  8. A feasible repetitive transcranial magnetic stimulation clinical protocol in migraine prevention.

    Science.gov (United States)

    Zardouz, Shawn; Shi, Lei; Leung, Albert

    2016-01-01

    This case series was conducted to determine the clinical feasibility of a repetitive transcranial magnetic stimulation protocol for the prevention of migraine (with and without aura). Five patients with migraines underwent five repetitive transcranial magnetic stimulation sessions separated in 1- to 2-week intervals for a period of 2 months at a single tertiary medical center. Repetitive transcranial magnetic stimulation was applied to the left motor cortex with 2000 pulses (20 trains with 1s inter-train interval) delivered per session, at a frequency of 10 Hz and 80% resting motor threshold. Pre- and post-treatment numerical rating pain scales were collected, and percent reductions in intensity, frequency, and duration were generated. An average decrease in 37.8%, 32.1%, and 31.2% were noted in the intensity, frequency, and duration of migraines post-repetitive transcranial magnetic stimulation, respectively. A mean decrease in 1.9±1.0 (numerical rating pain scale ± standard deviation; range: 0.4-2.8) in headache intensity scores was noted after the repetitive transcranial magnetic stimulation sessions. The tested repetitive transcranial magnetic stimulation protocol is a well-tolerated, safe, and effective method for migraine prevention.

  9. Dosimetry for radiation processing

    DEFF Research Database (Denmark)

    Miller, Arne

    1986-01-01

    During the past few years significant advances have taken place in the different areas of dosimetry for radiation processing, mainly stimulated by the increased interest in radiation for food preservation, plastic processing and sterilization of medical products. Reference services both...... and sterilization dosimetry, optichromic dosimeters in the shape of small tubes for food processing, and ESR spectroscopy of alanine for reference dosimetry. In this paper the special features of radiation processing dosimetry are discussed, several commonly used dosimeters are reviewed, and factors leading...

  10. Impact of using a local protocol in preoperative testing: blind randomized clinical trial.

    Science.gov (United States)

    Santos, Mônica Loureiro; Iglesias, Antônio Carlos

    2017-01-01

    to evaluate the impact of the use of a local protocol of preoperative test requests in reducing the number of exams requested and in the occurrence of changes in surgical anesthetic management and perioperative complications. we conducted a randomized, blinded clinical trial at the Gaffrée and Guinle University Hospital with 405 patients candidates for elective surgery randomly divided into two groups, according to the practice of requesting preoperative exams: a group with non-selectively requested exams and a protocol group with exams requested according to the study protocol. Studied exams: complete blood count, coagulogram, glycemia, electrolytes, urea and creatinine, ECG and chest X-ray. Primary outcomes: changes in surgical anesthetic management caused by abnormal exams, reduction of the number of exams requested after the use of the protocol and perioperative complications. there was a significant difference (pgrupos segundo a prática de solicitação de exames pré-operatórios: grupo Rotina com exames solicitados de maneira não seletiva e grupo Protocolo com exames solicitados de acordo com o protocolo em estudo. Exames em estudo: hemograma, coagulograma, glicemia, eletrólitos, ureia e creatinina, ECG e radiografia de tórax. Desfechos primários: alterações na conduta anestésico-cirúrgica motivadas por exames anormais, redução do número de exames solicitados após o uso do protocolo e complicações perioperatórias. foi observada diferença significativa (pgrupos (14,9% x 29,1%) e redução de 57,3% no número de exames pedidos entre os dois grupos (pgrupos. Na análise multivariada hemograma e coagulograma foram os únicos exames capazes de modificar a conduta anestésico-cirúrgica. o protocolo proposto foi efetivo em eliminar um quantitativo significativo de exames complementares sem indicação clínica, sem que houvesse aumento na morbidade e mortalidades perioperatórias.

  11. Multisite Semiautomated Clinical Data Repository for Duplication 15q Syndrome: Study Protocol and Early Uses.

    Science.gov (United States)

    Ajayi, Oluwaseun Jessica; Smith, Ebony Jeannae; Viangteeravat, Teeradache; Huang, Eunice Y; Nagisetty, Naga Satya V Rao; Urraca, Nora; Lusk, Laina; Finucane, Brenda; Arkilo, Dimitrios; Young, Jennifer; Jeste, Shafali; Thibert, Ronald; Reiter, Lawrence T

    2017-10-18

    Chromosome 15q11.2-q13.1 duplication syndrome (Dup15q syndrome) is a rare disorder caused by duplications of chromosome 15q11.2-q13.1, resulting in a wide range of developmental disabilities in affected individuals. The Dup15q Alliance is an organization that provides family support and promotes research to improve the quality of life of patients living with Dup15q syndrome. Because of the low prevalence of this condition, the establishment of a single research repository would have been difficult and more time consuming without collaboration across multiple institutions. The goal of this project is to establish a national deidentified database with clinical and survey information on individuals diagnosed with Dup15q syndrome. The development of a multiclinic site repository for clinical and survey data on individuals with Dup15q syndrome was initiated and supported by the Dup15q Alliance. Using collaborative workflows, communication protocols, and stakeholder engagement tools, a comprehensive database of patient-centered information was built. We successfully established a self-report populating, centralized repository for Dup15q syndrome research. This repository also resulted in the development of standardized instruments that can be used for other studies relating to developmental disorders. By standardizing the data collection instruments, it allows us integrate our data with other national databases, such as the National Database for Autism Research. A substantial portion of the data collected from the questionnaires was facilitated through direct engagement of participants and their families. This allowed for a more complete set of information to be collected with a minimal turnaround time. We developed a repository that can efficiently be mined for shared clinical phenotypes observed at multiple clinic sites and used as a springboard for future clinical and basic research studies. ©Oluwaseun Jessica Ajayi, Ebony Jeannae Smith, Teeradache Viangteeravat

  12. [Clinical outcomes and economic analysis of two ovulation induction protocols in patients undergoing repeated IVF/ICSI cycles].

    Science.gov (United States)

    Chen, Xiao; Geng, Ling; Li, Hong

    2014-04-01

    To compare the clinical outcomes and cost-effectiveness of luteal phase down-regulation with gonadotrophin-releasing hormone (GnRH) agonist protocol and GnRH antagonist protocol in patients undergoing repeated in vitro fertilization and intracytoplasmic sperm injection (IVF-ICSI) cycles. A retrospective analysis of clinical outcomes and costs was conducted among 198 patients undergoing repeated IVF-ICSI cycles, including 109 receiving luteal phase down-regulation with GnRH agonist protocol (group A) and 89 receiving GnRH antagonist protocol (group B). The numbers of oocytes retrieved and good embryos, clinical pregnancy rate, abortion rate, the live birth rate, mean total cost, and the cost-effective ratio were compared between the two groups. In patients undergoing repeated IVF-ICSI cycles, the two protocols produced no significant differences in the number of good embryos, clinical pregnancy rate, abortion rate, or twin pregnancy rate. Compared with group B, group A had better clinical outcomes though this difference was not statistically significant. The number of retrieved oocytes was significantly greater and live birth rate significantly higher in group A than in group B (9.13=4.98 vs 7.11=4.74, and 20.2% vs 9.0%, respectively). Compared with group B, group A had higher mean total cost per cycle but lower costs for each oocyte retrieved (2729.11 vs 3038.60 RMB yuan), each good embryo (8867.19 vs 9644.85 RMB yuan), each clinical pregnancy (77598.06 vs 96139.85 RMB yuan). For patients undergoing repeated IVF/ICSI cycle, luteal phase down-regulation with GnRH agonist protocol produces good clinical outcomes with also good cost-effectiveness in spite an unsatisfactory ovarian reserve.

  13. Neutron dosimetry - A review

    Energy Technology Data Exchange (ETDEWEB)

    Baum, J W

    1955-03-29

    This review summarizes information on the following subjects: (1) physical processes of importance in neutron dosimetry; (2) biological effects of neutrons; (3) neutron sources; and (4) instruments and methods used in neutron dosimetry. Also, possible improvements in dosimetry instrumentation are outlined and discussed. (author)

  14. Accuracy Requirements in Medical Radiation Dosimetry

    International Nuclear Information System (INIS)

    Andreo, P.

    2011-01-01

    The need for adopting unambiguous terminology on 'accuracy in medical radiation dosimetry' which is consistent with international recommendations for metrology is emphasized. Uncertainties attainable, or the need for improving their estimates, are analysed for the fields of radiotherapy, diagnostic radiology and nuclear medicine dosimetry. This review centres on uncertainties related to the first step of the dosimetry chain in the three fields, which in all cases involves the use of a detector calibrated by a standards laboratory to determine absorbed dose, air kerma or activity under reference conditions in a clinical environment. (author)

  15. Radiation risk assessment in neonatal radiographic examinations of the chest and abdomen: a clinical and Monte Carlo dosimetry study

    International Nuclear Information System (INIS)

    Makri, T; Yakoumakis, E; Papadopoulou, D; Gialousis, G; Theodoropoulos, V; Sandilos, P; Georgiou, E

    2006-01-01

    Seeking to assess the radiation risk associated with radiological examinations in neonatal intensive care units, thermo-luminescence dosimetry was used for the measurement of entrance surface dose (ESD) in 44 AP chest and 28 AP combined chest-abdominal exposures of a sample of 60 neonates. The mean values of ESD were found to be equal to 44 ± 16 μGy and 43 ± 19 μGy, respectively. The MCNP-4C2 code with a mathematical phantom simulating a neonate and appropriate x-ray energy spectra were employed for the simulation of the AP chest and AP combined chest-abdominal exposures. Equivalent organ dose per unit ESD and energy imparted per unit ESD calculations are presented in tabular form. Combined with ESD measurements, these calculations yield an effective dose of 10.2 ± 3.7 μSv, regardless of sex, and an imparted energy of 18.5 ± 6.7 μJ for the chest radiograph. The corresponding results for the combined chest-abdominal examination are 14.7 ± 7.6 μSv (males)/17.2 ± 7.6 μSv (females) and 29.7 ± 13.2 μJ. The calculated total risk per radiograph was low, ranging between 1.7 and 2.9 per million neonates, per film, and being slightly higher for females. Results of this study are in good agreement with previous studies, especially in view of the diversity met in the calculation methods

  16. Radiation risk assessment in neonatal radiographic examinations of the chest and abdomen: a clinical and Monte Carlo dosimetry study

    Science.gov (United States)

    Makri, T.; Yakoumakis, E.; Papadopoulou, D.; Gialousis, G.; Theodoropoulos, V.; Sandilos, P.; Georgiou, E.

    2006-10-01

    Seeking to assess the radiation risk associated with radiological examinations in neonatal intensive care units, thermo-luminescence dosimetry was used for the measurement of entrance surface dose (ESD) in 44 AP chest and 28 AP combined chest-abdominal exposures of a sample of 60 neonates. The mean values of ESD were found to be equal to 44 ± 16 µGy and 43 ± 19 µGy, respectively. The MCNP-4C2 code with a mathematical phantom simulating a neonate and appropriate x-ray energy spectra were employed for the simulation of the AP chest and AP combined chest-abdominal exposures. Equivalent organ dose per unit ESD and energy imparted per unit ESD calculations are presented in tabular form. Combined with ESD measurements, these calculations yield an effective dose of 10.2 ± 3.7 µSv, regardless of sex, and an imparted energy of 18.5 ± 6.7 µJ for the chest radiograph. The corresponding results for the combined chest-abdominal examination are 14.7 ± 7.6 µSv (males)/17.2 ± 7.6 µSv (females) and 29.7 ± 13.2 µJ. The calculated total risk per radiograph was low, ranging between 1.7 and 2.9 per million neonates, per film, and being slightly higher for females. Results of this study are in good agreement with previous studies, especially in view of the diversity met in the calculation methods.

  17. BRIDG: a domain information model for translational and clinical protocol-driven research.

    Science.gov (United States)

    Becnel, Lauren B; Hastak, Smita; Ver Hoef, Wendy; Milius, Robert P; Slack, MaryAnn; Wold, Diane; Glickman, Michael L; Brodsky, Boris; Jaffe, Charles; Kush, Rebecca; Helton, Edward

    2017-09-01

    It is critical to integrate and analyze data from biological, translational, and clinical studies with data from health systems; however, electronic artifacts are stored in thousands of disparate systems that are often unable to readily exchange data. To facilitate meaningful data exchange, a model that presents a common understanding of biomedical research concepts and their relationships with health care semantics is required. The Biomedical Research Integrated Domain Group (BRIDG) domain information model fulfills this need. Software systems created from BRIDG have shared meaning "baked in," enabling interoperability among disparate systems. For nearly 10 years, the Clinical Data Standards Interchange Consortium, the National Cancer Institute, the US Food and Drug Administration, and Health Level 7 International have been key stakeholders in developing BRIDG. BRIDG is an open-source Unified Modeling Language-class model developed through use cases and harmonization with other models. With its 4+ releases, BRIDG includes clinical and now translational research concepts in its Common, Protocol Representation, Study Conduct, Adverse Events, Regulatory, Statistical Analysis, Experiment, Biospecimen, and Molecular Biology subdomains. The model is a Clinical Data Standards Interchange Consortium, Health Level 7 International, and International Standards Organization standard that has been utilized in national and international standards-based software development projects. It will continue to mature and evolve in the areas of clinical imaging, pathology, ontology, and vocabulary support. BRIDG 4.1.1 and prior releases are freely available at https://bridgmodel.nci.nih.gov . © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  18. Chemical dosimetry principles in high dose dosimetry

    International Nuclear Information System (INIS)

    Mhatre, Sachin G.V.

    2016-01-01

    In radiation processing, activities of principal concern are process validation and process control. The objective of such formalized procedures is to establish documentary evidence that the irradiation process has achieved the desired results. The key element of such activities is inevitably a well characterized reliable dosimetry system that is traceable to recognized national and international dosimetry standards. Only such dosimetry systems can help establish the required documentary evidence. In addition, industrial radiation processing such as irradiation of foodstuffs and sterilization of health careproducts are both highly regulated, in particular with regard to dose. Besides, dosimetry is necessary for scaling up processes from the research level to the industrial level. Thus, accurate dosimetry is indispensable

  19. Patient-reported outcome (PRO assessment in clinical trials: a systematic review of guidance for trial protocol writers.

    Directory of Open Access Journals (Sweden)

    Melanie Calvert

    Full Text Available Evidence suggests there are inconsistencies in patient-reported outcome (PRO assessment and reporting in clinical trials, which may limit the use of these data to inform patient care. For trials with a PRO endpoint, routine inclusion of key PRO information in the protocol may help improve trial conduct and the reporting and appraisal of PRO results; however, it is currently unclear exactly what PRO-specific information should be included. The aim of this review was to summarize the current PRO-specific guidance for clinical trial protocol developers.We searched the MEDLINE, EMBASE, CINHAL and Cochrane Library databases (inception to February 2013 for PRO-specific guidance regarding trial protocol development. Further guidance documents were identified via Google, Google scholar, requests to members of the UK Clinical Research Collaboration registered clinical trials units and international experts. Two independent investigators undertook title/abstract screening, full text review and data extraction, with a third involved in the event of disagreement. 21,175 citations were screened and 54 met the inclusion criteria. Guidance documents were difficult to access: electronic database searches identified just 8 documents, with the remaining 46 sourced elsewhere (5 from citation tracking, 27 from hand searching, 7 from the grey literature review and 7 from experts. 162 unique PRO-specific protocol recommendations were extracted from included documents. A further 10 PRO recommendations were identified relating to supporting trial documentation. Only 5/162 (3% recommendations appeared in ≥50% of guidance documents reviewed, indicating a lack of consistency.PRO-specific protocol guidelines were difficult to access, lacked consistency and may be challenging to implement in practice. There is a need to develop easily accessible consensus-driven PRO protocol guidance. Guidance should be aimed at ensuring key PRO information is routinely included in

  20. Dosimetry system 1986

    International Nuclear Information System (INIS)

    Woolson, William A.; Egbert, Stephen D.; Gritzner, Michael L.

    1987-01-01

    In May 1983, the authors proposed a dosimetry system for use by the Radiation Effects Research Foundation (RERF) that would incorporate the new findings and calculations of the joint United States - Japan working groups on the reassessment of A-bomb dosimetry. The proposed dosimetry system evolved from extensive discussions with RERF personnel, numerous meetings of the scientists from Japan and the United States involved in the dosimetry reassessment research, and requirements expressed by epidemiologists and radiobiologists on the various review panels. The dosimetry system proposed was based on considerations of the dosimetry requirements for the normal work of RERF and for future research in radiobiology, the computerized input data on A-bomb survivors available in the RERF data base, the level of detail, precision, and accuracy of various components of the dosimetric estimates, and the computer resources available at RERF in Hiroshima. These discussions and our own experience indicated that, in light of the expansion of computer and radiation technologies and the desire for more detail in the dosimetry, an entirely new approach to the dosimetry system was appropriate. This resulted in a complete replacement of the T65D system as distinguished from a simpler approach involving a renormalization of T65D parameters to reflect the new dosimetry. The proposed dosimetry system for RERF and the plan for implementation was accepted by the Department of Energy (DOE) Working Group on A-bomb Dosimetry chaired by Dr. R.F. Christy. The dosimetry system plan was also presented to the binational A-bomb dosimetry review groups for critical comment and was discussed at joint US-Japan workshop. A prototype dosimetry system incorporating preliminary dosimetry estimates and applicable to only a limited set of A-bomb survivors was installed on the RERF computer system in the fall of 1984. This system was successfully operated at RERF and provided an initial look at the impact of

  1. Assessment of radiation damage - the need for a multi-parametric and integrative approach with the help of both clinical and biological dosimetry

    International Nuclear Information System (INIS)

    Meineke, Viktor

    2008-01-01

    Full text: Accidental exposure to ionising radiation leads to a damage on different levels of the biological organization of the organism. Depending on exposure conditions, such as nature of radiation, time and affected organs and organ systems, the clinical endpoint of radiation damage and the resulting acute and chronic radiation syndromes may vary to a great extent. Exposure situations range from pure localised radiation scenarios and partial body exposures up to whole body exposures. Therefore clinical pictures vary from localized radiation injuries up to the extreme situation of a radiation-induced multi-organ involvement and failure requiring immediate, intensive and interdisciplinary medical treatment. These total different and complex clinical situations not only show up most different clinical diagnostic and therapeutic aspects but necessarily due to different levels of the underlying biological damage, biological indicators of effects may vary to a wide extent. This fact means that an exact assessment of the extent of radiation damage within individual patients can only be performed when taking into consideration both clinical signs and symptoms as well as different biological indicators. Among the clinical indicators, routine laboratory parameters such as blood counts and the documentation of clinical signs and symptoms (such as the METREPOL system) are the key parameters, whereas the dicentric assay, the gold standard for biological dosimetry, but also methods under development such as the gamma-H2Ax focus assay or the estimation of variations of gene expression have to be taken into account. Each method provides best results in different situations, or in other words, there are methods that work better in a specific exposure condition or at a given time of examination (e.g. time after exposure) than others. Some methods show up results immediately, others require days to weeks until results are available for clinical decision making. Therefore to

  2. Evaluation of ion chamber dependent correction factors for ionisation chamber dosimetry in proton beams using a Monte Carlo method

    International Nuclear Information System (INIS)

    Palmans, H.; Verhaegen, F.

    1995-01-01

    In the last decade, several clinical proton beam therapy facilities have been developed. To satisfy the demand for uniformity in clinical (routine) proton beam dosimetry two dosimetry protocols (ECHED and AAPM) have been published. Both protocols neglect the influence of ion chamber dependent parameters on dose determination in proton beams because of the scatter properties of these beams, although the problem has not been studied thoroughly yet. A comparison between water calorimetry and ionisation chamber dosimetry showed a discrepancy of 2.6% between the former method and ionometry following the ECHED protocol. Possibly, a small part of this difference can be attributed to chamber dependent correction factors. Indications for this possibility are found in ionometry measurements. To allow the simulation of complex geometries with different media necessary for the study of those corrections, an existing proton Monte Carlo code (PTRAN, Berger) has been modified. The original code, that applies Mollire's multiple scattering theory and Vavilov's energy straggling theory, calculates depth dose profiles, energy distributions and radial distributions for pencil beams in water. Comparisons with measurements and calculations reported in the literature are done to test the program's accuracy. Preliminary results of the influence of chamber design and chamber materials on dose to water determination are presented

  3. Evaluation of ion chamber dependent correction factors for ionisation chamber dosimetry in proton beams using a Monte Carlo method

    Energy Technology Data Exchange (ETDEWEB)

    Palmans, H [Ghent Univ. (Belgium). Dept. of Biomedical Physics; Verhaegen, F

    1995-12-01

    In the last decade, several clinical proton beam therapy facilities have been developed. To satisfy the demand for uniformity in clinical (routine) proton beam dosimetry two dosimetry protocols (ECHED and AAPM) have been published. Both protocols neglect the influence of ion chamber dependent parameters on dose determination in proton beams because of the scatter properties of these beams, although the problem has not been studied thoroughly yet. A comparison between water calorimetry and ionisation chamber dosimetry showed a discrepancy of 2.6% between the former method and ionometry following the ECHED protocol. Possibly, a small part of this difference can be attributed to chamber dependent correction factors. Indications for this possibility are found in ionometry measurements. To allow the simulation of complex geometries with different media necessary for the study of those corrections, an existing proton Monte Carlo code (PTRAN, Berger) has been modified. The original code, that applies Mollire`s multiple scattering theory and Vavilov`s energy straggling theory, calculates depth dose profiles, energy distributions and radial distributions for pencil beams in water. Comparisons with measurements and calculations reported in the literature are done to test the program`s accuracy. Preliminary results of the influence of chamber design and chamber materials on dose to water determination are presented.

  4. Hanford External Dosimetry Technical Basis Manual PNL-MA-842

    International Nuclear Information System (INIS)

    Rathbone, Bruce A.

    2006-01-01

    The Hanford External Dosimetry Technical Basis Manual PNL-MA-842 documents the design and implementation of the external dosimetry system used at Hanford. The manual describes the dosimeter design, processing protocols, dose calculation methodology, radiation fields encountered, dosimeter response characteristics, limitations of dosimeter design under field conditions, and makes recommendations for effective use of the dosimeters in the field. The manual describes the technical basis for the dosimetry system in a manner intended to help ensure defensibility of the dose of record at Hanford and to demonstrate compliance with 10 CFR 835, DOELAP, DOE-RL, ORP, PNSO, and Hanford contractor requirements. The dosimetry system is operated by PNNL's Hanford External Dosimetry Program which provides dosimetry services to all Hanford contractors. The primary users of this manual are DOE and DOE contractors at Hanford using the dosimetry services of PNNL. Development and maintenance of this manual is funded directly by DOE and DOE contractors. Its contents have been reviewed and approved by DOE and DOE contractors at Hanford through the Hanford Personnel Dosimetry Advisory Committee which is chartered and chaired by DOE-RL and serves as means of coordinating dosimetry practices across contractors at Hanford. This manual was established in 1996. Since inception, it has been revised many times and maintained by PNNL as a controlled document with controlled distribution. Rev. 0 marks the first revision to be released through PNNL's Electronic Records & Information Capture Architecture (ERICA) database

  5. Hanford External Dosimetry Technical Basis Manual PNL-MA-842

    Energy Technology Data Exchange (ETDEWEB)

    Rathbone, Bruce A.

    2005-02-25

    The Hanford External Dosimetry Technical Basis Manual PNL-MA-842 documents the design and implementation of the external dosimetry system used at Hanford. The manual describes the dosimeter design, processing protocols, dose calculation methodology, radiation fields encountered, dosimeter response characteristics, limitations of dosimeter design under field conditions, and makes recommendations for effective use of the dosimeters in the field. The manual describes the technical basis for the dosimetry system in a manner intended to help ensure defensibility of the dose of record at Hanford and to demonstrate compliance with 10 CFR 835, DOELAP, DOE-RL, ORP, PNSO, and Hanford contractor requirements. The dosimetry system is operated by PNNL’s Hanford External Dosimetry Program which provides dosimetry services to all Hanford contractors. The primary users of this manual are DOE and DOE contractors at Hanford using the dosimetry services of PNNL. Development and maintenance of this manual is funded directly by DOE and DOE contractors. Its contents have been reviewed and approved by DOE and DOE contractors at Hanford through the Hanford Personnel Dosimetry Advisory Committee which is chartered and chaired by DOE-RL and serves as means of coordinating dosimetry practices across contractors at Hanford. This manual was established in 1996. Since inception, it has been revised many times and maintained by PNNL as a controlled document with controlled distribution. Rev. 0 marks the first revision to be released through PNNL’s Electronic Records & Information Capture Architecture (ERICA) database.

  6. [Development of clinical trial education program for pharmaceutical science students through small group discussion and role-playing using protocol].

    Science.gov (United States)

    Imakyure, Osamu; Shuto, Hideki; Nishikawa, Fumi; Hagiwara, Yoshifuka; Inoue, Sachiko; Koyanagi, Taeko; Hirakawa, Masaaki; Kataoka, Yasufumi

    2010-08-01

    The acquirement of basic knowledge of clinical trials and professional attitude in their practices is a general instructional objective in the Model Core Curriculum for Pharmaceutical Education. Unfortunately, the previous program of clinical trial education was not effective in the acquirement of a professional attitude in their practices. Then, we developed the new clinical trial education program using protocol through small group discussion (SGD) and roll-playing. Our program consists of 7 steps of practical training. In step 1, the students find some problems after presentation of the protocol including case and prescription. In step 2, they analyse the extracted problems and share the information obtained in SGD. In steps 3 and 5, five clinical case scenarios are presented to the students and they discuss which case is suitable for entry to the clinical trial or which case corresponds to the discontinuance criteria in the present designed protocol. In steps 4 and 6, the roll-playing is performed by teachers and students as doctors and clinical research coordinators (CRC) respectively. Further, we conducted a trial practice based on this program for the students. In the student's self-evaluation into five grades, the average score of the skill acquisition level in each step was 3.8-4.7 grade. Our clinical trial education program could be effective in educating the candidates for CRC or clinical pharmacists.

  7. Risks to the fetus from diagnostic imaging during pregnancy: review and proposal of a clinical protocol

    International Nuclear Information System (INIS)

    Gomes, Mafalda; Matias, Alexandra; Macedo, Filipe

    2015-01-01

    Every day, medical practitioners face the dilemma of exposing pregnant or possibly pregnant patients to radiation from diagnostic examinations. Both doctors and patients often have questions about the risks of radiation. The most vulnerable period is between the 8th and 15th weeks of gestation. Deterministic effects like pregnancy loss, congenital malformations, growth retardation and neurobehavioral abnormalities have threshold doses above 100-200 mGy. The risk is considered negligible at 50 mGy and in reality no diagnostic examination exceeds this limit. The risk of carcinogenesis is slightly higher than in the general population. Intravenous iodinated contrast is discouraged, except in highly selected patients. Considering all the possible noxious effects of radiation exposure, measures to diminish radiation are essential and affect the fetal outcome. Nonionizing procedures should be considered whenever possible and every radiology center should have its own data analysis on fetal radiation exposure. In this review, we analyze existing literature on fetal risks due to radiation exposure, producing a clinical protocol to guide safe radiation use in a clinical setting. (orig.)

  8. Risks to the fetus from diagnostic imaging during pregnancy: review and proposal of a clinical protocol.

    Science.gov (United States)

    Gomes, Mafalda; Matias, Alexandra; Macedo, Filipe

    2015-12-01

    Every day, medical practitioners face the dilemma of exposing pregnant or possibly pregnant patients to radiation from diagnostic examinations. Both doctors and patients often have questions about the risks of radiation. The most vulnerable period is between the 8th and 15th weeks of gestation. Deterministic effects like pregnancy loss, congenital malformations, growth retardation and neurobehavioral abnormalities have threshold doses above 100-200 mGy. The risk is considered negligible at 50 mGy and in reality no diagnostic examination exceeds this limit. The risk of carcinogenesis is slightly higher than in the general population. Intravenous iodinated contrast is discouraged, except in highly selected patients. Considering all the possible noxious effects of radiation exposure, measures to diminish radiation are essential and affect the fetal outcome. Nonionizing procedures should be considered whenever possible and every radiology center should have its own data analysis on fetal radiation exposure. In this review, we analyze existing literature on fetal risks due to radiation exposure, producing a clinical protocol to guide safe radiation use in a clinical setting.

  9. Risks to the fetus from diagnostic imaging during pregnancy: review and proposal of a clinical protocol

    Energy Technology Data Exchange (ETDEWEB)

    Gomes, Mafalda; Matias, Alexandra [University of Porto, Faculty of Medicine, Porto (Portugal); Macedo, Filipe [SMIC, Porto (Portugal)

    2015-12-15

    Every day, medical practitioners face the dilemma of exposing pregnant or possibly pregnant patients to radiation from diagnostic examinations. Both doctors and patients often have questions about the risks of radiation. The most vulnerable period is between the 8th and 15th weeks of gestation. Deterministic effects like pregnancy loss, congenital malformations, growth retardation and neurobehavioral abnormalities have threshold doses above 100-200 mGy. The risk is considered negligible at 50 mGy and in reality no diagnostic examination exceeds this limit. The risk of carcinogenesis is slightly higher than in the general population. Intravenous iodinated contrast is discouraged, except in highly selected patients. Considering all the possible noxious effects of radiation exposure, measures to diminish radiation are essential and affect the fetal outcome. Nonionizing procedures should be considered whenever possible and every radiology center should have its own data analysis on fetal radiation exposure. In this review, we analyze existing literature on fetal risks due to radiation exposure, producing a clinical protocol to guide safe radiation use in a clinical setting. (orig.)

  10. Postoperative vaginal cuff irradiation using high dose rate remote afterloading: a Phase II clinical protocol

    International Nuclear Information System (INIS)

    Noyes, William R.; Bastin, Kenneth; Edwards, Scott A.; Buchler, Dolores A.; Stitt, Judith A.; Thomadsen, Bruce R.; Fowler, Jack F.; Kinsella, Timothy J.

    1995-01-01

    Purpose: In September 1989, a postoperative Phase II high dose rate (HDR) brachytherapy protocol was started for International Federation of Gynecology and Obstetrics (FIGO) Stage I endometrial adenocarcinoma. This review reports the overall survival, local control, and complication rates for the initial 63 patients treated in this Phase II study. Methods and Materials: High dose rate brachytherapy was delivered using an Iridium-192 HDR remote afterloader. Sixty-three patients were entered into the Phase II protocol, each receiving two vaginal cuff treatments 1 week apart (range 4-12 days) with vaginal ovoids (diameter 2.0-3.0 cm). No patient received adjuvant external beam radiation. A dose of 32.4 Gy in two fractions was prescribed to the ovoid surface in 63 patients. The first three patients treated at our institution received 15, 16.2, and 29 Gy, respectively, to determine acute effects. Results: At a median follow-up of 1.6 years (range 0.75-4.3 years) no patient has developed a vaginal cuff recurrence. One regional recurrence (1.6%) occurred at 1.2 years at the pelvic side wall. This patient is alive and without evidence of disease 7 months after completion of salvage irradiation, which resulted in the only vaginal stenosis (1.6%). Fourteen patients (22%) experienced vaginal apex fibrosis by physical exam, which was clinically symptomatic in four patients. Two patients reported stress incontinence; however, these symptoms were noted prior to their HDR therapy. One patient died 2.4 years after HDR therapy due to cardiovascular disease without evidence of cancer at autopsy. Conclusion: Preliminary results of our phase II HDR vaginal cuff protocol for postoperative FIGO Stage IA, Grade 3 or Stage IB, Grade 1-2 patients demonstrate that 32.4 Gy in two fractions is well tolerated by the vaginal cuff mucosa. Local control appears comparable to our prior experience and others with low dose rate (LDR) brachytherapy. Additional patient accrual and further follow

  11. [Effect of a multidisciplinar protocol on the clinical results obtained after bariatric surgery].

    Science.gov (United States)

    Cánovas Gaillemin, B; Sastre Martos, J; Moreno Segura, G; Llamazares Iglesias, O; Familiar Casado, C; Abad de Castro, S; López Pardo, R; Sánchez-Cabezudo Muñoz, M A

    2011-01-01

    Bariatric surgery has been shown to be an effective therapy for weight loss in patients with severe obesity, and the implementation of a multidisciplinar management protocol is recommended. To assess the usefulness of the implementation of a management protocol in obesity surgery based on the Spanish Consensus Document of the SEEDO. Retrospective comparative study of the outcomes in patients previously operated (51 patients) and after the implementation of the protocol (66 patients). The following data were gathered: anthropometry, pre-and post-surgery comorbidities, post-surgical nutritional and surgical complications, validated Quality of Life questionnaire, and dietary habits. Withdrawals (l7.6%) and alcoholism (5.8%) were higher in patients pre- versus post-implementation of the protocol (4.5% vs. 3%, respectively), the differences being statistically significant. The mortality rate was 2% in the pre-protocol group and 0% in the postprotocol group. The dietary habits were better in the post-protocol group, the pre-protocol group presenting a higher percentage of feeding-behavior disorders (5.1%) although not reaching a statistical significance. The improvement in quality of life was higher in the post-protocol group for all items, but only reaching statistical significance in sexual activity (p = 0.004). In the pre-protocol group, 70.5% of the patients had more than one nutritional complication vs. 32.8% in the post-protocol group (p 50% in 81.3% in the pre-protocol group vs. 74.8% in the pos-protocol group) or the comorbidities. Bariatric surgery achieves excellent outcomes in weight loss, comorbidities, and quality of life, but presents nutritional, surgical, and psychiatric complications that require a protocol-based and multidisciplinary approach. Our protocol improves the outcomes regarding the withdrawal rates, feeding-behavior disorders, dietary habits, nutritional complications, and quality of life.

  12. Guidelines for Inclusion of Patient-Reported Outcomes in Clinical Trial Protocols: The SPIRIT-PRO Extension.

    Science.gov (United States)

    Calvert, Melanie; Kyte, Derek; Mercieca-Bebber, Rebecca; Slade, Anita; Chan, An-Wen; King, Madeleine T; Hunn, Amanda; Bottomley, Andrew; Regnault, Antoine; Chan, An-Wen; Ells, Carolyn; O'Connor, Daniel; Revicki, Dennis; Patrick, Donald; Altman, Doug; Basch, Ethan; Velikova, Galina; Price, Gary; Draper, Heather; Blazeby, Jane; Scott, Jane; Coast, Joanna; Norquist, Josephine; Brown, Julia; Haywood, Kirstie; Johnson, Laura Lee; Campbell, Lisa; Frank, Lori; von Hildebrand, Maria; Brundage, Michael; Palmer, Michael; Kluetz, Paul; Stephens, Richard; Golub, Robert M; Mitchell, Sandra; Groves, Trish

    2018-02-06

    Patient-reported outcome (PRO) data from clinical trials can provide valuable evidence to inform shared decision making, labeling claims, clinical guidelines, and health policy; however, the PRO content of clinical trial protocols is often suboptimal. The SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) statement was published in 2013 and aims to improve the completeness of trial protocols by providing evidence-based recommendations for the minimum set of items to be addressed, but it does not provide PRO-specific guidance. To develop international, consensus-based, PRO-specific protocol guidance (the SPIRIT-PRO Extension). The SPIRIT-PRO Extension was developed following the Enhancing Quality and Transparency of Health Research (EQUATOR) Network's methodological framework for guideline development. This included (1) a systematic review of existing PRO-specific protocol guidance to generate a list of potential PRO-specific protocol items (published in 2014); (2) refinements to the list and removal of duplicate items by the International Society for Quality of Life Research (ISOQOL) Protocol Checklist Taskforce; (3) an international stakeholder survey of clinical trial research personnel, PRO methodologists, health economists, psychometricians, patient advocates, funders, industry representatives, journal editors, policy makers, ethicists, and researchers responsible for evidence synthesis (distributed by 38 international partner organizations in October 2016); (4) an international Delphi exercise (n = 137 invited; October 2016 to February 2017); and (5) consensus meeting (n = 30 invited; May 2017). Prior to voting, consensus meeting participants were informed of the results of the Delphi exercise and given data from structured reviews evaluating the PRO protocol content of 3 defined samples of trial protocols. The systematic review identified 162 PRO-specific protocol recommendations from 54 sources. The ISOQOL Taskforce (n

  13. Effects of triploidy incidence on clinical outcomes for IVF-ET cycles in different ovarian stimulation protocols.

    Science.gov (United States)

    Li, Mingzhao; Xue, Xia; Zhang, Silin; Li, Wei; Zhao, Xiaoli; Ren, Wenjuan; Shi, Juanzi

    2015-10-01

    To discuss the relationship between triploidy incidence and clinical outcomes of embryos derived from normally fertilized oocytes from the same cohort for in vitro fertilization-embryo transfer (IVF-ET) cycles in different ovarian stimulation protocol. This study included 2070 in vitro fertilization (IVF) cycles with long-term protocol, 802 IVF cycles with ultra short-term protocol and 508 IVF-D (in vitro fertilization by donor semen) cycles with long-term protocol from January 2013 to September 2014. According to the different 3PN rate, patients were divided into three groups as follows: Group 1 included patients with 0% 3PN zygotes, Group 2 included patients with 1-25% 3PN zygotes and Group 3 included patients with >25% 3PN zygotes. female age, no. of retrieved oocytes, normal fertilization rate, day-3 grade I + II embryos rate, day-3 grade I + II + III embryos rate, implantation rate, pregnancy rate and early abortion rate. Triploidy cycle incidence rate in IVF and IVF-D cycles with long-term protocol were significantly higher than in IVF cycles with ultra short-term protocol (p  0.05). In three protocols, normal fertilization rate in 3PN = 0% and 3PN = 1-25% groups were significantly higher compared to 3PN > 25% group (p cycles with long-term protocol, the day-3 grade I + II embryos, implantation and pregnancy rate in 3PN > 25% group were significantly lower than other two groups (p  0.05). In IVF cycles with ultra short-term protocol, there were no significant differences found in day-3 grade I + II embryos, day-3 grade I + II + III embryos, implantation, pregnancy and early abortion rate (p > 0.05). In IVF-D cycles with long-term protocol, the day-3 grade I + II embryos, day-3 grade I + II + III embryos and implantation rate in 3PN > 25% group were significantly lower than other two groups (p  0.05). We observed that high proportion of triploid zygotes made a negative effect on

  14. Clinical benefits of incorporating doxycycline into a canine heartworm treatment protocol

    Directory of Open Access Journals (Sweden)

    C. Thomas Nelson

    2017-11-01

    Full Text Available Abstract Background The objective of heartworm treatment is to improve the clinical condition of the patient and to eliminate pre-cardiac, juvenile, and adult worm stages with minimal complications. Pulmonary thromboembolisms are an inevitable consequence of worm death and can result in severe pulmonary reactions and even death of the patient. To minimize these reactions, various treatment protocols involving melarsomine, the only adulticidal drug approved by the US Food and Drug Administrations (FDA, in conjunction with macrocyclic lactone heartworm preventives and glucocorticosteroids have been advocated. The discovery of the bacterial endosymbiont Wolbachia in Dirofilaria immitis has led to several experimental studies examining the effects of administering doxycycline to reduce or eliminate Wolbachia organism. These studies have shown a decrease in gross and microscopic pathology of pulmonary parenchyma in experimental heartworm infections pretreated with doxycycline before melarsomine administration. Methods Electronic medical records from a large veterinary practice in northeast Alabama were searched to identify dogs treated for heartworms with melarsomine from January 2005 through December 2012. The search was refined further to select for dogs that met the following criteria: 1 received two or three doses of ivermectin heartworm preventive prior to melarsomine injections, 2 received one injection of melarsomine followed by two injections 4 to 8 weeks later, and 3 were treated with prednisone following melarsomine injections. The dogs were then divided into those that also were treated with doxycycline 10 mg/kg BID for 4 weeks (Group A, n = 47 and those that did not receive doxycycline (Group B, n = 47. The medical notes of all 94 cases were then reviewed for comments concerning coughing, dyspnea, or hemoptysis in the history, physical exam template, or from telephone conversations with clients the week following each visit. Any

  15. Clinical benefits of incorporating doxycycline into a canine heartworm treatment protocol.

    Science.gov (United States)

    Nelson, C Thomas; Myrick, Elizabeth S; Nelson, Thomas A

    2017-11-09

    The objective of heartworm treatment is to improve the clinical condition of the patient and to eliminate pre-cardiac, juvenile, and adult worm stages with minimal complications. Pulmonary thromboembolisms are an inevitable consequence of worm death and can result in severe pulmonary reactions and even death of the patient. To minimize these reactions, various treatment protocols involving melarsomine, the only adulticidal drug approved by the US Food and Drug Administrations (FDA), in conjunction with macrocyclic lactone heartworm preventives and glucocorticosteroids have been advocated. The discovery of the bacterial endosymbiont Wolbachia in Dirofilaria immitis has led to several experimental studies examining the effects of administering doxycycline to reduce or eliminate Wolbachia organism. These studies have shown a decrease in gross and microscopic pathology of pulmonary parenchyma in experimental heartworm infections pretreated with doxycycline before melarsomine administration. Electronic medical records from a large veterinary practice in northeast Alabama were searched to identify dogs treated for heartworms with melarsomine from January 2005 through December 2012. The search was refined further to select for dogs that met the following criteria: 1) received two or three doses of ivermectin heartworm preventive prior to melarsomine injections, 2) received one injection of melarsomine followed by two injections 4 to 8 weeks later, and 3) were treated with prednisone following melarsomine injections. The dogs were then divided into those that also were treated with doxycycline 10 mg/kg BID for 4 weeks (Group A, n = 47) and those that did not receive doxycycline (Group B, n = 47). The medical notes of all 94 cases were then reviewed for comments concerning coughing, dyspnea, or hemoptysis in the history, physical exam template, or from telephone conversations with clients the week following each visit. Any dog that died within one year of treatment

  16. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Treatment Improvement Protocol (TIP) Series 40

    Science.gov (United States)

    Boone, Margaret; Brown, Nancy J.; Moon, Mary A.; Schuman, Deborah J.; Thomas, Josephine; Wright, Denise L.

    2004-01-01

    This Treatment Improvement Protocol (TIP) addresses the clinical use of buprenorphine in the treatment of opioid addiction. TIPs are best-practice guidelines for the treatment of substance use disorders that make the latest research in substance abuse treatment available to counselors and educators. The content was generated by a panel of experts…

  17. SU-F-R-06: Traumatic Brachial Plexus Injury Imaging, Developing a Coherent Clinical Protocol From Literature Review Through Practice

    International Nuclear Information System (INIS)

    Wu, D; France, E; Lambert, J; Hinkle, J

    2016-01-01

    Purpose: Medical Physics teams can now play a critical role to help plan and provide studied approaches for traumatic brachial plexus MR imaging (tbpMRI). This is especially important for coordination with uncommon applications, since it is challenging to select the right modality, parameters, and train technologists on the essential components. For this work, we started with a review of the medical literature, performed crossover/volunteer studies to bring tbpMRI to practice with greater image QC and protocol management. Methods: To the best of our knowledge, we reviewed the known searchable domain for tbpMRI. We found 69 total articles since 2000. Articles were evaluated with our published protocol for literature management (LIMES3). Two physicists and two radiologists condensed the information from all articles into a knowledgebase. Results: The initial literature demonstrated great heterogeneity, which was a sign that this area needed greater consistency. Despite inconsistency and imprecision, we extracted the most relevant targets using our long-term experience with protocol development in MSK. We ran volunteers on six different magnets of various field strengths with multiple receiver coils, and rebuilt a coherent protocol for tbpMRI. Our radiologists rated LIMES3 work as superior. We have received referrals from the ER and have conducted four patient evaluations. Conclusion: Traumatic brachial plexus MRI has great possible benefits for patients. This work supports the complexity of tbpMRI scanning. As this is rarely performed, it requires a more diligent protocol workflow, coordination of caregivers, and education within multiple clinical departments. Choosing the correct imaging exam can be critical, as patients can have significant neuropathy and/or paralysis. The LIMES3 protocol is well liked at our institution, and forms the cornerstone of understanding for our work. Our literature management led to a better clinical protocol creation despite the diffuse

  18. SU-F-R-06: Traumatic Brachial Plexus Injury Imaging, Developing a Coherent Clinical Protocol From Literature Review Through Practice

    Energy Technology Data Exchange (ETDEWEB)

    Wu, D; France, E; Lambert, J; Hinkle, J [The University of Oklahoma Health Sciences Center, Oklahoma City, OK (United States)

    2016-06-15

    Purpose: Medical Physics teams can now play a critical role to help plan and provide studied approaches for traumatic brachial plexus MR imaging (tbpMRI). This is especially important for coordination with uncommon applications, since it is challenging to select the right modality, parameters, and train technologists on the essential components. For this work, we started with a review of the medical literature, performed crossover/volunteer studies to bring tbpMRI to practice with greater image QC and protocol management. Methods: To the best of our knowledge, we reviewed the known searchable domain for tbpMRI. We found 69 total articles since 2000. Articles were evaluated with our published protocol for literature management (LIMES3). Two physicists and two radiologists condensed the information from all articles into a knowledgebase. Results: The initial literature demonstrated great heterogeneity, which was a sign that this area needed greater consistency. Despite inconsistency and imprecision, we extracted the most relevant targets using our long-term experience with protocol development in MSK. We ran volunteers on six different magnets of various field strengths with multiple receiver coils, and rebuilt a coherent protocol for tbpMRI. Our radiologists rated LIMES3 work as superior. We have received referrals from the ER and have conducted four patient evaluations. Conclusion: Traumatic brachial plexus MRI has great possible benefits for patients. This work supports the complexity of tbpMRI scanning. As this is rarely performed, it requires a more diligent protocol workflow, coordination of caregivers, and education within multiple clinical departments. Choosing the correct imaging exam can be critical, as patients can have significant neuropathy and/or paralysis. The LIMES3 protocol is well liked at our institution, and forms the cornerstone of understanding for our work. Our literature management led to a better clinical protocol creation despite the diffuse

  19. SU-E-T-02: 90Y Microspheres Dosimetry Calculation with Voxel-S-Value Method: A Simple Use in the Clinic

    International Nuclear Information System (INIS)

    Maneru, F; Gracia, M; Gallardo, N; Olasolo, J; Fuentemilla, N; Bragado, L; Martin-Albina, M; Lozares, S; Pellejero, S; Miquelez, S; Rubio, A; Otal, A

    2015-01-01

    Purpose: To present a simple and feasible method of voxel-S-value (VSV) dosimetry calculation for daily clinical use in radioembolization (RE) with 90 Y microspheres. Dose distributions are obtained and visualized over CT images. Methods: Spatial dose distributions and dose in liver and tumor are calculated for RE patients treated with Sirtex Medical miscrospheres at our center. Data obtained from the previous simulation of treatment were the basis for calculations: Tc-99m maggregated albumin SPECT-CT study in a gammacamera (Infinia, General Electric Healthcare.). Attenuation correction and ordered-subsets expectation maximization (OSEM) algorithm were applied.For VSV calculations, both SPECT and CT were exported from the gammacamera workstation and registered with the radiotherapy treatment planning system (Eclipse, Varian Medical systems). Convolution of activity matrix and local dose deposition kernel (S values) was implemented with an in-house developed software based on Python code. The kernel was downloaded from www.medphys.it. Final dose distribution was evaluated with the free software Dicompyler. Results: Liver mean dose is consistent with Partition method calculations (accepted as a good standard). Tumor dose has not been evaluated due to the high dependence on its contouring. Small lesion size, hot spots in health tissue and blurred limits can affect a lot the dose distribution in tumors. Extra work includes: export and import of images and other dicom files, create and calculate a dummy plan of external radiotherapy, convolution calculation and evaluation of the dose distribution with dicompyler. Total time spent is less than 2 hours. Conclusion: VSV calculations do not require any extra appointment or any uncomfortable process for patient. The total process is short enough to carry it out the same day of simulation and to contribute to prescription decisions prior to treatment. Three-dimensional dose knowledge provides much more information than other

  20. SU-E-T-02: 90Y Microspheres Dosimetry Calculation with Voxel-S-Value Method: A Simple Use in the Clinic

    Energy Technology Data Exchange (ETDEWEB)

    Maneru, F; Gracia, M; Gallardo, N; Olasolo, J; Fuentemilla, N; Bragado, L; Martin-Albina, M; Lozares, S; Pellejero, S; Miquelez, S; Rubio, A [Complejo Hospitalario de Navarra, Pamplona, Navarra (Spain); Otal, A [Hospital Clinica Benidorm, Benidorm, Alicante (Spain)

    2015-06-15

    Purpose: To present a simple and feasible method of voxel-S-value (VSV) dosimetry calculation for daily clinical use in radioembolization (RE) with {sup 90}Y microspheres. Dose distributions are obtained and visualized over CT images. Methods: Spatial dose distributions and dose in liver and tumor are calculated for RE patients treated with Sirtex Medical miscrospheres at our center. Data obtained from the previous simulation of treatment were the basis for calculations: Tc-99m maggregated albumin SPECT-CT study in a gammacamera (Infinia, General Electric Healthcare.). Attenuation correction and ordered-subsets expectation maximization (OSEM) algorithm were applied.For VSV calculations, both SPECT and CT were exported from the gammacamera workstation and registered with the radiotherapy treatment planning system (Eclipse, Varian Medical systems). Convolution of activity matrix and local dose deposition kernel (S values) was implemented with an in-house developed software based on Python code. The kernel was downloaded from www.medphys.it. Final dose distribution was evaluated with the free software Dicompyler. Results: Liver mean dose is consistent with Partition method calculations (accepted as a good standard). Tumor dose has not been evaluated due to the high dependence on its contouring. Small lesion size, hot spots in health tissue and blurred limits can affect a lot the dose distribution in tumors. Extra work includes: export and import of images and other dicom files, create and calculate a dummy plan of external radiotherapy, convolution calculation and evaluation of the dose distribution with dicompyler. Total time spent is less than 2 hours. Conclusion: VSV calculations do not require any extra appointment or any uncomfortable process for patient. The total process is short enough to carry it out the same day of simulation and to contribute to prescription decisions prior to treatment. Three-dimensional dose knowledge provides much more information than

  1. Multi-disciplinary clinical protocol for the diagnosis of bulbar amyotrophic lateral sclerosis.

    Science.gov (United States)

    Chiaramonte, Rita; Di Luciano, Carmela; Chiaramonte, Ignazio; Serra, Agostino; Bonfiglio, Marco

    2018-04-23

    The objective of this study was to examine the role of different specialists in the diagnosis of amyotrophic lateral sclerosis (ALS), to understand changes in verbal expression and phonation, respiratory dynamics and swallowing that occurred rapidly over a short period of time. 22 patients with bulbar ALS were submitted for voice assessment, ENT evaluation, Multi-Dimensional Voice Program (MDVP), spectrogram, electroglottography, fiberoptic endoscopic evaluation of swallowing. In the early stage of the disease, the oral tract and velopharyngeal port were involved. Three months after the initial symptoms, most of the patients presented hoarseness, breathy voice, dysarthria, pitch modulation problems and difficulties in pronunciation of explosive, velar and lingual consonants. Values of MDVP were altered. Spectrogram showed an additional formant, due to nasal resonance. Electroglottography showed periodic oscillation of the vocal folds only during short vocal cycle. Swallowing was characterized by weakness and incoordination of oro-pharyngeal muscles with penetration or aspiration. A specific multidisciplinary clinical protocol was designed to report vocal parameters and swallowing disorders that changed more quickly in bulbar ALS patients. Furthermore, the patients were stratified according to involvement of pharyngeal structures, and severity index. Copyright © 2018 Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Physical Therapy Protocol After Hip Arthroscopy: Clinical Guidelines Supported by 2-Year Outcomes.

    Science.gov (United States)

    Domb, Benjamin G; Sgroi, Terrance A; VanDevender, Jeremy C

    2016-07-01

    Femoroacetabular impingement (FAI) was first described by Ganz in 2003 and is a significant cause of decreased function and mobility. Femoroacetabular impingement must be treated in an individualized, goal-oriented, stepwise fashion. This protocol was developed with biomechanical considerations of soft tissue and bony structures surrounding the hip joint. The PubMed database was searched for scientific and review articles from the years 2000 to 2015 utilizing the search terms: hip rehabilitation, femoroacetabular impingement, and arthroscopy. Clinical review. Level 5. Five hundred ninety-five of 738 patients were available for follow-up showing improvement from preoperative to 2-year follow-up of 61.29 to 82.02 for modified Harris Hip Score (mHHS), 62.79 to 83.04 for Hip Outcome Score-Activities of Daily Living (HOS-ADL), 40.96 to 70.07 for Hip Outcome Score-Sport-Specific Subscale (HOS-SSS), and 57.97 to 80.41 for Non-Arthritic Hip Score (NAHS); visual analog scale (VAS) scores decreased from 5.86 preoperatively to 2.94 postoperatively. Following a structured, criteria-based program, appropriate patients undergoing hip arthroscopy may achieve excellent outcomes and return to full independent activities of daily living as well as sport. © 2016 The Author(s).

  3. Correction: PAIS: paracetamol (acetaminophen in stroke; protocol for a randomized, double blind clinical trial. [ISCRTN74418480

    Directory of Open Access Journals (Sweden)

    Kappelle L Jaap

    2008-11-01

    Full Text Available Abstract Background The Paracetamol (Acetaminophen In Stroke (PAIS study is a phase III multicenter, double blind, randomized, placebo-controlled clinical trial of high-dose acetaminophen in patients with acute stroke. The trial compares treatment with a daily dose of 6 g acetaminophen, started within 12 hours after the onset of symptoms, with matched placebo. The purpose of this study is to assess whether treatment with acetaminophen for 3 days will result in improved functional outcome through a modest reduction in body temperature and prevention of fever. The previously planned statistical analysis based on a dichotomization of the scores on the modified Rankin Scale (mRS may not make the most efficient use of the available baseline information. Therefore, the planned primary analysis of the PAIS study has been changed from fixed dichotomization of the mRS to a sliding dichotomy analysis. Methods Instead of taking a single definition of good outcome for all patients, the definition is tailored to each individual patient's baseline prognosis on entry into the trial. Conclusion The protocol change was initiated because of both advances in statistical approaches and to increase the efficiency of the trial by improving statistical power. Trial Registration Current Controlled Trials [ISCRTN74418480

  4. Thermoluminescence albedo-neutron dosimetry

    International Nuclear Information System (INIS)

    Strand, T.; Storruste, A.

    1986-10-01

    The report discusses neutron detection with respect to dosimetry and compares different thermoluminescent dosimetry materials for neutron dosimetry. Construction and calibration of a thermoluminescence albedo neutron dosemeter, developed by the authors, is described

  5. Thermoluminescence in medical dosimetry

    International Nuclear Information System (INIS)

    Rivera, T.

    2011-10-01

    The dosimetry by thermoluminescence (Tl) is applied in the entire world for the dosimetry of ionizing radiations specially to personal and medical dosimetry. This dosimetry method has been very interesting for measures in vivo because the Tl dosimeters have the advantage of being very sensitive in a very small volume and they are also equivalent to tissue and they do not need additional accessories (for example, cable, electrometer, etc.) The main characteristics of the diverse Tl materials to be used in the radiation measures and practical applications are: the Tl curve, the share homogeneity, the signal stability after the irradiation, precision and exactitude, the response in function with the dose and the energy influence. In this work a brief summary of the advances of the radiations dosimetry is presented by means of the thermally stimulated luminescence and its application to the dosimetry in radiotherapy. (Author)

  6. Thin film tritium dosimetry

    Science.gov (United States)

    Moran, Paul R.

    1976-01-01

    The present invention provides a method for tritium dosimetry. A dosimeter comprising a thin film of a material having relatively sensitive RITAC-RITAP dosimetry properties is exposed to radiation from tritium, and after the dosimeter has been removed from the source of the radiation, the low energy electron dose deposited in the thin film is determined by radiation-induced, thermally-activated polarization dosimetry techniques.

  7. Internal sources dosimetry

    International Nuclear Information System (INIS)

    Savio, Eduardo

    1994-01-01

    The absorbed dose, need of estimation in risk evaluation in the application of radiopharmaceuticals in Nuclear Medicine practice,internal dosimetry,internal and external sources. Calculation methodology,Marinelli model,MIRD system for absorbed dose calculation based on biological parameters of radiopharmaceutical in human body or individual,energy of emitted radiations by administered radionuclide, fraction of emitted energy that is absorbed by target body.Limitation of the MIRD calculation model. A explanation of Marinelli method of dosimetry calculation,β dosimetry. Y dosimetry, effective dose, calculation in organs and tissues, examples. Bibliography .

  8. Dosimetry of ionizing radiation

    International Nuclear Information System (INIS)

    Musilek, L.; Seda, J.; Trousil, J.

    1992-01-01

    The publication deals with a major field of ionizing radiation dosimetry, viz., integrating dosimetric methods, which are the basic means of operative dose determination. It is divided into the following sections: physical and chemical effects of ionizing radiation; integrating dosimetric methods for low radiation doses (film dosimetry, nuclear emulsions, thermoluminescence, radiophotoluminescence, solid-state track detectors, integrating ionization dosemeters); dosimetry of high ionizing radiation doses (chemical dosimetric methods, dosemeters based on the coloring effect, activation detectors); additional methods applicable to integrating dosimetry (exoelectron emission, electron spin resonance, lyoluminescence, etc.); and calibration techniques for dosimetric instrumentation. (Z.S.). 422 refs

  9. Experimental IMRT breast dosimetry in a thorax phantom

    Energy Technology Data Exchange (ETDEWEB)

    Pimenta, Elsa B.; Campos, Tarcisio P.R.; Nogueira, Luciana B.; Lima, Andre C.S., E-mail: elsabpimenta@gmail.com, E-mail: tprcampos@pq.cnpq.br, E-mail: lucibn19@yahoo.com.br, E-mail: radioterapia.andre@gmail.com [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil); Centro de Tratamento em Radioterapia, Betim, MG (Brazil)

    2017-11-01

    Radiation therapy (RT) is an essential therapeutic method. RT is often used as adjuvant therapy in the treatment of breast cancer. The dose-volume restrictions of the organs at risk limit the prescribed dose to the target volume and biological and clinical effects may influence the final treatment outcome. The breast RT provides large risks to the adjacent organs and consequently the recommended dosimetry to the prescribed dose volume (PTV) is 50 Gy, lower than the most prescribed dose in other treatments (70-85 Gy). Such values implies in less tumor control compared to other sites. The present research proposal aimed to measure absorbed dose in a thorax phantom with synthetic breasts provided by an Intensity-Modulate Radiation Therapy (IMRT) protocol in a RT center. On the methodology, IMRT protocol was selected following recommendations from the Radiation Therapy Oncology Group (RTOG). Radiochromic films and a thorax simulator were prepared by the Ionizing Radiation Research Group (NRI). Dosimeters were calibrated on a selected linear accelerator (LINAC). The comparison of the dosimetry from treatment planning system (TPS), Xio (Elekta) and from experimental data was performed. The spatial distribution of the breast internal dose and in the adjacent organs was depicted by the experimental data. In the film's calibration, the quadratic polynomial fit presented a satisfactory coefficient. Two-dimensional dose profiles were obtained in the breast suggesting that films can supply details and information that TPS does not provide. At the phantom's dosimetry, the internal mean doses taken at the synthetic breast presented usual values above the prescribed dose, besides overall values were within the dosimetric MSKCC criterion. The non full reproduction of the build-up region in the films had occurred due to the asymmetrical positioning of the films in the inner breast, in addition to their non constant distance from the skin. The hot regions were present may

  10. Experimental IMRT breast dosimetry in a thorax phantom

    International Nuclear Information System (INIS)

    Pimenta, Elsa B.; Campos, Tarcisio P.R.; Nogueira, Luciana B.; Lima, Andre C.S.

    2017-01-01

    Radiation therapy (RT) is an essential therapeutic method. RT is often used as adjuvant therapy in the treatment of breast cancer. The dose-volume restrictions of the organs at risk limit the prescribed dose to the target volume and biological and clinical effects may influence the final treatment outcome. The breast RT provides large risks to the adjacent organs and consequently the recommended dosimetry to the prescribed dose volume (PTV) is 50 Gy, lower than the most prescribed dose in other treatments (70-85 Gy). Such values implies in less tumor control compared to other sites. The present research proposal aimed to measure absorbed dose in a thorax phantom with synthetic breasts provided by an Intensity-Modulate Radiation Therapy (IMRT) protocol in a RT center. On the methodology, IMRT protocol was selected following recommendations from the Radiation Therapy Oncology Group (RTOG). Radiochromic films and a thorax simulator were prepared by the Ionizing Radiation Research Group (NRI). Dosimeters were calibrated on a selected linear accelerator (LINAC). The comparison of the dosimetry from treatment planning system (TPS), Xio (Elekta) and from experimental data was performed. The spatial distribution of the breast internal dose and in the adjacent organs was depicted by the experimental data. In the film's calibration, the quadratic polynomial fit presented a satisfactory coefficient. Two-dimensional dose profiles were obtained in the breast suggesting that films can supply details and information that TPS does not provide. At the phantom's dosimetry, the internal mean doses taken at the synthetic breast presented usual values above the prescribed dose, besides overall values were within the dosimetric MSKCC criterion. The non full reproduction of the build-up region in the films had occurred due to the asymmetrical positioning of the films in the inner breast, in addition to their non constant distance from the skin. The hot regions were present may be due to

  11. Clinical benefits after the implementation of a multimodal perioperative protocol in elderly patients.

    Science.gov (United States)

    Aguilar-Nascimento, José Eduardo de; Salomão, Alberto Bicudo; Caporossi, Cervantes; Diniz, Breno Nadaf

    2010-01-01

    Multimodal protocol of perioperative care may enhance recovery after surgery. Based on evidence these new routines of perioperative care changed conventional prescriptions in surgery. To evaluate the results of a multimodal protocol (ACERTO protocol) in elderly patients. Non-randomized historical cohort study was performed at the surgical ward of a tertiary university hospital. One hundred seventeen patients aged 60 and older were submitted to elective abdominal operations under either conventional (n = 42; conventional group, January 2004-June 2005) or a fast-track perioperative protocol named ACERTO (n = 75; ACERTO group, July 2005-December 2007). Main endpoints were preoperative fasting time, postoperative day of re-feeding, volume of intravenous fluids, length of hospital stay and morbidity. The implantation of the ACERTO protocol was followed by a decrease in both preoperative fasting (15 [8-20] vs 4 [2-20] hours, P<0.001) and postoperative day of refeeding (1st [1st-10th] vs 0 [0-5th] PO day; P<0.01), and intravenous fluids (10.7 [2.5-57.5] vs 2.5 [0.5-82] L, P<0.001). The changing of protocols reduced the mean length of hospital stay by 4 days (6[1-43] vs 2[1-97] days; P = 0.002) and surgical site infection rate by 85.7% (19%; 8/42 vs 2.7%; 2/75, P<0.001; relative risk = 1.20; 95% confidence interval = 1.03-1.39). Per-protocol analysis showed that hospital stay in major operations diminished only in patients who completed the protocol (P<0.01). The implementation of multidisciplinary routines of the ACERTO protocol diminished both hospitalization and surgical site infection in elderly patients submitted to abdominal operations.

  12. The Vinca dosimetry experiment

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1962-03-15

    On 15 October 1958 there occurred a very brief uncontrolled run of the zero-power reactor at the Boris Kidric Institute of Nuclear Science, Vinca, near Belgrade, Yugoslavia. During this run six persons received various doses of radiation. They were subsequently given medical treatment of a novel kind at the Curie Hospital, Paris. In atomic energy operations to date, very few accidents involving excessive radiation exposure to human beings have occurred. In fact, the cases of acute radiation injury are limited to about 30 known high exposures, few of which were in the lethal or near-lethal range. Since direct experiment to determine the effects of ionizing radiation on man is unacceptable, information on these effects has to be based on a consideration of data relating to accidental exposures, viewed in the light of the much more extensive data obtained from experiments on animals. Therefore, any direct information on the effects of radiation on humans is very valuable. The international dosimetry project described in this report was carried out at Vinca, Yugoslavia, under the auspices of the International Atomic Energy Agency to determine the precise amount of radiation to which the persons had been exposed during the accident. These dosimetry data, together with the record of the carefully observed clinical effects, are of importance both for the scientific study of radiation effects on man and for the development of methods of therapy. The experiment and measurements were carried out at the end of April 1960. The project formed part of the Agency's research programme in the field of health and safety. The results of the experiment are made available through this report to all Member States.

  13. The Vinca dosimetry experiment

    International Nuclear Information System (INIS)

    1962-03-01

    On 15 October 1958 there occurred a very brief uncontrolled run of the zero-power reactor at the Boris Kidric Institute of Nuclear Science, Vinca, near Belgrade, Yugoslavia. During this run six persons received various doses of radiation. They were subsequently given medical treatment of a novel kind at the Curie Hospital, Paris. In atomic energy operations to date, very few accidents involving excessive radiation exposure to human beings have occurred. In fact, the cases of acute radiation injury are limited to about 30 known high exposures, few of which were in the lethal or near-lethal range. Since direct experiment to determine the effects of ionizing radiation on man is unacceptable, information on these effects has to be based on a consideration of data relating to accidental exposures, viewed in the light of the much more extensive data obtained from experiments on animals. Therefore, any direct information on the effects of radiation on humans is very valuable. The international dosimetry project described in this report was carried out at Vinca, Yugoslavia, under the auspices of the International Atomic Energy Agency to determine the precise amount of radiation to which the persons had been exposed during the accident. These dosimetry data, together with the record of the carefully observed clinical effects, are of importance both for the scientific study of radiation effects on man and for the development of methods of therapy. The experiment and measurements were carried out at the end of April 1960. The project formed part of the Agency's research programme in the field of health and safety. The results of the experiment are made available through this report to all Member States

  14. Dosimetry in radionuclide therapy

    International Nuclear Information System (INIS)

    Riccabona, G.

    2001-01-01

    While it is known that therapeutic effects of radionuclides are due to absorbed radiation dose and to radiosensitivity, individual dosimetry in 'Gy' is practiced rarely in clinical Nuclear Medicine but 'doses' are described in 'mCi' or 'MBq', which is only indirectly related to 'Gy' in the target. To estimate 'Gy', the volume of the target, maximum concentration of the radiopharmaceutical in it and residence time should be assessed individually. These parameters can be obtained usually only with difficulty, involving possibly also quantitative SPET or PET, modern imaging techniques (sonography, CT, MRT), substitution of y- or positron emitting radiotracers for β - emitting radiopharmaceuticals as well as whole-body distribution studies. Residence time can be estimated by obtaining data on biological half-life of a comparable tracer and transfer of these data in the physical characteristics of the therapeutic agent. With all these possibilities for gross dosimetry the establishment of a dose-response-relation should be possible. As distribution of the radiopharmaceutical in lesions is frequently inhomogenous and microdosimetric conditions are difficult to assess in vivo as yet, it could be observed since decades that empirically set, sometimes 'fixed' doses (mCi or MBq) can also be successful in many diseases. Detailed dosimetric studies, however, are work- and cost-intensive. Nevertheless, one should be aware at a time when more sophisticated therapeutic possibilities in Nuclear Medicine arise, that we should try to estimate radiation dose (Gy) in our new methods even as differences in individual radiosensitivity cannot be assessed yet and studies to define individual radiosensitivity in lesions should be encouraged. (author)

  15. Dosimetry in radiotherapy. V.1

    International Nuclear Information System (INIS)

    1988-01-01

    A series of symposia on dosimetry in medicine and biology have been held by the IAEA in co-operation with WHO. The present symposium was the first one focusing on ''Dosimetry in Radiotherapy''. The papers presented reflected the different steps in the calibration chain such as the calibration standards established by the National Standards Laboratories and the conversion of the reading of calibrated instruments to the desired quantity, i.e. absorbed dose to water at a reference point in the user's beam at the radiotherapy clinic. The programme further examined the procedures necessary for optimization of the treatment of the patient, such as treatment planning methods, dose distribution studies, new techniques of dose measurement, improvements in the physical dose distributions/conformation therapy and special problems involved in total body treatments. Results of quality assurance in radiotherapy were presented from local hospitals as well as from national and international studies. Refs, figs and tabs

  16. Imaging β-amyloid using [{sup 18}F]flutemetamol positron emission tomography: from dosimetry to clinical diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Heurling, Kerstin; Lubberink, Mark [Uppsala University, Section of Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala (Sweden); Leuzy, Antoine [Karolinska Institutet, Department NVS, Centre for Alzheimer Research, Division of Translational Alzheimer Neurobiology, Huddinge (Sweden); Zimmer, Eduardo R. [Pontifical Catholic University of Rio Grande do Sul (PUCRS), Brain Institute of Rio Grande do Sul (BraIns), Porto Alegre (Brazil); Federal University of Rio Grande do Sul (UFRGS), Department of Biochemistry, Porto Alegre (Brazil); Nordberg, Agneta [Karolinska Institutet, Department NVS, Centre for Alzheimer Research, Division of Translational Alzheimer Neurobiology, Huddinge (Sweden); Karolinska University Hospital Huddinge, Department of Geriatric Medicine, Stockholm (Sweden)

    2016-02-15

    In Alzheimer's disease (AD), the deposition of β-amyloid (Aβ) is hypothesized to result in a series of secondary neurodegenerative processes, leading ultimately to synaptic dysfunction and neuronal loss. Since the advent of the first Aβ-specific positron emission tomography (PET) ligand, {sup 11}C-Pittsburgh compound B ([{sup 11}C]PIB), several {sup 18}F ligands have been developed that circumvent the limitations of [{sup 11}C]PIB tied to its short half-life. To date, three such compounds have been approved for clinical use by the US and European regulatory bodies, including [{sup 18}F]AV-45 ([{sup 18}F]florbetapir; Amyvid trademark), [{sup 18}F]-BAY94-9172 ([{sup 18}F]florbetaben; Neuraceq trademark) and [{sup 18}F]3'-F-PIB ([{sup 18}F]flutemetamol; Vizamyl trademark). The present review aims to summarize and discuss the currently available knowledge on [{sup 18}F]flutemetamol PET. As the {sup 18}F analogue of [{sup 11}C]PIB, [{sup 18}F]flutemetamol may be of use in the differentiation of AD from related neurodegenerative disorders and may help with subject selection and measurement of target engagement in the context of clinical trials testing anti-amyloid therapeutics. We will also discuss its potential use in non-AD amyloidopathies. (orig.)

  17. Quality of care in palliative sedation: audit and compliance monitoring of a clinical protocol.

    Science.gov (United States)

    Benitez-Rosario, Miguel Angel; Castillo-Padrós, Manuel; Garrido-Bernet, Belén; Ascanio-León, Belen

    2012-10-01

    The European Association for Palliative Care and the U.S. National Hospice and Palliative Care Organization have published statements that recommend an audit of palliative sedation practices. The aim was to assess the feasibility of a quality care project in palliative sedation. We carried out an audit of adherence to a guideline regarding palliative sedation, undertaken as a yearly assessment during two years, of a sample of patient charts. With an audit tool, the charts were evaluated as to the presence of the ethical sedation checklist, information that justified palliative sedation, patient and/or family agreement, and the appropriateness of treatment in concordance with the clinical protocol. An educational program and result feedback meetings were used as the implementation strategy. Roughly 25% of the medical charts of patients who died in the palliative care unit were evaluated, 94 in 2007 and 110 in 2008. In 2007 and 2008, 63% and 57% of the patients, respectively, whose median age was 65 years, were sedated, with a median length of two days. The main reason for sedation was agitation concomitant with respiratory failure in roughly 60% and 75% of the cases in 2007 and 2008, respectively. Agreement of the patient/family about sedation was collected from 100% of the cases. The concordance of procedures with the sedation guideline was 100% in both years. Our quality-of-care strategy was shown to obtain a higher level of compliance with the palliative sedation guideline for at least two years. Copyright © 2012 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  18. Group differences in physician responses to handheld presentation of clinical evidence: a verbal protocol analysis

    Directory of Open Access Journals (Sweden)

    Pavlovic Nada J

    2007-07-01

    Full Text Available Abstract Background To identify individual differences in physicians' needs for the presentation of evidence resources and preferences for mobile devices. Methods Within-groups analysis of responses to semi-structured interviews. Interviews consisted of using prototypes in response to task-based scenarios. The prototypes were implemented on two different form factors: a tablet style PC and a pocketPC. Participants were from three user groups: general internists, family physicians and medicine residents, and from two different settings: urban and semi-urban. Verbal protocol analysis, which consists of coding utterances, was conducted on the transcripts of the testing sessions. Statistical relationships were investigated between staff physicians' and residents' background variables, self-reported experiences with the interfaces, and verbal code frequencies. Results 47 physicians were recruited from general internal medicine, family practice clinics and a residency training program. The mean age of participants was 42.6 years. Physician specialty had a greater effect on device and information-presentation preferences than gender, age, setting or previous technical experience. Family physicians preferred the screen size of the tablet computer and were less concerned about its portability. Residents liked the screen size of the tablet, but preferred the portability of the pocketPC. Internists liked the portability of the pocketPC, but saw less advantage to the large screen of the tablet computer (F[2,44] = 4.94, p = .012. Conclusion Different types of physicians have different needs and preferences for evidence-based resources and handheld devices. This study shows how user testing can be incorporated into the process of design to inform group-based customization.

  19. Clinical applicability and cutoff values for an unstructured neuropsychological assessment protocol for older adults with low formal education.

    Science.gov (United States)

    de Paula, Jonas Jardim; Bertola, Laiss; Ávila, Rafaela Teixeira; Moreira, Lafaiete; Coutinho, Gabriel; de Moraes, Edgar Nunes; Bicalho, Maria Aparecida Camargos; Nicolato, Rodrigo; Diniz, Breno Satler; Malloy-Diniz, Leandro Fernandes

    2013-01-01

    The neuropsychological exam plays a central role in the assessment of elderly patients with cognitive complaints. It is particularly relevant to differentiate patients with mild dementia from those subjects with mild cognitive impairment. Formal education is a critical factor in neuropsychological performance; however, there are few studies that evaluated the psychometric properties, especially criterion related validity, neuropsychological tests for patients with low formal education. The present study aims to investigate the validity of an unstructured neuropsychological assessment protocol for this population and develop cutoff values for clinical use. A protocol composed by the Rey-Auditory Verbal Learning Test, Frontal Assessment Battery, Category and Letter Fluency, Stick Design Test, Clock Drawing Test, Digit Span, Token Test and TN-LIN was administered to 274 older adults (96 normal aging, 85 mild cognitive impairment and 93 mild Alzheimer`s disease) with predominantly low formal education. Factor analysis showed a four factor structure related to Executive Functions, Language/Semantic Memory, Episodic Memory and Visuospatial Abilities, accounting for 65% of explained variance. Most of the tests showed a good sensitivity and specificity to differentiate the diagnostic groups. The neuropsychological protocol showed a significant ecological validity as 3 of the cognitive factors explained 31% of the variance on Instrumental Activities of Daily Living. The study presents evidence of the construct, criteria and ecological validity for this protocol. The neuropsychological tests and the proposed cutoff values might be used for the clinical assessment of older adults with low formal education.

  20. Standardizing data exchange for clinical research protocols and case report forms: An assessment of the suitability of the Clinical Data Interchange Standards Consortium (CDISC) Operational Data Model (ODM).

    Science.gov (United States)

    Huser, Vojtech; Sastry, Chandan; Breymaier, Matthew; Idriss, Asma; Cimino, James J

    2015-10-01

    Efficient communication of a clinical study protocol and case report forms during all stages of a human clinical study is important for many stakeholders. An electronic and structured study representation format that can be used throughout the whole study life-span can improve such communication and potentially lower total study costs. The most relevant standard for representing clinical study data, applicable to unregulated as well as regulated studies, is the Operational Data Model (ODM) in development since 1999 by the Clinical Data Interchange Standards Consortium (CDISC). ODM's initial objective was exchange of case report forms data but it is increasingly utilized in other contexts. An ODM extension called Study Design Model, introduced in 2011, provides additional protocol representation elements. Using a case study approach, we evaluated ODM's ability to capture all necessary protocol elements during a complete clinical study lifecycle in the Intramural Research Program of the National Institutes of Health. ODM offers the advantage of a single format for institutions that deal with hundreds or thousands of concurrent clinical studies and maintain a data warehouse for these studies. For each study stage, we present a list of gaps in the ODM standard and identify necessary vendor or institutional extensions that can compensate for such gaps. The current version of ODM (1.3.2) has only partial support for study protocol and study registration data mainly because it is outside the original development goal. ODM provides comprehensive support for representation of case report forms (in both the design stage and with patient level data). Inclusion of requirements of observational, non-regulated or investigator-initiated studies (outside Food and Drug Administration (FDA) regulation) can further improve future revisions of the standard. Published by Elsevier Inc.

  1. Accounting of costs in a service of physical health. Relative units of value in dosimetry clinic in teletherapy

    International Nuclear Information System (INIS)

    Font Gomez, J. A.; Gandia Martinez, A.; Jimenez Albericio, F. J.; Andres Redondon, M. M.; Mengual Gil, M. A.

    2013-01-01

    A single - although laborious - start in the economic and clinical management of our units can be come to the knowledge of the time invested in the tasks functional, having to differentiate them, name them and even encrypt them. The time spent in performing the tasks multiplied by the annual number of these will indicate the resources necessary to achieve our objectives. In addition, pooling the values of times that members of the Unit provide analysed inter-workers dispersal, their causes and possible solutions. The establishment of relative units of value in any process benefits all workers involved in the process since it allows to know the dispersion of the times that each person employed in the development of the tasks. (Author)

  2. Clinical protocol for conducting a bone scintigraphy subsequent SPECT/CT examination

    International Nuclear Information System (INIS)

    Jovanovska, A.; Dimcheva, M.; Doldurova, M.

    2013-01-01

    Full text: Introduction: Like any nuclear medicine study, bone scintigraphy is a diagnostic procedure associated with intravenous injection of a radioactive isotope with low activity - radiopharmaceutical. But recently in clinical practice hybrid imaging methods such as SPECT/ CT (Single Photon Emission Tomography - Computed Tomography) has necessitated, as they provide comprehensive information about the function and structure of the studied organ. Materials and methods: In the Department of Nuclear Medicine in The Specialized Hospital for Active Treatment of Oncology Diseases in Sofia it is installed a two-detector SPECT/CT gamma camera Siemens Symbia T2, on which the whole range of nuclear medicine studies in oncology practice is held: bone scintigraphy, 99mTc - MIBI scintigraphy, Lymphoscintigraphy, somatostatin receptor scintigraphy, tireostsintigraphy with 131I/99mTc, dynamic nephroscintgraphy etc. The working algorithm upon choosing the clinical protocols, and setting the parameters for scanning are complied with the requirements and recommendations established by the nuclear medicine standard. The presented are results from studies of patients when after whole body bone scintigraphy, an additional SPECT/CT study was conducted for more accurate diagnostic and interpretation of the results. Results: Practical introduction of hybrid imaging methods require from technicians besides knowledge in working with radioactive sources and practical skills such as: the selection of the matrix size, number of projections, choice of trajectory - circular or elliptical, set the appropriate degree of rotation of the detector (180 or 360). Particularly important in the processing of MR images is the appropriate choice of algorithm of reconstruction: filtered backprojection or iterative reconstruction methods. In MR images processing there is no rule for the optimal filter, which is why the quality of the reconstructed image depends primarily on the experience of the operator

  3. Evaluation of the response of thermoluminescent detectors in clinical beams dosimetry using different phantoms; Avaliacao da resposta de detectores termoluminescentes na dosimetria de feixes clinicos utilizando diferentes objetos simuladores

    Energy Technology Data Exchange (ETDEWEB)

    Matsushima, Luciana Cardoso

    2010-07-01

    Radiotherapy is one of the three principal treatment modalities used in the treatment of malignant diseases such as cancer, the other two are chemotherapy and radiosurgery. In contrast to other medical specialties that rely mainly on the clinical knowledge and experience of medical specialists, radiotherapy, with its use of ionizing radiation in treatment of cancer, relies heavily on modern technology and the collaborative efforts of several professionals whose coordinated team approach greatly influences the outcome of the treatment. In the area of clinical dosimetry, an efficient and accurate calibration of the radiation beam ensures knowledge of the radiation dose delivered to the patient, allowing thus the success of radiotherapy. This study aims to compare the thermoluminescent response of calcium sulfate doped with dysprosium (CaSO{sub 4}:Dy) dosimeters produced by IPEN (6 mm in diameter and 0,8 mm tick) with the response of lithium fluoride (3,15 x 3,15 x 0,9 mm{sup 3}) doped with magnesium and titanium (LiF:Mg,Ti) in dosimetry of clinical photons (6 and 15 MV) and electrons beams (6 and 9 MeV) using solid water (RMI-457), water and PMMA phantoms. Initially, the dose-response curves were obtained for irradiation in cobalt-60 gamma radiation source in air (PMMA plates) and under electronic equilibrium conditions and for clinical electrons and photons beams at depth of maximum dose. The sensitivities of the thermoluminescent dosimeters were also evaluated and the values of their reproducibilities and intrinsic efficiency were determined for the response to different types of phantoms and radiation energy. The obtained results indicate that the main advantage of CaSO{sub 4}:Dy dosimeters is the enhanced sensitivity to radiation doses measured for {sup 60}Co, photons and electrons beams, thus representing a viable alternative for application in dosimetry in the radiotherapy area. (author)

  4. Radiotherapy gel dosimetry

    International Nuclear Information System (INIS)

    Baldock, C.

    2002-01-01

    shapes and sizes while sparing normal tissue. The situation is further complicated if the normal tissues are critical organs or are particularly sensitive to radiation. Radiotherapy techniques employed to obtain a closer conformation of the dose distribution to the tumour volume are referred to as conformal radiotherapy techniques. The clinical implementation of conformal therapy has been delayed by limitations in the verification of conformal dose distributions calculated by treatment planning systems prior to the irradiation of the patient and the verification of complex treatments during its delivery to the patient. There are several aspects of conformal therapy that complicate dose verification. To achieve the dose distributions conforming to complex 3D volumes, high dose gradients arise in the treatment volume. Further, overdose or underdose regions can exist when separate radiation fields are used to deliver additional radiation. These aspects require that practical dose measurement (dosimetry) techniques be able to integrate dose over time and easily measure dose distributions in 3D with high spatial resolution. Traditional dosimeters, such as ion chambers, thermoluminescent dosimeters and radiographic film do not fulfil these requirements. Novel gel dosimetry techniques are being developed in which dose distributions can potentially be determined in vitro in 3D using anthropomorphic phantoms to simulate a clinically irradiated situation. As long ago as the 1950's, radiation-induced colour change in dyes was used to investigate radiation doses in gels. It was subsequently shown that radiation induced changes in nuclear magnetic resonance (NMR) relaxation properties of gels infused with conventional Fricke dosimetry solutions could be measured using magnetic resonance imaging (MRI). In Fricke gels, Fe 2+ ions in ferrous sulphate solutions are usually dispersed throughout a gelatin, agarose or PVA matrix. Radiation-induced changes in the dosimeters are considered to

  5. Radiochromic film dosimetry

    International Nuclear Information System (INIS)

    Xu Zhiyong

    2002-01-01

    Radiochromic film dosimetry was developed to measure ionization irradiation dose for industry and medicine. At this time, there are no comprehensive guideline on the medical application, calibration method and densitometer system for medicine. The review gives update on Radiochromic film dosimetry used for medicine, including principles, film model and material, characteristics, calibration method, scanning densitometer system and medical application

  6. Nuclear accident dosimetry

    International Nuclear Information System (INIS)

    1982-01-01

    The film presents statistical data on criticality accidents. It outlines past IAEA activities on criticality accident dosimetry and the technical documents that resulted from this work. The film furthermore illustrates an international comparison study on nuclear accident dosimetry conducted at the Atomic Energy Research Establishment, Harwell, United Kingdom

  7. Personal dosimetry in Kazakhstan

    International Nuclear Information System (INIS)

    Khvoshnyanskaya, I.R.; Vdovichenko, V.G.; Lozbin, A.Yu.

    2003-01-01

    KATEP-AE Radiation Laboratory is the first organization in Kazakhstan officially licensed by the Kazakhstan Atomic Energy Committee to provide individual dosimetry services. The Laboratory was established according to the international standards. Nowadays it is the largest company providing personal dosimetry services in the Republic of Kazakhstan. (author)

  8. Nuclear accident dosimetry

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1983-12-31

    The film presents statistical data on criticality accidents. It outlines past IAEA activities on criticality accident dosimetry and the technical documents that resulted from this work. The film furthermore illustrates an international comparison study on nuclear accident dosimetry conducted at the Atomic Energy Research Establishment, Harwell, United Kingdom

  9. 100 years of solid state dosimetry and radiation protection dosimetry

    International Nuclear Information System (INIS)

    Bartlett, David T.

    2008-01-01

    The use of solid state detectors in radiation dosimetry has passed its 100th anniversary. The major applications of these detectors in radiation dosimetry have been in personal dosimetry, retrospective dosimetry, dating, medical dosimetry, the characterization of radiation fields, and also in microdosimetry and radiobiology research. In this introductory paper for the 15th International Conference, I shall speak of the history of solid state dosimetry and of the radiation measurement quantities that developed at the same time, mention some landmark developments in detectors and applications, speak a bit more about dosimetry and measurement quantities, and briefly look at the past and future

  10. Baseline demographics, clinical features, and treatment protocols of 240 patients with optic neuropathy: experiences from a neuro-ophthalmological clinic in the Aegean region of Turkey.

    Science.gov (United States)

    Karti, Omer; Karti, Dilek Top; Kilic, İlay Hilal; Gokcay, Figen; Celebisoy, Nese

    2017-12-19

    To analyze the demographic patterns, clinical characteristics, and treatment protocols of optic neuropathies. The hospital data of patients with optic neuropathy admitted to the Department of Neuro-ophthalmology in a tertiary referral center in Turkey between January 2010 to January 2017 were retrospectively analyzed. Demographic patterns, clinical features, treatment protocols, and the natural disease courses were assessed. The total number of patients with optic neuropathy seen over this period was 240, which consist of 43 with idiopathic optic neuritis (17.9%), 40 with multiple sclerosis-related optic neuritis (16.7%), 12 with chronic relapsing inflammatory optic neuritis (5.0%), 12 with atypical optic neuritis (5.0%), 11 with neuromyelitis optica spectrum disorders-related optic neuritis (4.6%), 90 with non-arteritic ischemic optic neuropathy (37.5%), 4 with arteritic ischemic optic neuropathy (1.7%), 10 with traumatic optic neuropathy (4.1%), 6 with compressive optic neuropathy (2.5%), and 12 with mitochondrial optic neuropathy [9 with toxic optic neuropathy (3.7%) and 3 with Leber's hereditary optic neuropathy (1.2%)]. There were 101 males (42%) and 139 females (58%). The mean age was 43.34 ± 15.86 years. This study reported the demographics, clinical characteristics, and treatment protocols of optic neuropathies in a neuro-ophthalmology specialty clinic at a tertiary referral center in Turkey during the past decade. The data may be useful in assessing the global status of optic neuropathies.

  11. Dosimetry for radiation processing

    International Nuclear Information System (INIS)

    McLaughlin, W.L.; Boyd, A.W.; Chadwick, K.H.; McDonald, J.C.; Miller, A.

    1989-01-01

    Radiation processing is a relatively young industry with broad applications and considerable commercial success. Dosimetry provides an independent and effective way of developing and controlling many industrial processes. In the sterilization of medical devices and in food irradiation, where the radiation treatment impacts directly on public health, the measurements of dose provide the official means of regulating and approving its use. In this respect, dosimetry provides the operator with a means of characterizing the facility, of proving that products are treated within acceptable dose limits and of controlling the routine operation. This book presents an up-to-date review of the theory, data and measurement techniques for radiation processing dosimetry in a practical and useful way. It is hoped that this book will lead to improved measurement procedures, more accurate and precise dosimetry and a greater appreciation of the necessity of dosimetry for radiation processing. (author)

  12. Recent developments in polymer gel dosimetry

    International Nuclear Information System (INIS)

    John Schreiner, L.; Olding, Tim; Holmes, Oliver; McAuley, Kim

    2008-01-01

    Modern radiation therapy particularly with intensity modulation techniques (IMRT) offers the potential to improve patient outcomes by better limiting high doses to the tumour alone. In this presentation we report our progress in developing gel dosimetry with new less toxic dosimeters using a fast commercial optical computed tomography (OCT) scanner. We will demonstrate that these adjustments in the approach to gel dosimetry help facilitate its introduction into clinical use. We will review practical advances in system quality assurance and scatter correction to improve optical CT quantification, and show an example of a clinical implementation of an IGRT treatment validation

  13. Clinical protocol levels are required in laboratory animal surgery when using medical devices: experiences with ureteral replacement surgery in goats.

    Science.gov (United States)

    de Jonge, Paul K J D; Sloff, Marije; Janke, Heinz P; Kortmann, Barbara B M; de Gier, Robert P E; Geutjes, Paul J; Oosterwijk, Egbert; Feitz, Wout F J

    2017-10-01

    It is common to test medical devices in large animal studies that are or could also be used in humans. In this short report we describe the use of a ureteral J-stent for the evaluation of biodegradable tubular constructs for tissue reconstruction, and the regeneration of ureters in Saanen goats. Similarly to a previous study in pigs, the ureteral J-stent was blindly inserted until some resistance was met. During evaluation of the goats after three months, perforation of the renal cortex by the stent was observed in four out of seven animals. These results indicated that blind stent placement was not possible in goats. In four new goats, clinical protocols were followed using X-ray and iodinated contrast fluids to visualize the kidney and stent during stent placement. With this adaptation the stents were successfully placed in the kidneys of these four new goats with minimal additional effort. It is likely that other groups in other fields ran into similar problems that could have been avoided by following clinical protocols. Therefore, we would like to stress the importance of following clinical protocols when using medical devices in animals to prevent unnecessary suffering and to reduce the number of animals needed.

  14. Towards a clinically relevant lentiviral transduction protocol for primary human CD34 hematopoietic stem/progenitor cells.

    Directory of Open Access Journals (Sweden)

    Michelle Millington

    2009-07-01

    Full Text Available Hematopoietic stem cells (HSC, in particular mobilized peripheral blood stem cells, represent an attractive target for cell and gene therapy. Efficient gene delivery into these target cells without compromising self-renewal and multi-potency is crucial for the success of gene therapy. We investigated factors involved in the ex vivo transduction of CD34(+ HSCs in order to develop a clinically relevant transduction protocol for gene delivery. Specifically sought was a protocol that allows for efficient transduction with minimal ex vivo manipulation without serum or other reagents of animal origin.Using commercially available G-CSF mobilized peripheral blood (PB CD34(+ cells as the most clinically relevant target, we systematically examined factors including the use of serum, cytokine combinations, pre-stimulation time, multiplicity of infection (MOI, transduction duration and the use of spinoculation and/or retronectin. A self-inactivating lentiviral vector (SIN-LV carrying enhanced green fluorescent protein (GFP was used as the gene delivery vehicle. HSCs were monitored for transduction efficiency, surface marker expression and cellular function. We were able to demonstrate that efficient gene transduction can be achieved with minimal ex vivo manipulation while maintaining the cellular function of transduced HSCs without serum or other reagents of animal origin.This study helps to better define factors relevant towards developing a standard clinical protocol for the delivery of SIN-LV into CD34(+ cells.

  15. Remotely-Supervised Transcranial Direct Current Stimulation (tDCS for Clinical Trials: Guidelines for Technology and Protocols

    Directory of Open Access Journals (Sweden)

    Leigh E Charvet

    2015-03-01

    Full Text Available The effect of transcranial direct current stimulation (tDCS is cumulative. Treatment protocols typically require multiple consecutive sessions spanning weeks or months. However, traveling to clinic for a tDCS session can present an obstacle to subjects and their caregivers. With modified devices and headgear, tDCS treatment can be administered remotely under clinical supervision, potentially enhancing recruitment, throughput, and convenience. Here we propose standards and protocols for clinical trials utilizing remotely-supervised tDCS with the goal of providing safe, reproducible and well-tolerated stimulation therapy outside of the clinic. The recommendations include: 1 training of staff in tDCS treatment and supervision, 2 assessment of the user’s capability to participate in tDCS remotely, 3 ongoing training procedures and materials including assessments of the user and/or caregiver, 4 simple and fail-safe electrode preparation techniques and tDCS headgear, 5 strict dose control for each session, 6 ongoing monitoring to quantify compliance (device preparation, electrode saturation/placement, stimulation protocol, with corresponding corrective steps as required, 7 monitoring for treatment-emergent adverse effects, 8 guidelines for discontinuation of a session and/or study participation including emergency failsafe procedures tailored to the treatment population’s level of need. These guidelines are intended to provide a minimal level of methodological rigor for clinical trials seeking to apply tDCS outside a specialized treatment center. We outline indication-specific applications (Attention Deficit Hyperactivity Disorder, Depression, Multiple Sclerosis, Palliative Care following these recommendations that support a standardized framework for evaluating the tolerability and reproducibility of remote-supervised tDCS that, once established, will allow for translation of tDCS clinical trials to a greater size and range of patient populations.

  16. Sci-Thur AM: YIS – 04: Stopping power-to-Cherenkov power ratios and beam quality specification for clinical Cherenkov emission dosimetry of electrons: beam-specific effects and experimental validation

    International Nuclear Information System (INIS)

    Zlateva, Yana; Seuntjens, Jan; El Naqa, Issam

    2016-01-01

    Purpose: To advance towards clinical Cherenkov emission (CE)-based dosimetry by investigating beam-specific effects on Monte Carlo-calculated electron-beam stopping power-to-CE power ratios (SCRs), addressing electron beam quality specification in terms of CE, and validating simulations with measurements. Methods: The EGSnrc user code SPRRZnrc, used to calculate Spencer-Attix stopping-power ratios, was modified to instead calculate SCRs. SCRs were calculated for 6- to 22-MeV clinical electron beams from Varian TrueBeam, Clinac 21EX, and Clinac 2100C/D accelerators. Experiments were performed with a 20-MeV electron beam from a Varian TrueBeam accelerator, using a diffraction grating spectrometer with optical fiber input and a cooled back-illuminated CCD. A fluorophore was dissolved in the water to remove CE signal anisotropy. Results: It was found that angular spread of the incident beam has little effect on the SCR (≤ 0.3% at d max ), while both the electron spectrum and photon contamination increase the SCR at shallow depths and decrease it at large depths. A universal data fit of R 50 in terms of C 50 (50% CE depth) revealed a strong linear dependence (R 2 > 0.9999). The SCR was fit with a Burns-type equation (R 2 = 0.9974, NRMSD = 0.5%). Below-threshold incident radiation was found to have minimal effect on beam quality specification (< 0.1%). Experiments and simulations were in good agreement. Conclusions: Our findings confirm the feasibility of the proposed CE dosimetry method, contingent on computation of SCRs from additional accelerators and on further experimental validation. This work constitutes an important step towards clinical high-resolution out-of-beam CE dosimetry.

  17. Sci-Thur AM: YIS – 04: Stopping power-to-Cherenkov power ratios and beam quality specification for clinical Cherenkov emission dosimetry of electrons: beam-specific effects and experimental validation

    Energy Technology Data Exchange (ETDEWEB)

    Zlateva, Yana; Seuntjens, Jan; El Naqa, Issam [McGill University, Cedars Cancer Centre, University of Michigan (United States)

    2016-08-15

    Purpose: To advance towards clinical Cherenkov emission (CE)-based dosimetry by investigating beam-specific effects on Monte Carlo-calculated electron-beam stopping power-to-CE power ratios (SCRs), addressing electron beam quality specification in terms of CE, and validating simulations with measurements. Methods: The EGSnrc user code SPRRZnrc, used to calculate Spencer-Attix stopping-power ratios, was modified to instead calculate SCRs. SCRs were calculated for 6- to 22-MeV clinical electron beams from Varian TrueBeam, Clinac 21EX, and Clinac 2100C/D accelerators. Experiments were performed with a 20-MeV electron beam from a Varian TrueBeam accelerator, using a diffraction grating spectrometer with optical fiber input and a cooled back-illuminated CCD. A fluorophore was dissolved in the water to remove CE signal anisotropy. Results: It was found that angular spread of the incident beam has little effect on the SCR (≤ 0.3% at d{sub max}), while both the electron spectrum and photon contamination increase the SCR at shallow depths and decrease it at large depths. A universal data fit of R{sub 50} in terms of C{sub 50} (50% CE depth) revealed a strong linear dependence (R{sup 2} > 0.9999). The SCR was fit with a Burns-type equation (R{sup 2} = 0.9974, NRMSD = 0.5%). Below-threshold incident radiation was found to have minimal effect on beam quality specification (< 0.1%). Experiments and simulations were in good agreement. Conclusions: Our findings confirm the feasibility of the proposed CE dosimetry method, contingent on computation of SCRs from additional accelerators and on further experimental validation. This work constitutes an important step towards clinical high-resolution out-of-beam CE dosimetry.

  18. Economic comparison of common treatment protocols and J5 vaccination for clinical mastitis in dairy herds using optimized culling decisions.

    Science.gov (United States)

    Kessels, J A; Cha, E; Johnson, S K; Welcome, F L; Kristensen, A R; Gröhn, Y T

    2016-05-01

    This study used an existing dynamic optimization model to compare costs of common treatment protocols and J5 vaccination for clinical mastitis in US dairy herds. Clinical mastitis is an infection of the mammary gland causing major economic losses in dairy herds due to reduced milk production, reduced conception, and increased risk of mortality and culling for infected cows. Treatment protocols were developed to reflect common practices in dairy herds. These included targeted therapy following pathogen identification, and therapy without pathogen identification using a broad-spectrum antimicrobial or treating with the cheapest treatment option. The cost-benefit of J5 vaccination was also estimated. Effects of treatment were accounted for as changes in treatment costs, milk loss due to mastitis, milk discarded due to treatment, and mortality. Following ineffective treatments, secondary decisions included extending the current treatment, alternative treatment, discontinuing treatment, and pathogen identification followed by recommended treatment. Average net returns for treatment protocols and vaccination were generated using an existing dynamic programming model. This model incorporates cow and pathogen characteristics to optimize management decisions to treat, inseminate, or cull cows. Of the treatment protocols where 100% of cows received recommended treatment, pathogen-specific identification followed by recommended therapy yielded the highest average net returns per cow per year. Out of all treatment scenarios, the highest net returns were achieved with selecting the cheapest treatment option and discontinuing treatment, or alternate treatment with a similar spectrum therapy; however, this may not account for the full consequences of giving nonrecommended therapies to cows with clinical mastitis. Vaccination increased average net returns in all scenarios. Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

  19. A clinical trial protocol to treat massive Africanized honeybee (Apis mellifera) attack with a new apilic antivenom.

    Science.gov (United States)

    Barbosa, Alexandre Naime; Boyer, Leslie; Chippaux, Jean-Philippe; Medolago, Natalia Bronzatto; Caramori, Carlos Antonio; Paixão, Ariane Gomes; Poli, João Paulo Vasconcelos; Mendes, Mônica Bannwart; Dos Santos, Lucilene Delazari; Ferreira, Rui Seabra; Barraviera, Benedito

    2017-01-01

    Envenomation caused by multiple stings from Africanized honeybees Apis mellifera constitutes a public health problem in the Americas. In 2015, the Brazilian Ministry of Health reported 13,597 accidents (incidence of seven cases per 100,000 inhabitants) with 39 deaths (lethality of 0.25%). The toxins present in the venom, which include melittin and phospholipase A 2 , cause lesions in diverse organs and systems that may be fatal. As there has been no specific treatment to date, management has been symptomatic and supportive only. In order to evaluate the safety and neutralizing capacity of a new apilic antivenom, as well as to confirm its lowest effective dose, a clinical protocol was developed to be applied in a multicenter, non-randomized and open phase I/II clinical trial. Twenty participants with more than five stings, aged more than 18 years, of both sexes, who have not previously received the heterologous serum against bee stings, will be included for 24 months. The proposed dose was based on the antivenom neutralizing capacity and the number of stings. Treatment will be administered only in a hospital environment and the participants will be evaluated for a period up to 30 days after discharge for clinical and laboratory follow-up. This protocol, approved by the Brazilian regulatory agencies for ethics (National Commission for Ethics on Research - CONEP) and sanitation (National Health Surveillance Agency - ANVISA), is a guideline constituted by specific, adjuvant, symptomatic and complementary treatments, in addition to basic orientations for conducting a clinical trial involving heterologous sera. This is the first clinical trial protocol designed specifically to evaluate the preliminary efficacy and safety of a new antivenom against stings from the Africanized honeybee Apis mellifera . The results will support future studies to confirm a new treatment for massive bee attack that has a large impact on public health in the Americas.

  20. WE-AB-BRB-01: Development of a Probe-Format Graphite Calorimeter for Practical Clinical Dosimetry: Numerical Design Optimization, Prototyping, and Experimental Proof-Of-Concept

    International Nuclear Information System (INIS)

    Renaud, J; Seuntjens, J; Sarfehnia, A

    2015-01-01

    Purpose: In this work, the feasibility of performing absolute dose to water measurements using a constant temperature graphite probe calorimeter (GPC) in a clinical environment is established. Methods: A numerical design optimization study was conducted by simulating the heat transfer in the GPC resulting from irradiation using a finite element method software package. The choice of device shape, dimensions, and materials was made to minimize the heat loss in the sensitive volume of the GPC. The resulting design, which incorporates a novel aerogel-based thermal insulator, and 15 temperature sensitive resistors capable of both Joule heating and measuring temperature, was constructed in house. A software based process controller was developed to stabilize the temperatures of the GPC’s constituent graphite components to within a few 10’s of µK. This control system enables the GPC to operate in either the quasi-adiabatic or isothermal mode, two well-known, and independent calorimetry techniques. Absorbed dose to water measurements were made using these two methods under standard conditions in a 6 MV 1000 MU/min photon beam and subsequently compared against TG-51 derived values. Results: Compared to an expected dose to water of 76.9 cGy/100 MU, the average GPC-measured doses were 76.5 ± 0.5 and 76.9 ± 0.5 cGy/100 MU for the adiabatic and isothermal modes, respectively. The Monte Carlo calculated graphite to water dose conversion was 1.013, and the adiabatic heat loss correction was 1.003. With an overall uncertainty of about 1%, the most significant contributions were the specific heat capacity (type B, 0.8%) and the repeatability (type A, 0.6%). Conclusion: While the quasi-adiabatic mode of operation had been validated in previous work, this is the first time that the GPC has been successfully used isothermally. This proof-of-concept will serve as the basis for further study into the GPC’s application to small fields and MRI-linac dosimetry. This work has been

  1. Effectiveness of a mobile cooperation intervention during the clinical practicum of nursing students: a parallel group randomized controlled trial protocol.

    Science.gov (United States)

    Strandell-Laine, Camilla; Saarikoski, Mikko; Löyttyniemi, Eliisa; Salminen, Leena; Suomi, Reima; Leino-Kilpi, Helena

    2017-06-01

    The aim of this study was to describe a study protocol for a study evaluating the effectiveness of a mobile cooperation intervention to improve students' competence level, self-efficacy in clinical performance and satisfaction with the clinical learning environment. Nursing student-nurse teacher cooperation during the clinical practicum has a vital role in promoting the learning of students. Despite an increasing interest in using mobile technologies to improve the clinical practicum of students, there is limited robust evidence regarding their effectiveness. A multicentre, parallel group, randomized, controlled, pragmatic, superiority trial. Second-year pre-registration nursing students who are beginning a clinical practicum will be recruited from one university of applied sciences. Eligible students will be randomly allocated to either a control group (engaging in standard cooperation) or an intervention group (engaging in mobile cooperation) for the 5-week the clinical practicum. The complex mobile cooperation intervention comprises of a mobile application-assisted, nursing student-nurse teacher cooperation and a training in the functions of the mobile application. The primary outcome is competence. The secondary outcomes include self-efficacy in clinical performance and satisfaction with the clinical learning environment. Moreover, a process evaluation will be undertaken. The ethical approval for this study was obtained in December 2014 and the study received funding in 2015. The results of this study will provide robust evidence on mobile cooperation during the clinical practicum, a research topic that has not been consistently studied to date. © 2016 John Wiley & Sons Ltd.

  2. Theoretical basis for dosimetry

    International Nuclear Information System (INIS)

    Carlsson, G.A.

    1985-01-01

    Radiation dosimetry is fundamental to all fields of science dealing with radiation effects and is concerned with problems which are often intricate as hinted above. A firm scientific basis is needed to face increasing demands on accurate dosimetry. This chapter is an attempt to review and to elucidate the elements for such a basis. Quantities suitable for radiation dosimetry have been defined in the unique work to coordinate radiation terminology and usage by the International Commission on Radiation Units and Measurements, ICRU. Basic definitions and terminology used in this chapter conform with the recent ''Radiation Quantities and Units, Report 33'' of the ICRU

  3. Dosimetry for radiation processing

    International Nuclear Information System (INIS)

    Miller, Arne

    1986-01-01

    During the past few years significant advances have taken place in the different areas of dosimetry for radiation processing, mainly stimulated by the increased interest in radiation for food preservation, plastic processing and sterilization of medical products. Reference services both by international organizations (IAEA) and national laboratories have helped to improve the reliability of dose measurements. In this paper the special features of radiation processing dosimetry are discussed, several commonly used dosimeters are reviewed, and factors leading to traceable and reliable dosimetry are discussed. (author)

  4. Protocol for the quality control systems of electronic portal imaging used in verification of radiotherapy treatment

    International Nuclear Information System (INIS)

    Silvestre, Ileana; Alfonso, Rodolfo; Garcia, Fernando

    2009-01-01

    Following the approach of quality control of radiotherapy equipment, conceived in the IAEA TECDOC-1151, we analyzed the different tests must be to an EPID to guarantee levels of accuracy required in the administration of radiation treatments, including the study of the impact of different parameters, geometric and dosimetric imaging, involved in the process. Established the types and frequency of checks, as well as procedures for their implementation, the allowable tolerances set of values records and forms for recording . Was carried out assessment protocol in various services based on amorphous silicon EPID for its applicability and scope. Was designed and validated in clinical practice protocol for EPID quality control, demonstrating its applicability with a minimum of material and human resources. It We concluded that with proper and systematic quality control program, tests including dosimetry, the EPID can provide valuable information about physico-beam dosimetry, and ensure adequate accuracy geometric in the patient's location. (author)

  5. Protocol for Bone Augmentation with Simultaneous Early Implant Placement: A Retrospective Multicenter Clinical Study

    Directory of Open Access Journals (Sweden)

    Peter Fairbairn

    2015-01-01

    Full Text Available Purpose. To present a novel protocol for alveolar bone regeneration in parallel to early implant placement. Methods. 497 patients in need of extraction and early implant placement with simultaneous bone augmentation were treated in a period of 10 years. In all patients the same specific method was followed and grafting was performed utilizing in situ hardening fully resorbable alloplastic grafting materials consisting of β-tricalcium phosphate and calcium sulfate. The protocol involved atraumatic extraction, implant placement after 4 weeks with simultaneous bone augmentation, and loading of the implant 12 weeks after placement and grafting. Follow-up periods ranged from 6 months to 10 years (mean of 4 years. Results. A total of 601 postextraction sites were rehabilitated in 497 patients utilizing the novel protocol. Three implants failed before loading and three implants failed one year after loading, leaving an overall survival rate of 99.0%. Conclusions. This standardized protocol allows successful long-term functional results regarding alveolar bone regeneration and implant rehabilitation. The concept of placing the implant 4 weeks after extraction, augmenting the bone around the implant utilizing fully resorbable, biomechanically stable, alloplastic materials, and loading the implant at 12 weeks seems to offer advantages when compared with traditional treatment modalities.

  6. Use of protocol and evaluation of postoperative residual curarization incidence in the absence of intraoperative acceleromyography - Randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Filipe Nadir Caparica Santos

    Full Text Available Abstract Objective Evaluate the incidence of postoperative residual curarization (PORC in the post-anesthesia care unit (PACU after the use of protocol and absence of intraoperative acceleromyography (AMG. Methods Randomized clinical trial with 122 patients allocated into two groups (protocol and control. Protocol group received initial and additional doses of rocuronium (0.6 mg·kg-1 and 10 mg, respectively; the use of rocuronium was avoided in the final 45 min; blockade reversal with neostigmine (50 µg·kg-1; time ≥15 min between reversion and extubation. Control: initial and additional doses of rocuronium, blockade reversal, neostigmine dose, and extubation time, all at the discretion of the anesthesiologist. AMG was used in the PACU and PORC considered at T4/T1 ratio <1.0. Results The incidence of PORC was lower in protocol group than in control group (25% vs. 45.2%, p = 0.02. In control group, total dose of rocuronium was higher in patients with PORC than without PORC (0.43 vs. 0.35 mg·kg-1·h-1, p = 0.03 and the time interval between the last administration of rocuronium and neostigmine was lower (75.0 vs. 101.0 min, p < 0.01. In protocol group, there was no difference regarding the analyzed parameters (with PORC vs. without PORC. Considering the entire study population and the presence or absence of PORC, total dose of rocuronium was higher in patients with PORC (0.42 vs. 0.31 mg·kg-1·h-1, p = 0.01, while the time interval between the last administration of rocuronium and neostigmine was lower (72.5 vs. 99.0 min, p ≤ 0.01. Conclusion The proposed systematization reduced PORC incidence in PACU in the absence of intraoperative AMG.

  7. Patient skin dosimetry in interventional cardiology in the Czech Republic

    International Nuclear Information System (INIS)

    Sukupova, L.; Novak, L.; Kala, P.; Cervinka, P.; Stasek, J.

    2011-01-01

    In this study, skin dosimetry of patients undergoing interventional cardiology procedures is presented. Three hospitals were included. Two methods were used for skin dosimetry-radiochromic dosimetry films and reconstruction of skin dose distribution based on examination protocol. Maximum skin doses (MSD) obtained from both methods were compared for 175 patients. For patients for whom the film MSD was >1 Gy, the reconstruction MSD differed from the film MSD in the range of ± 50 % for 83 % of patients. For remaining patients, the difference was higher and it was caused by longer fluoroscopy time. For 59 patients for whom the cumulative dose was known, the cumulative dose was compared with the film MSD. Skin dosimetry with radiochromic films is more accurate than the reconstruction method, but films do not include X-ray fields from lateral projections whilst reconstructions do. (authors)

  8. Patient dosimetry in diagnostic radiology

    International Nuclear Information System (INIS)

    Rweyemamu, M.

    2013-04-01

    The objective of this project was to review patient dosimetry aiming at reducing the patient dose during diagnostic procedures while maintaining the best image quality in order to protect patients from ionizing radiation. CT examination was selected in this study to represent imaging protocols with high patient doses used in diagnostic radiology. Dosimetric parameters in CT which are CTDI, CTDIW, DLP, MSAD, organ dose and effective dose were discussed. Parameters such as tube current, tube voltage, filtration, scan volume and slice thickness were found to affect patient dose, therefore proper management of these factors was recommended. For optimization of protection of the patient, application of the “as low as reasonably achievable” (ALARA) principle was recommended as an important key for avoiding overexposure and minimizing patient doses. Also it was recommended that CT examinations should be performed if and only if is the only suitable option when weighed against other options which do not involve ionizing radiation exposure. (author)

  9. Automation in an Addiction Treatment Research Clinic: Computerized Contingency Management, Ecological Momentary Assessment, and a Protocol Workflow System

    Science.gov (United States)

    Vahabzadeh, Massoud; Lin, Jia-Ling; Mezghanni, Mustapha; Epstein, David H.; Preston, Kenzie L.

    2009-01-01

    Issues A challenge in treatment research is the necessity of adhering to protocol and regulatory strictures while maintaining flexibility to meet patients’ treatment needs and accommodate variations among protocols. Another challenge is the acquisition of large amounts of data in an occasionally hectic environment, along with provision of seamless methods for exporting, mining, and querying the data. Approach We have automated several major functions of our outpatient treatment research clinic for studies in drug abuse and dependence. Here we describe three such specialized applications: the Automated Contingency Management (ACM) system for delivery of behavioral interventions, the Transactional Electronic Diary (TED) system for management of behavioral assessments, and the Protocol Workflow System (PWS) for computerized workflow automation and guidance of each participant’s daily clinic activities. These modules are integrated into our larger information system to enable data sharing in real time among authorized staff. Key Findings ACM and TED have each permitted us to conduct research that was not previously possible. In addition, the time to data analysis at the end of each study is substantially shorter. With the implementation of the PWS, we have been able to manage a research clinic with an 80-patient capacity having an annual average of 18,000 patient-visits and 7,300 urine collections with a research staff of five. Finally, automated data management has considerably enhanced our ability to monitor and summarize participant-safety data for research oversight. Implications and conclusion When developed in consultation with end users, automation in treatment-research clinics can enable more efficient operations, better communication among staff, and expansions in research methods. PMID:19320669

  10. Automation in an addiction treatment research clinic: computerised contingency management, ecological momentary assessment and a protocol workflow system.

    Science.gov (United States)

    Vahabzadeh, Massoud; Lin, Jia-Ling; Mezghanni, Mustapha; Epstein, David H; Preston, Kenzie L

    2009-01-01

    A challenge in treatment research is the necessity of adhering to protocol and regulatory strictures while maintaining flexibility to meet patients' treatment needs and to accommodate variations among protocols. Another challenge is the acquisition of large amounts of data in an occasionally hectic environment, along with the provision of seamless methods for exporting, mining and querying the data. We have automated several major functions of our outpatient treatment research clinic for studies in drug abuse and dependence. Here we describe three such specialised applications: the Automated Contingency Management (ACM) system for the delivery of behavioural interventions, the transactional electronic diary (TED) system for the management of behavioural assessments and the Protocol Workflow System (PWS) for computerised workflow automation and guidance of each participant's daily clinic activities. These modules are integrated into our larger information system to enable data sharing in real time among authorised staff. ACM and the TED have each permitted us to conduct research that was not previously possible. In addition, the time to data analysis at the end of each study is substantially shorter. With the implementation of the PWS, we have been able to manage a research clinic with an 80 patient capacity, having an annual average of 18,000 patient visits and 7300 urine collections with a research staff of five. Finally, automated data management has considerably enhanced our ability to monitor and summarise participant safety data for research oversight. When developed in consultation with end users, automation in treatment research clinics can enable more efficient operations, better communication among staff and expansions in research methods.

  11. Glenoid version by CT scan: an analysis of clinical measurement error and introduction of a protocol to reduce variability

    Energy Technology Data Exchange (ETDEWEB)

    Bunt, Fabian van de [VU University Medical Center, Amsterdam (Netherlands); Pearl, Michael L.; Lee, Eric K.; Peng, Lauren; Didomenico, Paul [Kaiser Permanente, Los Angeles, CA (United States)

    2015-11-15

    Recent studies have challenged the accuracy of conventional measurements of glenoid version. Variability in the orientation of the scapula from individual anatomical differences and patient positioning, combined with differences in observer measurement practices, have been identified as sources of variability. The purpose of this study was to explore the utility and reliability of clinically available software that allows manipulation of three-dimensional images in order to bridge the variance between clinical and anatomic version in a clinical setting. Twenty CT scans of normal glenoids of patients who had proximal humerus fractures were measured for version. Four reviewers first measured version in a conventional manner (clinical version), measurements were made again (anatomic version) after employing a protocol for reformatting the CT data to align the coronal and sagittal planes with the superior-inferior axis of the glenoid, and the scapular body, respectively. The average value of clinical retroversion for all reviewers and all subjects was -1.4 (range, -16 to 21 ), as compared to -3.2 (range, -21 to 6 ) when measured from reformatted images. The mean difference between anatomical and clinical version was 1.9 ± 5.6 but ranged on individual measurements from -13 to 26 . In no instance did all four observers choose the same image slice from the sequence of images. This study confirmed the variation in glenoid version dependent on scapular orientation previously identified in other studies using scapular models, and presents a clinically accessible protocol to correct for scapular orientation from the patient's CT data. (orig.)

  12. Glenoid version by CT scan: an analysis of clinical measurement error and introduction of a protocol to reduce variability

    International Nuclear Information System (INIS)

    Bunt, Fabian van de; Pearl, Michael L.; Lee, Eric K.; Peng, Lauren; Didomenico, Paul

    2015-01-01

    Recent studies have challenged the accuracy of conventional measurements of glenoid version. Variability in the orientation of the scapula from individual anatomical differences and patient positioning, combined with differences in observer measurement practices, have been identified as sources of variability. The purpose of this study was to explore the utility and reliability of clinically available software that allows manipulation of three-dimensional images in order to bridge the variance between clinical and anatomic version in a clinical setting. Twenty CT scans of normal glenoids of patients who had proximal humerus fractures were measured for version. Four reviewers first measured version in a conventional manner (clinical version), measurements were made again (anatomic version) after employing a protocol for reformatting the CT data to align the coronal and sagittal planes with the superior-inferior axis of the glenoid, and the scapular body, respectively. The average value of clinical retroversion for all reviewers and all subjects was -1.4 (range, -16 to 21 ), as compared to -3.2 (range, -21 to 6 ) when measured from reformatted images. The mean difference between anatomical and clinical version was 1.9 ± 5.6 but ranged on individual measurements from -13 to 26 . In no instance did all four observers choose the same image slice from the sequence of images. This study confirmed the variation in glenoid version dependent on scapular orientation previously identified in other studies using scapular models, and presents a clinically accessible protocol to correct for scapular orientation from the patient's CT data. (orig.)

  13. Clinical outcomes and cost effectiveness of accelerated diagnostic protocol in a chest pain center compared with routine care of patients with chest pain.

    Science.gov (United States)

    Asher, Elad; Reuveni, Haim; Shlomo, Nir; Gerber, Yariv; Beigel, Roy; Narodetski, Michael; Eldar, Michael; Or, Jacob; Hod, Hanoch; Shamiss, Arie; Matetzky, Shlomi

    2015-01-01

    The aim of this study was to compare in patients presenting with acute chest pain the clinical outcomes and cost-effectiveness of an accelerated diagnostic protocol utilizing contemporary technology in a chest pain unit versus routine care in an internal medicine department. Hospital and 90-day course were prospectively studied in 585 consecutive low-moderate risk acute chest pain patients, of whom 304 were investigated in a designated chest pain center using a pre-specified accelerated diagnostic protocol, while 281 underwent routine care in an internal medicine ward. Hospitalization was longer in the routine care compared with the accelerated diagnostic protocol group (pdiagnostic protocol patients (98%) vs. 57 (20%) routine care patients underwent non-invasive testing, (pdiagnostic imaging testing was performed in 125 (44%) and 26 (9%) patients in the routine care and accelerated diagnostic protocol patients, respectively (pdiagnostic protocol patients compared with those receiving routine care was associated with a lower incidence of readmissions for chest pain [8 (3%) vs. 24 (9%), pdiagnostic protocol remained a predictor of lower acute coronary syndromes and readmissions after propensity score analysis [OR = 0.28 (CI 95% 0.14-0.59)]. Cost per patient was similar in both groups [($2510 vs. $2703 for the accelerated diagnostic protocol and routine care group, respectively, (p = 0.9)]. An accelerated diagnostic protocol is clinically superior and as cost effective as routine in acute chest pain patients, and may save time and resources.

  14. Dosimetry of internal emitters

    International Nuclear Information System (INIS)

    Anon.

    1982-01-01

    The Dosimetry of Internal Emitter Program endeavors to refine the correlation between radiation dose and observed biological effects. The program is presently engaged in the development of studies that will demonstrate the applicability of microdosimetry models developed under the Microdosimetry of Internal Sources Program. The program also provides guidance and assistance to Pacific Northwest Laboratory's Biology Department in the dosimetric analysis of internally deposited radionuclides. This report deals with alpha particle dosimetry plutonium 239 inhalation, and in vitro studies of chromosomal observations

  15. Individual neutron dosimetry

    International Nuclear Information System (INIS)

    Mauricio, C.L.P.

    1987-01-01

    The most important concepts and development in individual neutron dosimetry are presented, especially the dosimetric properties of the albedo technique. The main problem in albedo dosimetry is to calibrate the dosemeter in the environs of each neutron source. Some of the most used calibration techniques are discussed. The IRD albedo dosemeter used in the routine neutron individual monitoring is described in detail. Its dosimetric properties and calibration methods are discussed. (Author) [pt

  16. Preclinical pharmacokinetics, biodistribution, radiation dosimetry and acute toxicity studies required for regulatory approval of a Clinical Trial Application for a Phase I/II clinical trial of 111In-BzDTPA-pertuzumab

    International Nuclear Information System (INIS)

    Lam, Karen; Chan, Conrad; Done, Susan J.; Levine, Mark N.; Reilly, Raymond M.

    2015-01-01

    Introduction: 111 In-BzDTPA-pertuzumab is a novel imaging probe for detecting changes in HER2 expression in breast cancer (BC) caused by treatment with trastuzumab (Herceptin). Our aim was to evaluate the pharmacokinetics, normal tissue biodistribution, radiation dosimetry and acute toxicity of 111 In-BzDTPA-pertuzumab in non-tumor bearing mice in order to obtain regulatory approval to advance this agent to a first-in-humans Phase I/II clinical trial. Methods: Biodistribution and pharmacokinetic studies were performed in non-tumor bearing Balb/c mice injected i.v. with 111 In-BzDTPA-pertuzumab (2.5 MBq; 2 μg). The cumulative number of disintegrations per source organ derived from the biodistribution data was used to predict the radiation absorbed doses in humans using OLINDA/EXM software. Acute toxicity was studied at two weeks post-injection of 111 In-BzDTPA-pertuzumab (1.0 MBq, 20 μg) with comparison to control mice injected with unlabeled BzDTPA-pertuzumab (20 μg) or Sodium Chloride Injection USP. The dose of 111 In-BzDTPA-pertuzumab corresponded to 23-times the human radioactivity dose and 10-times the protein dose on a MBq/kg and mg/kg basis, respectively. Toxicity was assessed by monitoring body mass, complete blood cell count (CBC), hematocrit (Hct), hemoglobin (Hb), serum creatinine (SCr) and alanine aminotransferease (ALT) and by histopathological examination of tissues at necropsy. Results: 111 In-BzDTPA-pertuzumab exhibited a biphasic elimination from the blood with a distribution half-life (t 1/2 α) of 3.8 h and an elimination half-life (t 1/2 β) of 228.2 h. The radiopharmaceutical was distributed mainly in the blood, heart, lungs, liver, kidneys and spleen. The projected whole-body radiation absorbed dose in humans was 0.05 mSv/MBq corresponding to a total of 16.8 mSv for three separate administrations of 111 In-BzDTPA-pertuzumab (111 MBq) planned for the Phase I/II trial. There were slight changes in Hb and SCr levels associated with

  17. The HPA photon protocol and proposed electron protocol

    International Nuclear Information System (INIS)

    Pitchford, W.G.

    1985-01-01

    The Hospital Physicists Association (HPA) photon dosimetry protocol has been produced and was published in 1983. Revised values of some components of Csub(lambda) and refinements introduced into the theory in the last few years have enabled new Csub(lambda) values to be produced. The proposed HPA electron protocol is at present in draft form and will be published shortly. Both protocels are discussed. (Auth.)

  18. JENDL Dosimetry File

    International Nuclear Information System (INIS)

    Nakazawa, Masaharu; Iguchi, Tetsuo; Kobayashi, Katsuhei; Iwasaki, Shin; Sakurai, Kiyoshi; Ikeda, Yujiro; Nakagawa, Tsuneo.

    1992-03-01

    The JENDL Dosimetry File based on JENDL-3 was compiled and integral tests of cross section data were performed by the Dosimetry Integral Test Working Group of the Japanese Nuclear Data Committee. Data stored in the JENDL Dosimetry File are the cross sections and their covariance data for 61 reactions. The cross sections were mainly taken from JENDL-3 and the covariances from IRDF-85. For some reactions, data were adopted from other evaluated data files. The data are given in the neutron energy region below 20 MeV in both of point-wise and group-wise files in the ENDF-5 format. In order to confirm reliability of the data, several integral tests were carried out; comparison with the data in IRDF-85 and average cross sections measured in fission neutron fields, fast reactor spectra, DT neutron fields and Li(d, n) neutron fields. As a result, it has been found that the JENDL Dosimetry File gives better results than IRDF-85 but there are some problems to be improved in future. The contents of the JENDL Dosimetry File and the results of the integral tests are described in this report. All of the dosimetry cross sections are shown in a graphical form. (author) 76 refs

  19. Dosimetry and Calibration Section

    International Nuclear Information System (INIS)

    Otto, T.

    1999-01-01

    The Dosimetry and Calibration Section fulfils two tasks within CERN's Radiation Protection Group: the Individual Dosimetry Service monitors more than 5000 persons potentially exposed to ionizing radiation on the CERN sites, and the Calibration Laboratory verifies throughout the year, at regular intervals, over 1000 instruments, monitors, and electronic dosimeters used by RP Group. The establishment of a Quality Assurance System for the Individual Dosimetry Service, a requirement of the new Swiss Ordinance for personal dosimetry, put a considerable workload on the section. Together with an external consultant it was decided to identify and then describe the different 'processes' of the routine work performed in the dosimetry service. The resulting Quality Manual was submitted to the Federal Office for Public Health in Bern in autumn. The CERN Individual Dosimetry Service will eventually be officially endorsed after a successful technical test in March 1999. On the technical side, the introduction of an automatic development machine for gamma films was very successful. It processes the dosimetric films without an operator being present, and its built-in regeneration mechanism keeps the concentration of the processing chemicals at a constant level

  20. JENDL Dosimetry File

    Energy Technology Data Exchange (ETDEWEB)

    Nakazawa, Masaharu; Iguchi, Tetsuo [Tokyo Univ. (Japan). Faculty of Engineering; Kobayashi, Katsuhei [Kyoto Univ., Kumatori, Osaka (Japan). Research Reactor Inst.; Iwasaki, Shin [Tohoku Univ., Sendai (Japan). Faculty of Engineering; Sakurai, Kiyoshi; Ikeda, Yujior; Nakagawa, Tsuneo [Japan Atomic Energy Research Inst., Tokai, Ibaraki (Japan). Tokai Research Establishment

    1992-03-15

    The JENDL Dosimetry File based on JENDL-3 was compiled and integral tests of cross section data were performed by the Dosimetry Integral Test Working Group of the Japanese Nuclear Data Committee. Data stored in the JENDL Dosimetry File are the cross sections and their covariance data for 61 reactions. The cross sections were mainly taken from JENDL-3 and the covariances from IRDF-85. For some reactions, data were adopted from other evaluated data files. The data are given in the neutron energy region below 20 MeV in both of point-wise and group-wise files in the ENDF-5 format. In order to confirm reliability of the data, several integral tests were carried out; comparison with the data in IRDF-85 and average cross sections measured in fission neutron fields, fast reactor spectra, DT neutron fields and Li(d,n) neutron fields. As a result, it has been found that the JENDL Dosimetry File gives better results than IRDF-85 but there are some problems to be improved in future. The contents of the JENDL Dosimetry File and the results of the integral tests are described in this report. All of the dosimetry cross sections are shown in a graphical form.

  1. A protocol for classifying normal- and flat-arched foot posture for research studies using clinical and radiographic measurements

    Directory of Open Access Journals (Sweden)

    Menz Hylton B

    2009-07-01

    Full Text Available Abstract Background There are several clinical and radiological methods available to classify foot posture in research, however there is no clear strategy for selecting the most appropriate measurements. Therefore, the aim of this study was to develop a foot screening protocol to distinguish between participants with normal- and flat-arched feet who would then subsequently be recruited into a series of laboratory-based gait studies. Methods The foot posture of ninety-one asymptomatic young adults was assessed using two clinical measurements (normalised navicular height and arch index and four radiological measurements taken from antero-posterior and lateral x-rays (talus-second metatarsal angle, talo-navicular coverage angle, calcaneal inclination angle and calcaneal-first metatarsal angle. Normative foot posture values were taken from the literature and used to recruit participants with normal-arched feet. Data from these participants were subsequently used to define the boundary between normal- and flat-arched feet. This information was then used to recruit participants with flat-arched feet. The relationship between the clinical and radiographic measures of foot posture was also explored. Results Thirty-two participants were recruited to the normal-arched study, 31 qualified for the flat-arched study and 28 participants were classified as having neither normal- or flat-arched feet and were not suitable for either study. The values obtained from the two clinical and four radiological measurements established two clearly defined foot posture groups. Correlations among clinical and radiological measures were significant (p r = 0.24 to 0.70. Interestingly, the clinical measures were more strongly associated with the radiographic angles obtained from the lateral view. Conclusion This foot screening protocol provides a coherent strategy for researchers planning to recruit participants with normal- and flat-arched feet. However, further research is

  2. Implementation of MRI gel dosimetry in radiation therapy

    International Nuclear Information System (INIS)

    Baeck, S.Aa.J.

    1998-12-01

    Gel dosimetry was used together with magnetic resonance imaging (MRI) to measure three-dimensional absorbed dose distributions in radiation therapy. Two different dosimeters were studied: ferrous- and monomer gel, based on the principles of radiation-induced oxidation and polymerisation, respectively. Single clinical electron and photon beams were evaluated and gel dose distributions were mainly within 2% of conventional detector results. The ferrous-gel was also used for clinical proton beams. A decrease in signal per absorbed dose was found close to the end of the range of the protons (15-20%). This effect was explained as a linear energy transfer dependence, further supported with Monte Carlo simulations. A method for analysing and comparing data from treatment planning system (TPS) and gel measurements was developed. The method enables a new pixel by pixel evaluation, isodose comparison and dose volume histogram verification. Two standard clinical radiation therapy procedures were examined using the developed TPS verification method. The treatment regimes included several beams of different radiation qualities. The TPS calculated data were in very good agreement with the dose distribution measured by the ferrous-gel. However, in a beam abutment region, larger dose difference was found. Beam adjustment errors and a minor TPS underestimation of the lateral scatter contribution outside the primary electron beam may explain the discrepancy. The overall uncertainty in the ferrous-gel dose determination was considerably reduced using an optimised MRI acquisition protocol and a new MRI scanner. The relative dose uncertainty was found to be better than 3.3% for all dose levels (95% confidence level). Using the method developed for comparing measured gel data with calculated treatment plans, the gel dosimetry method was proven to be a useful tool for radiation treatment planning verification

  3. Implementation of MRI gel dosimetry in radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Baeck, S.Aa.J

    1998-12-01

    Gel dosimetry was used together with magnetic resonance imaging (MRI) to measure three-dimensional absorbed dose distributions in radiation therapy. Two different dosimeters were studied: ferrous- and monomer gel, based on the principles of radiation-induced oxidation and polymerisation, respectively. Single clinical electron and photon beams were evaluated and gel dose distributions were mainly within 2% of conventional detector results. The ferrous-gel was also used for clinical proton beams. A decrease in signal per absorbed dose was found close to the end of the range of the protons (15-20%). This effect was explained as a linear energy transfer dependence, further supported with Monte Carlo simulations. A method for analysing and comparing data from treatment planning system (TPS) and gel measurements was developed. The method enables a new pixel by pixel evaluation, isodose comparison and dose volume histogram verification. Two standard clinical radiation therapy procedures were examined using the developed TPS verification method. The treatment regimes included several beams of different radiation qualities. The TPS calculated data were in very good agreement with the dose distribution measured by the ferrous-gel. However, in a beam abutment region, larger dose difference was found. Beam adjustment errors and a minor TPS underestimation of the lateral scatter contribution outside the primary electron beam may explain the discrepancy. The overall uncertainty in the ferrous-gel dose determination was considerably reduced using an optimised MRI acquisition protocol and a new MRI scanner. The relative dose uncertainty was found to be better than 3.3% for all dose levels (95% confidence level). Using the method developed for comparing measured gel data with calculated treatment plans, the gel dosimetry method was proven to be a useful tool for radiation treatment planning verification 103 refs, 20 figs, 6 tabs

  4. Proton-beam radiation therapy dosimetry standardization

    International Nuclear Information System (INIS)

    Gall, K.P.

    1995-01-01

    Beams of protons have been used for radiation therapy applications for over 40 years. In the last decade the number of facilities treating patients and the total number of patients being treated has begun go grow rapidly. Due to the limited and experimental nature of the early programs, dosimetry protocols tended to be locally defined. With the publication of the AAPM Task Group 20 report open-quotes Protocol for Dosimetry of Heavy Charged Particlesclose quotes and the open-quotes European Code of Practice for Proton-Beam Dosimetryclose quotes the practice of determining dose in proton-beam therapy was somewhat unified. The ICRU has also recently commissioned a report on recommendations for proton-beam dosimetry. There have been three main methods of determining proton dose; the Faraday cup technique, the ionization chamber technique, and the calorimeter technique. For practical reasons the ionization chamber technique has become the most widely used. However, due to large errors in basic parameters (e.g., W-value) is also has a large uncertainty for absolute dose. It has been proposed that the development of water calorimeter absorbed dose standards would reduce the uncertainty in absolute proton dose as well as the relative dose between megavoltage X-ray beams and proton beams. The advantages and disadvantages are discussed

  5. A transferability study of the EPR-tooth-dosimetry technique

    International Nuclear Information System (INIS)

    Sholom, S.; Chumak, V.; Desrosiers, M.; Bouville, A.

    2006-01-01

    The transferability of a measurement protocol from one laboratory to another is an important feature of any mature, standardised protocol. The electron paramagnetic resonance (EPR)-tooth dosimetry technique that was developed in Scientific Center for Radiation Medicine, AMS (Ukraine) (SCRM) for routine dosimetry of Chernobyl liquidators has demonstrated consistent results in several inter-laboratory measurement comparisons. Transferability to the EPR dosimetry laboratory at the National Inst. of Standards and Technology (NIST) was examined. Several approaches were used to test the technique, including dose reconstruction of SCRM-NIST inter-comparison samples. The study has demonstrated full transferability of the technique and the possibility to reproduce results in a different laboratory environment. (authors)

  6. CT dosimetry and quality control of its operation

    International Nuclear Information System (INIS)

    Mechi, Saida

    2011-01-01

    This thesis focuses on the dosimetry of a scanner, quality control of its operations and the development of a protocol. It allowed us the mastery of the art scanner and participation in all quality controls with appropriate ghosts. CT is a radiographic examination sophisticated and accurate, widely used to screen for various diseases, among other cancer. We worked on the dosimetry of a scanner and we have made simulations with a program called Impact that calculates the CT CTDI and the PDL and compared with values displayed on the console. Similarly, the software calculates the absorbed dose and compared with that calculated by Caldose X. This work is complemented by the development of a protocol with the quality control procedures of the image and dosimetry in chronological order.

  7. Hanford External Dosimetry Technical Basis Manual PNL-MA-842

    Energy Technology Data Exchange (ETDEWEB)

    Rathbone, Bruce A.

    2009-08-28

    The Hanford External Dosimetry Technical Basis Manual PNL-MA-842 documents the design and implementation of the external dosimetry system used at Hanford. The manual describes the dosimeter design, processing protocols, dose calculation methodology, radiation fields encountered, dosimeter response characteristics, limitations of dosimeter design under field conditions, and makes recommendations for effective use of the dosimeters in the field. The manual describes the technical basis for the dosimetry system in a manner intended to help ensure defensibility of the dose of record at Hanford and to demonstrate compliance with 10 CFR 835, DOELAP, DOE-RL, ORP, PNSO, and Hanford contractor requirements. The dosimetry system is operated by PNNL’s Hanford External Dosimetry Program (HEDP) which provides dosimetry services to all Hanford contractors. The primary users of this manual are DOE and DOE contractors at Hanford using the dosimetry services of PNNL. Development and maintenance of this manual is funded directly by DOE and DOE contractors. Its contents have been reviewed and approved by DOE and DOE contractors at Hanford through the Hanford Personnel Dosimetry Advisory Committee (HPDAC) which is chartered and chaired by DOE-RL and serves as means of coordinating dosimetry practices across contractors at Hanford. This manual was established in 1996. Since inception, it has been revised many times and maintained by PNNL as a controlled document with controlled distribution. The first revision to be released through PNNL’s Electronic Records & Information Capture Architecture (ERICA) database was designated Revision 0. Revision numbers that are whole numbers reflect major revisions typically involving changes to all chapters in the document. Revision numbers that include a decimal fraction reflect minor revisions, usually restricted to selected chapters or selected pages in the document.

  8. Relationships of clinical protocols and reconstruction kernels with image quality and radiation dose in a 128-slice CT scanner: Study with an anthropomorphic and water phantom

    International Nuclear Information System (INIS)

    Paul, Jijo; Krauss, B.; Banckwitz, R.; Maentele, W.; Bauer, R.W.; Vogl, T.J.

    2012-01-01

    Research highlights: ► Clinical protocol, reconstruction kernel, reconstructed slice thickness, phantom diameter or the density of material it contains directly affects the image quality of DSCT. ► Dual energy protocol shows the lowest DLP compared to all other protocols examined. ► Dual-energy fused images show excellent image quality and the noise is same as that of single- or high-pitch mode protocol images. ► Advanced CT technology improves image quality and considerably reduce radiation dose. ► An important finding is the comparatively higher DLP of the dual-source high-pitch protocol compared to other single- or dual-energy protocols. - Abstract: Purpose: The aim of this study was to explore the relationship of scanning parameters (clinical protocols), reconstruction kernels and slice thickness with image quality and radiation dose in a DSCT. Materials and methods: The chest of an anthropomorphic phantom was scanned on a DSCT scanner (Siemens Somatom Definition flash) using different clinical protocols, including single- and dual-energy modes. Four scan protocols were investigated: 1) single-source 120 kV, 110 mA s, 2) single-source 100 kV, 180 mA s, 3) high-pitch 120 kV, 130 mA s and 4) dual-energy with 100/Sn140 kV, eff.mA s 89, 76. The automatic exposure control was switched off for all the scans and the CTDIvol selected was in between 7.12 and 7.37 mGy. The raw data were reconstructed using the reconstruction kernels B31f, B80f and B70f, and slice thicknesses were 1.0 mm and 5.0 mm. Finally, the same parameters and procedures were used for the scanning of water phantom. Friedman test and Wilcoxon-Matched-Pair test were used for statistical analysis. Results: The DLP based on the given CTDIvol values showed significantly lower exposure for protocol 4, when compared to protocol 1 (percent difference 5.18%), protocol 2 (percent diff. 4.51%), and protocol 3 (percent diff. 8.81%). The highest change in Hounsfield Units was observed with dual

  9. Development of software for clinical protocols in nuclear medicine. Final report for the period 21 November 1994 - 21 November 1995

    International Nuclear Information System (INIS)

    Todd-Pokropek, A.

    1996-01-01

    After two technical contracts of IAEA, a portable image processing software (PIP) has been developed and some clinical protocols for nuclear medicine studies with IBM PCs which are connected to analogue gamma cameras. In addition, a suitable front end for driving some PC/gamma camera interface cards have been successfully tested and extended. The on-line help facilities and the user interface within PIP was remarkably improved, for medical physicists as developers as well as for technologists as users for routine studies

  10. Clinical Experience With Image-Guided Radiotherapy in an Accelerated Partial Breast Intensity-Modulated Radiotherapy Protocol

    International Nuclear Information System (INIS)

    Leonard, Charles E.; Tallhamer, Michael M.S.; Johnson, Tim; Hunter, Kari C.M.D.; Howell, Kathryn; Kercher, Jane; Widener, Jodi; Kaske, Terese; Paul, Devchand; Sedlacek, Scot; Carter, Dennis L.

    2010-01-01

    Purpose: To explore the feasibility of fiducial markers for the use of image-guided radiotherapy (IGRT) in an accelerated partial breast intensity modulated radiotherapy protocol. Methods and Materials: Nineteen patients consented to an institutional review board approved protocol of accelerated partial breast intensity-modulated radiotherapy with fiducial marker placement and treatment with IGRT. Patients (1 patient with bilateral breast cancer; 20 total breasts) underwent ultrasound guided implantation of three 1.2- x 3-mm gold markers placed around the surgical cavity. For each patient, table shifts (inferior/superior, right/left lateral, and anterior/posterior) and minimum, maximum, mean error with standard deviation were recorded for each of the 10 BID treatments. The dose contribution of daily orthogonal films was also examined. Results: All IGRT patients underwent successful marker placement. In all, 200 IGRT treatment sessions were performed. The average vector displacement was 4 mm (range, 2-7 mm). The average superior/inferior shift was 2 mm (range, 0-5 mm), the average lateral shift was 2 mm (range, 1-4 mm), and the average anterior/posterior shift was 3 mm (range, 1 5 mm). Conclusions: This study shows that the use of IGRT can be successfully used in an accelerated partial breast intensity-modulated radiotherapy protocol. The authors believe that this technique has increased daily treatment accuracy and permitted reduction in the margin added to the clinical target volume to form the planning target volume.

  11. Clinical outcome comparison of immediate blanket treatment versus a delayed pathogen-based treatment protocol for clinical mastitis in a New York dairy herd.

    Science.gov (United States)

    Vasquez, A K; Nydam, D V; Capel, M B; Eicker, S; Virkler, P D

    2017-04-01

    The purpose was to compare immediate intramammary antimicrobial treatment of all cases of clinical mastitis with a selective treatment protocol based on 24-h culture results. The study was conducted at a 3,500-cow commercial farm in New York. Using a randomized design, mild to moderate clinical mastitis cases were assigned to either the blanket therapy or pathogen-based therapy group. Cows in the blanket therapy group received immediate on-label intramammary treatment with ceftiofur hydrochloride for 5 d. Upon receipt of 24 h culture results, cows in the pathogen-based group followed a protocol automatically assigned via Dairy Comp 305 (Valley Agricultural Software, Tulare, CA): Staphylococcus spp., Streptococcus spp., or Enterococcus spp. were administered on-label intramammary treatment with cephapirin sodium for 1 d. Others, including cows with no-growth or gram-negative results, received no treatment. A total of 725 cases of clinical mastitis were observed; 114 cows were not enrolled due to severity. An additional 122 cases did not meet inclusion criteria. Distribution of treatments for the 489 qualifying events was equal between groups (pathogen-based, n = 246; blanket, n = 243). The proportions of cases assigned to the blanket and pathogen-based groups that received intramammary therapy were 100 and 32%, respectively. No significant differences existed between blanket therapy and pathogen-based therapy in days to clinical cure; means were 4.8 and 4.5 d, respectively. The difference in post-event milk production between groups was not statistically significant (blanket therapy = 34.7 kg; pathogen-based = 35.4 kg). No differences were observed in test-day linear scores between groups; least squares means of linear scores was 4.3 for pathogen-based cows and 4.2 for blanket therapy cows. Odds of survival 30 d postenrollment was similar between groups (odds ratio of pathogen-based = 1.6; 95% confidence interval: 0.7-3.7) as was odds of survival to 60 d (odds ratio

  12. In vivo dosimetry in radiation therapy in Sweden; In vivo-dosimetri inom straalbehandling i Sverige

    Energy Technology Data Exchange (ETDEWEB)

    Eriksson, Jacob; Blomquist, Michael (Norrlands universitetssjukhus, Umeaa (Sweden))

    2010-07-15

    A prerequisite for achieving high radiation safety for patients receiving external beam radiation therapy is that the hospitals have a quality assurance program. The program should include include monitoring of the radiation dose given to the patient. Control measurements are performed both at the system level and at the individual level. Control measurement is normally performed using in vivo dosimetry, e.g. a method to measure the radiation dose at the individual level during the actual radiation treatment time. In vivo dosimetry has proven to be an important tool to detect and prevent serious errors in patient treatment. The purpose of this research project was to identify the extent to which vivo dosimetry is used and the methods available for this at Swedish radiation therapy clinics. The authority also wanted to get an overall picture of how hospitals manage results of in vivo dosimetry, and how clinics control radiation dose when using modern treatment techniques. The report reflects the situation in Swedish radiotherapy clinics 2007. The report shows that all hospitals use some form of in vivo dosimetry. The instruments used are mainly diodes and termoluminiscence dosimeters

  13. Patient dosimetry in diagnostic radiology

    International Nuclear Information System (INIS)

    Shrimpton, P.C.

    2000-01-01

    Full text: X-ray examinations remain an essential and widely used diagnostic tool in medicine and hence the most significant source of exposure to man-made radiation for populations. Patterns of practice in diagnostic radiology continue to evolve, with overall growth in the numbers of procedures worldwide and, particularly in developed countries, increasing importance for complex procedures such as computed tomography (CT) and interventional techniques. In order to maximise the benefits from x-rays relative to the associated radiation risks, there is a need to ensure the prior justification of all examinations and the optimisation of patient protection such that doses are as low as reasonably practicable to meet specific clinical requirements. Accordingly, patient dosimetry is a fundamental requirement in diagnostic radiology. Detailed measurements for the assessment of risks or comparison of different types of procedure require the estimation of organ and effective doses. Such comprehensive dosimetry necessarily involves the simulation of clinical practice using anthropomorphic phantoms, with either measurements in a physical phantom or calculations utilising a mathematical phantom. Simpler measurements for the routine monitoring of dose in x-ray departments can be based on practical quantities such as entrance surface dose, dose-area product and, for CT, weighted CT dose index and dose-length product. Widescale surveys reveal significant variations between departments in the typical doses for a given type of procedure and potential scope for dose reductions. In order to promote improvements in practice, the results of periodic dose surveys in departments should be compared with appropriate standards, such as diagnostic reference levels for adult and paediatric patients, that are set nationally or locally for the purposes of promoting critical review of the equipment and techniques in use. Patient dosimetry should form an essential element of routine quality

  14. The Dysphagia in Stroke Protocol Reduces Aspiration Pneumonia in Patients with Dysphagia Following Acute Stroke: a Clinical Audit.

    Science.gov (United States)

    Perry, Sarah E; Miles, Anna; Fink, John N; Huckabee, Maggie-Lee

    2018-03-30

    Cough reflex testing has been evaluated as a component of the clinical swallowing assessment as a means of identifying patients at risk of aspiration during swallowing. A previous study by our research group found good sensitivity and specificity of the cough reflex test for identifying patients at risk of aspiration post-stroke, yet its use did not decrease pneumonia rates, contrary to previous reports. The aim of this study was to expand on our earlier work by implementing a clinical management protocol incorporating cough reflex testing within the same healthcare setting and compare patient outcomes to those from the original study and to evaluate clinical outcomes in patients with acute stroke who were managed using the Dysphagia in Stroke Protocol (DiSP). Secondarily, to compare those outcomes to historical data prior to implementation of the DiSP. This clinical audit measured outcomes from 284 patients with acute stroke managed per the DiSP, which guides use of videofluoroscopic swallowing study and patient management based on clinical exam with cough reflex testing. Data from our previous trial were included for comparison of pre- and post-DiSP patient outcomes. Data collection took place between November 2012 and April 2016 at four urban hospitals within New Zealand. Following implementation of the DiSP, the rate of aspiration pneumonia (10%) was substantially lower than the pre-DiSP rate (28%), with no pneumonia readmissions within 3 months. Pneumonia-related mortality was unchanged. By 3 months, 81% of the patients were on a normal diet and 67% had returned home, compared to pre-DiSP outcomes of 55% and 55% respectively. Previous work has suggested that simply implementing cough reflex testing in dysphagia management may not be sufficient to improve patient outcomes. The present study adds to this picture by suggesting that the true variable of influence may be the way in which the results of the test are applied to patient care. There is a strong case

  15. Image in nuclear dosimetry using thermoluminescent dosimetry

    International Nuclear Information System (INIS)

    Guinsburg, G.; Matsuoka, M.; Watanabe, S.

    1987-01-01

    A low cost methodology to produce images of internal sick organs by radioisotopic intake, is presented. Dosimetries of thermoluminescent material and Teflon (ratio:50%) in bidimensional matrix shape are used with a Pb collimator. This collimator-bidimensional matrix system was tested ''in vivo'' and in thyroid phantoms using 99m Tc. A comparative evaluation between this method and the scintigraphy one is presented. (M.A.C.) [pt

  16. Full-mouth disinfection as a therapeutic protocol for type-2 diabetic subjects with chronic periodontitis: twelve-month clinical outcomes: a randomized controlled clinical trial.

    Science.gov (United States)

    Santos, Vanessa R; Lima, Jadson A; Miranda, Tamires S; Gonçalves, Tiago E D; Figueiredo, Luciene C; Faveri, Marcelo; Duarte, Poliana M

    2013-02-01

    The aim of this randomized controlled clinical trial was to evaluate the clinical effects of chlorhexidine (CHX) application in a full-mouth disinfection (FMD) protocol in poorly controlled type-2 diabetic subjects with generalized chronic periodontitis. Thirty-eight subjects were randomly assigned into FMD group (n=19): full-mouth scaling and root planing (FMSRP) within 24 h + local application of CHX gel + CHX rinses for 60 days or Control group (n = 19): FMSRP within 24 h + local application of placebo gel + placebo rinses for 60 days. Clinical parameters, glycated haemoglobin and fasting plasma glucose were assessed at baseline, 3, 6 and 12 months post-therapies. All clinical parameters improved significantly at 3, 6 and 12 months post-therapies for both groups (p clinical parameters, and glycemic condition at any time-point (p > 0.05). The treatments did not differ with respect to clinical parameters, including the primary outcome variable (i.e. changes in clinical attachment level in deep pockets), for up to 12 months post-treatments. © 2012 John Wiley & Sons A/S.

  17. SSDL newsletter. No. 27[Secondary Standard Dosimetry Laboratories

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1988-12-01

    This issue of the newsletter presents a report of the third meeting of the SSDL Scientific Committee. Articles on ''Absorbed dose determination in photon and electron beams'' and ''Comparison of absorbed dose determinations using the IAEA dosimetry protocol and the ferrous sulphate dosimeter'' are the major topics covered.

  18. Evaluation of the thermoluminescent detector answers of CaSO4:Dy, LiF:Mg,Ti and micro LiF:Mg,Ti in photon clinical beams dosimetry using water simulator

    International Nuclear Information System (INIS)

    Matsushima, Luciana C.; Veneziani, Glauco R.; Campos, Leticia L.

    2011-01-01

    This paper perform the comparative study of thermoluminescent answer of calcium sulfate dosemeter doped with dysprosium (DaSO 4 :Dy) produced by the IPEN, Sao Paulo, with answer of lithium fluoride dosemeters doped with magnesium and titanium (LiF:Mg, Ti) in the dosimetry of clinical beams of photons (6 and 15 MV) by using water simulator object. Dose-answer curves were obtained for gamma radiation of cobalt-60 in the air and in conditions of electronic equilibrium (plate of PMMA), and clinical photons of CLINAC model 2100C accelerators of the two evaluated hospitals: Hospital das Clinicas of the Faculty of Medicine of Sao Paulo university and Hospital Albert Einstein. It was also evaluated the sensitivity and reproduction of the three dosemeters

  19. SU-E-J-166: Sensitivity of Clinically Relevant Dosimetric Parameters to Contouring Uncertainty During Post Implant Dosimetry of Prostate Permanent Seed Implants

    Energy Technology Data Exchange (ETDEWEB)

    Mashouf, S [Sunnybrook Odette Cancer Centre, Toronto, ON (Canada); University of Toronto, Dept. of Radiation Oncology, Toronto, ON (Canada); Ravi, A; Morton, G; Song, W [Sunnybrook Odette Cancer Centre, Toronto, ON (Canada); University of Toronto, Dept. of Radiation Oncology, Toronto, ON (Canada); Sunnybrook Research Institute, Toronto, ON (Canada)

    2015-06-15

    Purpose: There is a strong evidence relating post-implant dosimetry for permanent seed prostate brachytherpy to local control rates. The delineation of the prostate on CT images, however, represents a challenge as it is difficult to confidently identify the prostate borders from soft tissue surrounding it. This study aims at quantifying the sensitivity of clinically relevant dosimetric parameters to prostate contouring uncertainty. Methods: The post-implant CT images and plans for a cohort of 43 patients, who have received I–125 permanent prostate seed implant in our centre, were exported to MIM Symphony LDR brachytherapy treatment planning system (MIM Software Inc., Cleveland, OH). The prostate contours in post-implant CT images were expanded/contracted uniformly for margins of ±1.00mm, ±2.00mm, ±3.00mm, ±4.00mm and ±5.00mm (±0.01mm). The values for V100 and D90 were extracted from Dose Volume Histograms for each contour and compared. Results: The mean value of V100 and D90 was obtained as 92.3±8.4% and 108.4±12.3% respectively (Rx=145Gy). V100 was reduced by −3.2±1.5%, −7.2±3.0%, −12.8±4.0%, −19.0±4.8%, − 25.5±5.4% for expanded contours of prostate with margins of +1mm, +2mm, +3mm, +4mm, and +5mm, respectively, while it was increased by 1.6±1.2%, 2.4±2.4%, 2.7±3.2%, 2.9±4.2%, 2.9±5.1% for the contracted contours. D90 was reduced by −6.9±3.5%, −14.5±6.1%, −23.8±7.1%, − 33.6±8.5%, −40.6±8.7% and increased by 4.1±2.6%, 6.1±5.0%, 7.2±5.7%, 8.1±7.3% and 8.1±7.3% for the same set of contours. Conclusion: Systematic expansion errors of more than 1mm may likely render a plan sub-optimal. Conversely contraction errors may Result in labeling a plan likely as optimal. The use of MRI images to contour the prostate should results in better delineation of prostate organ which increases the predictive value of post-op plans. Since observers tend to overestimate the prostate volume on CT, compared with MRI, the impact of the

  20. The evaluation of complex clinical trial protocols: resources available to research ethics committees and the use of clinical trial registries--a case study.

    Science.gov (United States)

    Homedes, Núria; Ugalde, Antonio

    2015-06-01

    To assess the potential role of clinical trial (CT) registries and other resources available to research ethics committees (RECs) in the evaluation of complex CT protocols in low-income and middle-income countries. Using a case study approach, the authors examined the decision-making process of a REC in Argentina and its efforts to use available resources to decide on a complex protocol. We also analysed the information in the USA and other CT registries and consulted 24 CT experts in seven countries. Information requested by the Argentinean REC from other national RECs and ethics' experts was not useful to verify the adequacy of the REC's decision whether or not to approve the CT. The responses from the national regulatory agency and the sponsor were not helpful either. The identification of international resources that could assist was beyond the REC's capability. The information in the USA and other CT registries is limited, and at times misleading; and its accuracy is not verified by register keepers. RECs have limited access to experts and institutions that could assist them in their deliberations. Sponsors do not always answer RECs' request for information to properly conduct the ethical and methodological assessment of CT protocols. The usefulness of the CT registries is curtailed by the lack of appropriate codes and by data errors. Information about reasons for rejection, withdrawal or suspension of the trial should be included in the registries. Establishing formal channels of communication among national and foreign RECs and with independent international reference centres could strengthen the ethical review of CT protocols. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  1. Assessment of Adverse Events in Protocols, Clinical Study Reports, and Published Papers of Trials of Orlistat: A Document Analysis.

    Directory of Open Access Journals (Sweden)

    Jeppe Bennekou Schroll

    2016-08-01

    Full Text Available Little is known about how adverse events are summarised and reported in trials, as detailed information is usually considered confidential. We have acquired clinical study reports (CSRs from the European Medicines Agency through the Freedom of Information Act. The CSRs describe the results of studies conducted as part of the application for marketing authorisation for the slimming pill orlistat. The purpose of this study was to study how adverse events were summarised and reported in study protocols, CSRs, and published papers of orlistat trials.We received the CSRs from seven randomised placebo controlled orlistat trials (4,225 participants submitted by Roche. The CSRs consisted of 8,716 pages and included protocols. Two researchers independently extracted data on adverse events from protocols and CSRs. Corresponding published papers were identified on PubMed and adverse event data were extracted from this source as well. All three sources were compared. Individual adverse events from one trial were summed and compared to the totals in the summary report. None of the protocols or CSRs contained instructions for investigators on how to question participants about adverse events. In CSRs, gastrointestinal adverse events were only coded if the participant reported that they were "bothersome," a condition that was not specified in the protocol for two of the trials. Serious adverse events were assessed for relationship to the drug by the sponsor, and all adverse events were coded by the sponsor using a glossary that could be updated by the sponsor. The criteria for withdrawal due to adverse events were in one case related to efficacy (high fasting glucose led to withdrawal, which meant that one trial had more withdrawals due to adverse events in the placebo group. Finally, only between 3% and 33% of the total number of investigator-reported adverse events from the trials were reported in the publications because of post hoc filters, though six of

  2. Consensus recommendations for a standardized Brain Tumor Imaging Protocol in clinical trials

    NARCIS (Netherlands)

    B.M. Ellingson (Benjamin M.); M. Bendszus (Martin); J. Boxerman (Jerrold); D. Barboriak (Daniel); B.J. Erickson (Bradley J.); M. Smits (Marion); S.J. Nelson (Sarah J.); E. Gerstner (Elizabeth); B. Alexander (Brian); G. Goldmacher (Gregory); W. Wick (Wolfgang); M.A. Vogelbaum (Michael); M. Weller (Michael); E. Galanis (Evanthia); J. Kalpathy-Cramer (Jayashree); L. Shankar; P. Jacobs (Paula); W.B. Pope (Whitney B.); D. Yang (Dewen); C. Chung (Caroline); R.H. Knopp; S. Cha (Soonme); M.J. van den Bent (Martin); S.M. Chang (Susan); W.K. Al Yung; T.F. Cloughesy (Timothy F.); P.Y. Wen (Patrick Y.); M.R. Gilbert (Mark R.); A. Whitney (Andrew); D. Sandak (David); A. Musella (Al); C. Haynes (Chas); M. Wallace (Max); D.F. Arons (David F.); A. Kingston (Ann)

    2015-01-01

    textabstractA recent joint meeting was held on January 30, 2014, with the US Food and Drug Administration (FDA), National Cancer Institute (NCI), clinical scientists, imaging experts, pharmaceutical and biotech companies, clinical trials cooperative groups, and patient advocate groups to discuss

  3. SU-F-T-272: Patient Specific Quality Assurance of Prostate VMAT Plans with Portal Dosimetry

    Energy Technology Data Exchange (ETDEWEB)

    Darko, J; Osei, E [Grand River Cancer Centre @ Grand River Hospital, Kitchener, ON (Canada); University of Waterloo, Waterloo, ON (Canada); Kiciak, A [University of Waterloo, Waterloo, ON (Canada); Badu, S; Grigorov, G; Fleck, A [Grand River Cancer Centre @ Grand River Hospital, Kitchener, ON (Canada)

    2016-06-15

    Purpose: To evaluate the effectiveness of using the Portal Dosimetry (PD) method for patient specific quality assurance of prostate VMAT plans. Methods: As per institutional protocol all VMAT plans were measured using the Varian Portal Dosimetry (PD) method. A gamma evaluation criterion of 3%-3mm with a minimum area gamma pass rate (gamma <1) of 95% is used clinically for all plans. We retrospectively evaluated the portal dosimetry results for 170 prostate patients treated with VMAT technique. Three sets of criterions were adopted for re-evaluating the measurements; 3%-3mm, 2%-2mm and 1%-1mm. For all criterions two areas, Field+1cm and MLC-CIAO were analysed.To ascertain the effectiveness of the portal dosimetry technique in determining the delivery accuracy of prostate VMAT plans, 10 patients previously measured with portal dosimetry, were randomly selected and their measurements repeated using the ArcCHECK method. The same criterion used in the analysis of PD was used for the ArcCHECK measurements. Results: All patient plans reviewed met the institutional criteria for Area Gamma pass rate. Overall, the gamma pass rate (gamma <1) decreases for 3%-3mm, 2%-2mm and 1%-1mm criterion. For each criterion the pass rate was significantly reduced when the MLC-CIAO was used instead of FIELD+1cm. There was noticeable change in sensitivity for MLC-CIAO with 2%-2mm criteria and much more significant reduction at 1%-1mm. Comparable results were obtained for the ArcCHECK measurements. Although differences were observed between the clockwise verses the counter clockwise plans in both the PD and ArcCHECK measurements, this was not deemed to be statistically significant. Conclusion: This work demonstrates that Portal Dosimetry technique can be effectively used for quality assurance of VMAT plans. Results obtained show similar sensitivity compared to ArcCheck. To reveal certain delivery inaccuracies, the use of a combination of criterions may provide an effective way in improving

  4. Secondary standard dosimetry laboratory (SSDL)

    International Nuclear Information System (INIS)

    Md Saion bin Salikin.

    1983-01-01

    A secondary Standard Dosimetry Laboratory has been established in the Tun Ismail Research Centre, Malaysia as a national laboratory for reference and standardization purposes in the field of radiation dosimetry. This article gives brief accounts on the general information, development of the facility, programmes to be carried out as well as other information on the relevant aspects of the secondary standard dosimetry laboratory. (author)

  5. Using a clinical protocol for orthognathic surgery and assessing a 3-dimensional virtual approach: current therapy.

    Science.gov (United States)

    Quevedo, Luis A; Ruiz, Jessica V; Quevedo, Cristobal A

    2011-03-01

    Oral and maxillofacial surgeons who perform orthognathic surgery face major changes in their practices, and these challenges will increase in the near future, because the extraordinary advances in technology applied to our profession are not only amazing but are becoming the standard of care as they promote improved outcomes for our patients. Orthognathic surgery is one of the favorite areas of practicing within the scope of practice of an oral and maxillofacial surgeon. Our own practice in orthognathic surgery has completed over 1,000 surgeries of this type. Success is directly related to the consistency and capability of the surgical-orthodontic team to achieve predictable, stable results, and our hypothesis is that a successful result is directly related to the way we take our records and perform diagnosis and treatment planning following basic general principles. Now that we have the opportunity to plan and treat 3-dimensional (3D) problems with 3D technology, we should enter into this new era with appropriate standards to ensure better results, instead of simply enjoying these new tools, which will clearly show not only us but everyone what we do when we perform orthognathic surgery. Appropriate principles need to be taken into account when implementing this new technology. In other words, new technology is welcome, but we do not have to reinvent the wheel. The purpose of this article is to review the current protocol that we use for orthognathic surgery and compare it with published protocols that incorporate new 3D and virtual technology. This report also describes our approach to this new technology. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  6. A fixed protocol for outpatient clinic routines in the care of patients with severe renal failure.

    Science.gov (United States)

    Hadimeri, Henrik; Frisenette-Fich, Carsten; Deurell, Sven-Ingemar; Svensson, Lars; Carlsson-Bjering, Lena; Fernström, Anders; Almroth, Gabriel; Melander, Stefan; Haarhaus, Mattias; Andersson, Per-Olof; Cassel, Agneta; Mauritz, Nils-Johan; Ståhl-Nilsson, Agneta; Wilske, Jan; Nordström, Kataryna; Oruda, Pavel; Eriksson, Marie; Larsson, Annelie Inghilesi; Stegmayr, Bernd

    2013-07-01

    The primary aim of this study was to assess whether a fixed protocol, using a specially trained team, for intermediate follow-up to fulfillment of guideline targets is non-inferior to conventional follow-up in the care of uraemic patients. A secondary aim was to investigate possible impact on patient outcome. The cohort comprised 424 patients from seven centers. Inclusion criteria were either serum creatinine exceeding 200 µmol/l or calculated clearance below 30 ml/min, representing CKD 4 or 5a. Six centers followed a standardized protocol (group 1). One center provided controls (group 2). The study design was prospective and interventional. The variables measured were blood hemoglobin, bicarbonate, calcium, phosphate, intact parathyroid hormone, albumin, renal function variables, blood pressure and RAAS blockade. The number of patients achieving the set goals was analyzed as a time trend to determine if the intervention resulted in an improvement. At baseline, group 1 had significantly lower GFR and higher serum creatinine, calcium, phosphate, calcium × phosphate product and bicarbonate, lower mean arterial pressure (MAP), systolic blood pressures and less use of RAAS. During the intervention, group 1 improved in the direction of guidelines for blood hemoglobin, albumin, bicarbonate and MAP. Outcome of secondary endpoints gave a risk of death of 30% in both groups, while the risk of renal replacement therapy was higher in group 1. However, the time to renal replacement therapy was significantly shorter in the intervention group, indicating that other variables than guideline achievements are important for the patient.

  7. Clinical utility of a complete diagnostic protocol for the ocular evaluation of free-living raptors.

    Science.gov (United States)

    Labelle, Amber L; Whittington, Julia K; Breaux, Carrie B; Labelle, Philippe; Mitchell, Mark A; Zarfoss, Mitzi K; Schmidt, Stephanie A; Hamor, Ralph E

    2012-01-01

      To describe a protocol for the examination of free-living raptors and report the ophthalmic examination findings of seven raptor species native to central Illinois, namely the barred owl, Cooper's hawk, eastern screech owl, great horned owl, American kestrel, red-tailed hawk, and turkey vulture and to determine if the findings relative to visual prognosis affected eligibility for future release.   Seventy-nine free-living raptors.   Under manual restraint, complete ophthalmic examination including slit-lamp biomicroscopy and indirect funduscopy, applanation tonometry, rebound tonometry, ocular morphometrics, B-mode ultrasound, and electroretinography (ERG) were performed on each bird. Histopathology of enucleated globes was performed after euthanasia or death in selected cases.   The examination protocol was easily performed using manual restraint alone on all birds. Ocular lesions were detected in 48.1% of birds, with 47.3% affected unilaterally and 52.6% affected bilaterally. Ocular lesions were considered to be vision threatening in 29.0% of the unilaterally affected birds and 29.0% of the bilaterally affected birds. The most common case outcomes were discharge from hospital to rehabilitation facility (45.6%) followed by euthanasia (43.0%). The presence of an ocular lesion or a vision-threatening ocular lesion was not significantly associated with outcome. Reference ranges are reported for B-mode ultrasound, ocular morphometrics, and horizontal corneal diameter in all species.   Complete ophthalmic examination can be supplemented by the use of ocular morphometrics, ultrasound, and ERG in the manually restrained raptor. These advanced diagnostic techniques may be useful in developing more objective criteria for evaluating eligibility for release following rehabilitation of free-living birds of prey. © 2011 American College of Veterinary Ophthalmologists.

  8. The role of the National Physical Laboratory in monitoring and improving dosimetry in UK radiotherapy

    International Nuclear Information System (INIS)

    Thomas, R.A.S.; Duane, S.; McEwen, M.R.; Rosser, K.E.

    2002-01-01

    In the UK, the National Physical Laboratory, in collaboration with the Institute for Physics and Engineering in Medicine operates an audit programme to ensure national consistency in radiotherapy dosimetry. The present programme covers dosimetry of megavoltage photons and electrons (3-19 MeV) and low and medium energy (10-300 kV) photons. The aim of each audit is to verify the local measurement of absorbed dose at the radiotherapy centre. The audit measurements - principally beam quality and linac output - are made following the same protocol as the clinic but using different equipment. The audit is not an absolute measurement of the absorbed dose but amounts to a check that the equipment used by the centre is operating as expected and that the Code of Practice is being followed correctly. The protocols used in the UK are IPSM 1990 for high-energy photons, IPEMB 1996 for electrons and IPEMB 1996 for low energy photons. For the purpose of these audits, NPL maintains a set of calibrated ionisation chambers

  9. Co-Designing Mobile Apps to Assist in Clinical Nursing Education: A Study Protocol.

    Science.gov (United States)

    O'Connor, Siobhan; Andrews, Tom

    2016-01-01

    Mobile applications (apps) to train health professionals is gaining momentum as the benefits of mobile learning (mLearning) are becoming apparent in complex clinical environments. However, most educational apps are generic, off-the-shelf pieces of software that do not take into consideration the unique needs of nursing students. The proposed study will apply a user-centred design process to create a tailored mobile app for nursing students to learn and apply clinical skills in practice. The app will be piloted and evaluated to understand how nursing students use mobile technology in clinical settings to support their learning and educational needs.

  10. Investigation of the Study Characteristics Affecting Clinical Trial Quality Using the Protocol Deviations Leading to Exclusion of Subjects From the Per Protocol Set Data in Studies for New Drug Application: A Retrospective Analysis.

    Science.gov (United States)

    Kohara, Norihito; Kaneko, Masayuki; Narukawa, Mamoru

    2018-01-01

    The concept of the risk-based approach has been introduced as an effort to secure the quality of clinical trials. In the risk-based approach, identification and evaluation of risk in advance are considered important. For recently completed clinical trials, we investigated the relationship between study characteristics and protocol deviations leading to the exclusion of subjects from Per Protocol Set (PPS) efficacy analysis. New drugs approved in Japan in the fiscal year 2014-2015 were targeted in the research. The reasons for excluding subjects from the PPS efficacy analysis were described in 102 trials out of 492 in the summary of new drug application documents, which was publicly disclosed after the drug's regulatory approval. The author extracted these reasons along with the numbers of the cases and the study characteristics of each clinical trial. Then, the direct comparison, univariate regression analysis, and multivariate regression analysis was carried out based on the exclusion rate. The study characteristics for which exclusion of subjects from the PPS efficacy analysis were frequently observed was multiregional clinical trials in study region; inhalant and external use in administration route; Anti-infective for systemic use; Respiratory system, Dermatologicals, and Nervous system in therapeutic drug under the Anatomical Therapeutic Chemical Classification. In the multivariate regression analysis, the clinical trial variables of inhalant, Respiratory system, or Dermatologicals were selected as study characteristics leading to a higher exclusion rate. The characteristics of the clinical trial that is likely to cause protocol deviations that will affect efficacy analysis were suggested. These studies should be considered for specific attention and priority observation in the trial protocol or its monitoring plan and execution, such as a clear description of inclusion/exclusion criteria in the protocol, development of training materials to site staff, and

  11. Neutron dosimetry in biology

    International Nuclear Information System (INIS)

    Sigurbjoernsson, B.; Smith, H.H.; Gustafsson, A.

    1965-01-01

    To study adequately the biological effects of different energy neutrons it is necessary to have high-intensity sources which are not contaminated by other radiations, the most serious of which are gamma rays. An effective dosimetry must provide an accurate measure of the absorbed dose, in biological materials, of each type of radiation at any reactor facility involved in radiobiological research. A standardized biological dosimetry, in addition to physical and chemical methods, may be desirable. The ideal data needed to achieve a fully documented dosimetry has been compiled by H. Glubrecht: (1) Energy spectrum and intensity of neutrons; (2) Angular distribution of neutrons on the whole surface of the irradiated object; (3) Additional undesired radiation accompanying the neutrons; (4) Physical state and chemical composition of the irradiated object. It is not sufficient to note only an integral dose value (e.g. in 'rad') as the biological effect depends on the above data

  12. Determinants of successful clinical networks: the conceptual framework and study protocol.

    Science.gov (United States)

    Haines, Mary; Brown, Bernadette; Craig, Jonathan; D'Este, Catherine; Elliott, Elizabeth; Klineberg, Emily; McInnes, Elizabeth; Middleton, Sandy; Paul, Christine; Redman, Sally; Yano, Elizabeth M

    2012-03-13

    Clinical networks are increasingly being viewed as an important strategy for increasing evidence-based practice and improving models of care, but success is variable and characteristics of networks with high impact are uncertain. This study takes advantage of the variability in the functioning and outcomes of networks supported by the Australian New South Wales (NSW) Agency for Clinical Innovation's non-mandatory model of clinical networks to investigate the factors that contribute to the success of clinical networks. The objective of this retrospective study is to examine the association between external support, organisational and program factors, and indicators of success among 19 clinical networks over a three-year period (2006-2008). The outcomes (health impact, system impact, programs implemented, engagement, user perception, and financial leverage) and explanatory factors will be collected using a web-based survey, interviews, and record review. An independent expert panel will provide judgements about the impact or extent of each network's initiatives on health and system impacts. The ratings of the expert panel will be the outcome used in multivariable analyses. Following the rating of network success, a qualitative study will be conducted to provide a more in-depth examination of the most successful networks. This is the first study to combine quantitative and qualitative methods to examine the factors that contribute to the success of clinical networks and, more generally, is the largest study of clinical networks undertaken. The adaptation of expert panel methods to rate the impacts of networks is the methodological innovation of this study. The proposed project will identify the conditions that should be established or encouraged by agencies developing clinical networks and will be of immediate use in forming strategies and programs to maximise the effectiveness of such networks.

  13. Aging of monolithic zirconia dental prostheses: Protocol for a 5-year prospective clinical study using ex vivo analyses.

    Science.gov (United States)

    Koenig, Vinciane; Wulfman, Claudine P; Derbanne, Mathieu A; Dupont, Nathalie M; Le Goff, Stéphane O; Tang, Mie-Leng; Seidel, Laurence; Dewael, Thibaut Y; Vanheusden, Alain J; Mainjot, Amélie K

    2016-12-15

    Recent introduction of computer-aided design/computer-aided manufacturing (CAD/CAM) monolithic zirconia dental prostheses raises the issue of material low thermal degradation (LTD), a well-known problem with zirconia hip prostheses. This phenomenon could be accentuated by masticatory mechanical stress. Until now zirconia LTD process has only been studied in vitro . This work introduces an original protocol to evaluate LTD process of monolithic zirconia prostheses in the oral environment and to study their general clinical behavior, notably in terms of wear. 101 posterior monolithic zirconia tooth elements (molars and premolars) are included in a 5-year prospective clinical trial. On each element, several areas between 1 and 2 mm 2 (6 on molars, 4 on premolars) are determined on restoration surface: areas submitted or non-submitted to mastication mechanical stress, glazed or non-glazed. Before prosthesis placement, ex vivo analyses regarding LTD and wear are performed using Raman spectroscopy, SEM imagery and 3D laser profilometry. After placement, restorations are clinically evaluated following criteria of the World Dental Federation (FDI), complemented by the analysis of fracture clinical risk factors. Two independent examiners perform the evaluations. Clinical evaluation and ex vivo analyses are carried out after 6 months and then each year for up to 5 years. For clinicians and patients, the results of this trial will justify the use of monolithic zirconia restorations in dental practice. For researchers, the originality of a clinical study including ex vivo analyses of material aging will provide important data regarding zirconia properties.Trial registration: ClinicalTrials.gov Identifier: NCT02150226.

  14. Study of the positioning of the films of the MLC by a Test of bands and your influence in the clinic dosimetry in IMRT; Estudio del posicionamiento de las laminas del MLC mediante un test de bandas y su influencia en la dosimetria clinica en IMRT

    Energy Technology Data Exchange (ETDEWEB)

    Serrano Zabaleta, S.; Millan Cebrian, E.; Calvo Carrillo, S.; Alba Escorihuela, V.; Garcia Romero, A.; Ortega Pardina, P.; Canella Anoz, M.; Hernandez Vitoria, A.

    2015-07-01

    We performed a test of adjacent bands inspired by the proposed in AAPM Report No. 72, we provides a parameter characterizing the state of the MLC as to the actual position of its blades. This test has been validated by studying repeatability and reproducibility and has found the correlation between the parameter and creep detected by the ILD. Subsequently it has studied the impact of changes in the positioning of the blades on clinical dosimetry in IMRT patients, reconstructing the patient dose by Matrix Evolution team and Compass software, IBA Dosimetry. (Author)

  15. Matrix-assisted laser desorption/ionization-time of flight mass spectrometry: protocol standardization and database expansion for rapid identification of clinically important molds.

    Science.gov (United States)

    Paul, Saikat; Singh, Pankaj; Rudramurthy, Shivaprakash M; Chakrabarti, Arunaloke; Ghosh, Anup K

    2017-12-01

    To standardize the matrix-assisted laser desorption ionization-time of flight mass spectrometry protocols and expansion of existing Bruker Biotyper database for mold identification. Four different sample preparation methods (protocol A, B, C and D) were evaluated. On analyzing each protein extraction method, reliable identification and best log scores were achieved through protocol D. The same protocol was used to identify 153 clinical isolates. Of these 153, 123 (80.3%) were accurately identified by using existing database and remaining 30 (19.7%) were not identified due to unavailability in database. On inclusion of missing main spectrum profile in existing database, all 153 isolates were identified. Matrix-assisted laser desorption ionization-time of flight mass spectrometry can be used for routine identification of clinically important molds.

  16. Clinical manifestations of tension pneumothorax: protocol for a systematic review and meta-analysis

    Science.gov (United States)

    2014-01-01

    Background Although health care providers utilize classically described signs and symptoms to diagnose tension pneumothorax, available literature sources differ in their descriptions of its clinical manifestations. Moreover, while the clinical manifestations of tension pneumothorax have been suggested to differ among subjects of varying respiratory status, it remains unknown if these differences are supported by clinical evidence. Thus, the primary objective of this study is to systematically describe and contrast the clinical manifestations of tension pneumothorax among patients receiving positive pressure ventilation versus those who are breathing unassisted. Methods/Design We will search electronic bibliographic databases (MEDLINE, PubMed, EMBASE, and the Cochrane Database of Systematic Reviews) and clinical trial registries from their first available date as well as personal files, identified review articles, and included article bibliographies. Two investigators will independently screen identified article titles and abstracts and select observational (cohort, case–control, and cross-sectional) studies and case reports and series that report original data on clinical manifestations of tension pneumothorax. These investigators will also independently assess risk of bias and extract data. Identified data on the clinical manifestations of tension pneumothorax will be stratified according to whether adult or pediatric study patients were receiving positive pressure ventilation or were breathing unassisted, as well as whether the two investigators independently agreed that the clinical condition of the study patient(s) aligned with a previously published tension pneumothorax working definition. These data will then be summarized using a formal narrative synthesis alongside a meta-analysis of observational studies and then case reports and series where possible. Pooled or combined estimates of the occurrence rate of clinical manifestations will be calculated using

  17. Dosimetry and monitoring of X-rays narrow beams produced by linear particle accelerator, for using in radiosurgery

    International Nuclear Information System (INIS)

    Campos, J.C.F.; Vizeu, D.M.

    1987-01-01

    The main characteristics of X-rays narrow beams dosimetry and monitoring are examined, aiming the introduction of this system in brain radiosurgery. The non-protocolize detectors are used, once that the detectors used in therapy by megavoltage were projected for dosimetry with an irradiation field above 40 mm diameter. (C.G.C.) [pt

  18. INDIVIDUAL DOSIMETRY SERVICE

    CERN Multimedia

    2000-01-01

    Personnel in the distribution groups Aleph, Delphi, L3, Opal who also work for other experiments than at LEP, should contact their dispatchers to explain their activities for the future, after LEP dismantling in order to be maintained on the regular distribution list at Individual DosimetryWe inform all staff and users under regular dosimetric control that the dosimeters for the monitoring period MAY/JUNE will be available from their usual dispatchers on Tuesday 2 May.Please have your films changed before the 12 May.The colour of the dosimeter valid in is MAY/JUNE is YELLOW.Individual Dosimetry Service will be closed on Friday 28 April.

  19. Nuclear medicine radiation dosimetry

    CERN Document Server

    McParland, Brian J

    2010-01-01

    Complexities of the requirements for accurate radiation dosimetry evaluation in both diagnostic and therapeutic nuclear medicine (including PET) have grown over the past decade. This is due primarily to four factors: growing consideration of accurate patient-specific treatment planning for radionuclide therapy as a means of improving the therapeutic benefit, development of more realistic anthropomorphic phantoms and their use in estimating radiation transport and dosimetry in patients, design and use of advanced Monte Carlo algorithms in calculating the above-mentioned radiation transport and

  20. Medical reference dosimetry using EPR measurements of alanine

    DEFF Research Database (Denmark)

    Helt-Hansen, Jakob; Rosendal, F.; Kofoed, I.M.

    2009-01-01

    Background. Electron spin resonance (EPR) is used to determine the absorbed dose of alanine dosimeters exposed to clinical photon beams in a solid-water phantom. Alanine is potentially suitable for medical reference dosimetry, because of its near water equivalence over a wide energy spectrum, low...... methods the proposed algorithm can be applied without normalisation of phase shifts caused by changes in the g-value of the cavity. The study shows that alanine dosimetry is a suitable candidate for medical reference dosimetry especially for quality control applications.......Background. Electron spin resonance (EPR) is used to determine the absorbed dose of alanine dosimeters exposed to clinical photon beams in a solid-water phantom. Alanine is potentially suitable for medical reference dosimetry, because of its near water equivalence over a wide energy spectrum, low...

  1. Clinical outcomes and mortality before and after implementation of a pediatric sepsis protocol in a limited resource setting: A retrospective cohort study in Bangladesh.

    Directory of Open Access Journals (Sweden)

    Teresa Bleakly Kortz

    Full Text Available Pediatric sepsis has a high mortality rate in limited resource settings. Sepsis protocols have been shown to be a cost-effective strategy to improve morbidity and mortality in a variety of populations and settings. At Dhaka Hospital in Bangladesh, mortality from pediatric sepsis in high-risk children previously approached 60%, which prompted the implementation of an evidenced-based protocol in 2010. The clinical effectiveness of this protocol had not been measured. We hypothesized that implementation of a pediatric sepsis protocol improved clinical outcomes, including reducing mortality and length of hospital stay.This was a retrospective cohort study of children 1-59 months old with a diagnosis of sepsis, severe sepsis or septic shock admitted to Dhaka Hospital from 10/25/2009-10/25/2011. The primary outcome was inpatient mortality pre- and post-protocol implementation. Secondary outcomes included fluid overload, heart failure, respiratory insufficiency, length of hospital stay, and protocol compliance, as measured by antibiotic and fluid bolus administration within 60 minutes of hospital presentation.404 patients were identified by a key-word search of the electronic medical record; 328 patients with a primary diagnosis of sepsis, severe sepsis, or septic shock were included (143 pre- and185 post-protocol in the analysis. Pre- and post-protocol mortality were similar and not statistically significant (32.17% vs. 34.59%, p = 0.72. The adjusted odds ratio (AOR for post-protocol mortality was 1.55 (95% CI, 0.88-2.71. The odds for developing fluid overload were significantly higher post-protocol (AOR 3.45, 95% CI, 2.04-5.85, as were the odds of developing heart failure (AOR 4.52, 95% CI, 1.43-14.29 and having a longer median length of stay (AOR 1.81, 95% CI 1.10-2.96. There was no statistically significant difference in respiratory insufficiency (pre- 65.7% vs. post- 70.3%, p = 0.4 or antibiotic administration between the cohorts (pre- 16.08% vs

  2. Blockchain protocols in clinical trials: Transparency and traceability of consent [version 3; referees: 1 approved, 2 approved with reservations, 1 not approved

    OpenAIRE

    Mehdi Benchoufi; Raphael Porcher; Philippe Ravaud

    2017-01-01

    Clinical trial consent for protocols and their revisions should be transparent for patients and traceable for stakeholders. Our goal is to implement a process allowing the collection of patients’ informed consent, which is bound to protocol revisions, storing and tracking the consent in a secure, unfalsifiable and publicly verifiable way, and enabling the sharing of this information in real time. For that, we will built a consent workflow using a rising technology called Blockchain. This is a...

  3. Automation of CT-based haemorrhagic stroke assessment for improved clinical outcomes: study protocol and design.

    Science.gov (United States)

    Chinda, Betty; Medvedev, George; Siu, William; Ester, Martin; Arab, Ali; Gu, Tao; Moreno, Sylvain; D'Arcy, Ryan C N; Song, Xiaowei

    2018-04-19

    Haemorrhagic stroke is of significant healthcare concern due to its association with high mortality and lasting impact on the survivors' quality of life. Treatment decisions and clinical outcomes depend strongly on the size, spread and location of the haematoma. Non-contrast CT (NCCT) is the primary neuroimaging modality for haematoma assessment in haemorrhagic stroke diagnosis. Current procedures do not allow convenient NCCT-based haemorrhage volume calculation in clinical settings, while research-based approaches are yet to be tested for clinical utility; there is a demonstrated need for developing effective solutions. The project under review investigates the development of an automatic NCCT-based haematoma computation tool in support of accurate quantification of haematoma volumes. Several existing research methods for haematoma volume estimation are studied. Selected methods are tested using NCCT images of patients diagnosed with acute haemorrhagic stroke. For inter-rater and intrarater reliability evaluation, different raters will analyse haemorrhage volumes independently. The efficiency with respect to time of haematoma volume assessments will be examined to compare with the results from routine clinical evaluations and planimetry assessment that are known to be more accurate. The project will target the development of an enhanced solution by adapting existing methods and integrating machine learning algorithms. NCCT-based information of brain haemorrhage (eg, size, volume, location) and other relevant information (eg, age, sex, risk factor, comorbidities) will be used in relation to clinical outcomes with future project development. Validity and reliability of the solution will be examined for potential clinical utility. The project including procedures for deidentification of NCCT data has been ethically approved. The study involves secondary use of existing data and does not require new consent of participation. The team consists of clinical neuroimaging

  4. Validation of the Tensoval Duo Control II blood pressure monitor for clinic use and self-measurement according to the British Hypertension Society protocol and the European Society of Hypertension International Protocol Revision 2010.

    Science.gov (United States)

    de Greeff, Annemarie; Shennan, Andrew H

    2013-06-01

    The Tensoval Duo Control II is an automated upper arm device that uses a combination of oscillometric and auscultatory technology to determine blood pressure noninvasively. The accuracy of this device was assessed according to the British Hypertension Society (BHS) protocol and the European Society of Hypertension International Protocol revision 2010 (ESH-IP2) in an adult population. Ethical approval was obtained. Eighty-five and 33 adult individuals, respectively, were recruited to fulfil the requirements of each protocol. Trained observers took nine sequential same-arm measurements alternating between a mercury sphygmomanometer and the device. The device had to achieve at least a B grade for both systolic and diastolic pressures to pass the BHS protocol and had to fulfil the criteria of all three phases of the ESH-IP2 protocol to receive recommendation. The device achieved an A/A grading for the BHS protocol and passed all three phases of the ESH-IP2 protocol. The mean difference±SD for the BHS/ESH protocols, respectively, was -1.8±6.5/-0.7±5.7 mmHg for systolic pressure and 1.9±5.1/2.4±4.5 mmHg for diastolic pressure. The device maintained its A/A grading throughout the low-pressure, medium-pressure and high-pressure ranges. The Tensoval Duo Control II device is recommended for clinical and home use according to both the BHS and the ESH-IP2 standard.

  5. Clinical results after different protocols of combined local heat and radiation

    International Nuclear Information System (INIS)

    Arcangeli, G.; Cividalli, A.; Nervi, C.; Lovisolo, G.

    1983-01-01

    Since 1977, 69 patients with 138 multiple lesions have been treated with combined radiotherapy and hyperthermia, according to 3 protocols. Firstly, radiotherapy was given following a thrice-a-day fractionation scheme of 1.5 to 2 Gy/fraction, up to 60 Gy. Hyperthermia (42.5 0 C/45 min) was applied each other day, immediately after the 2nd radiation fraction. Immediate response resulted significantly higher in the combined group (76% clearances in comparison with 46% after radiotherapy alone). Secondly, tumors received 40 Gy/8 fractions, twice a week, and hyperthermia (42.5 0 C/45 min) was applied with each radiotherapy fraction, either immediately after irradiation (simultaneously) of 4 h later (sequentially). A remarkable improvement of radiation response was obtained, especially with the simultaneous treatment. Thirdly, tumors received 30 Gy/6 fractions, twice a week. Hyperthermia (45 0 C/30 min) was applied simultaneously with each radiotherapy fraction and the surrounding skin was cooled. Complete tumor clearance was achieved in 88% lesions in comparison with 31% after radiotherapy alone. As expected, the incidence of thermal damage on uncooled skin was also increased. In conclusion, the best therapeutic ratio was obtained with low fractional radiotherapy doses and low temperature hyperthermia. (orig.) [de

  6. Safety of a clinical surveillance protocol with 3- and 6-week warfarin prophylaxis after total joint arthroplasty.

    Science.gov (United States)

    Goldstein, W M; Jimenez, M L; Bailie, D S; Wall, R; Branson, J

    2001-07-01

    The charts of 1869 patients were reviewed for the occurrence of deep venous thrombosis (DVT) and pulmonary embolism after total hip or knee arthroplasty. Prophylaxis consisted of 3 (group 1; n=1235) or 6 (group 2; n=634) weeks low-dose warfarin, pneumatic compression boots worn by patients in the hospital, mobilization on the first postoperative day, and a clinical surveillance protocol. Venous ultrasound or ventilation/perfusion lung scintigraphy (V/Q) was performed only if patients became symptomatic. patients. Twenty-three (1.8%) patients were positive for DVT. Ventilation/perfusion lung scintigraphy was performed on 25 patients, and 5 (0.4%) patients were positive for pulmonary embolism. In group 2, 117 patients were evaluated for DVT, and 19 (3%) patients had positive results determined by ultrasound. Twenty-five patients were evaluated with V/Q and only 1 (0.16%) patient was positive for pulmonary embolism. No patient developed a fatal pulmonary embolism or postphlebitic syndrome. This prophylaxis protocol is an efficient and cost-effective method for the prevention of significant events after surgery.

  7. Development and implementation of a clinical pathway for cardiac surgery in the intensive care unit: Effects on protocol adherence.

    Science.gov (United States)

    van der Kolk, Marion; van den Boogaard, Mark; Ter Brugge-Speelman, Corine; Hol, Jeroen; Noyez, Luc; van Laarhoven, Kees; van der Hoeven, Hans; Pickkers, Peter

    2017-12-01

    Cardiac surgery (CS) is facilitated by multiple perioperative guidelines and protocols. Use of a clinical pathway (CP) may facilitate the care of these patients. This is a pre-post design study in the ICU of a tertiary referral centre. A CP for CS patients in the ICU was developed by ICU-nurses and enabled them to execute proactively predefined actions in accordance with and within the preset boundaries which were part of a variance report. A tailored implementation strategy was used. Primary outcome measure was protocol adherence above 80% on the domains of blood pressure control, action on chest tube blood loss and electrolyte control within the CP. In a 4-month period, 84 consecutive CP patients were included and compared with 162 matched control patients admitted in the year before implementation; 3 patients were excluded. Propensity score was used as matching parameter. CP patients were more likely to receive early adequate treatment for derangements in electrolytes (96% vs 47%, P blueprint for the implementation and use of a CP in low-volume high complex surgery. © 2017 John Wiley & Sons, Ltd.

  8. TH-A-BRC-02: AAPM TG-178 Gamma Stereotactic Radiosurgery Dosimetry and Quality Assurance

    Energy Technology Data Exchange (ETDEWEB)

    Goetsch, S. [San Diego Medical Physics (United States)

    2016-06-15

    AAPM TG-135U1 QA for Robotic Radiosurgery - Sonja Dieterich Since the publication of AAPM TG-135 in 2011, the technology of robotic radiosurgery has rapidly developed. AAPM TG-135U1 will provide recommendations on the clinical practice for using the IRIS collimator, fiducial-less real-time motion tracking, and Monte Carlo based treatment planning. In addition, it will summarize currently available literature about uncertainties. Learning Objectives: Understand the progression of technology since the first TG publication Learn which new QA procedures should be implemented for new technologies Be familiar with updates to clinical practice guidelines AAPM TG-178 Gamma Stereotactic Radiosurgery Dosimetry and Quality Assurance - Steven Goetsch Purpose: AAPM Task Group 178 Gamma Stereotactic Radiosurgery Dosimetry and Quality Assurance was formed in August, 2008. The Task Group has 12 medical physicists, two physicians and two consultants. Methods: A round robin dosimetry intercomparison of proposed ionization chambers, electrometer and dosimetry phantoms was conducted over a 15 month period in 2011 and 2012 (Med Phys 42, 11, Nov, 2015). The data obtained at 9 institutions (with ten different Elekta Gamma Knife units) was analyzed by the lead author using several protocols. Results: The most consistent results were obtained using the Elekta ABS 16cm diameter phantom, with the TG-51 protocol modified as recommended by Alfonso et al (Med Phys 35, 11, Nov 2008). A key white paper (Med Phys, in press) sponsored by Elekta Corporation, was used to obtain correction factors for the ionization chambers and phantoms used in this intercomparison. Consistent results were obtained for both Elekta Gamma Knife Model 4C and Gamma Knife Perfexion units as measured with each of two miniature ionization chambers. Conclusion: The full report gives clinical history and background of gamma stereotactic radiosurgery, clinical examples and history, quality assurance recommendations and outline

  9. TH-A-BRC-02: AAPM TG-178 Gamma Stereotactic Radiosurgery Dosimetry and Quality Assurance

    International Nuclear Information System (INIS)

    Goetsch, S.

    2016-01-01

    AAPM TG-135U1 QA for Robotic Radiosurgery - Sonja Dieterich Since the publication of AAPM TG-135 in 2011, the technology of robotic radiosurgery has rapidly developed. AAPM TG-135U1 will provide recommendations on the clinical practice for using the IRIS collimator, fiducial-less real-time motion tracking, and Monte Carlo based treatment planning. In addition, it will summarize currently available literature about uncertainties. Learning Objectives: Understand the progression of technology since the first TG publication Learn which new QA procedures should be implemented for new technologies Be familiar with updates to clinical practice guidelines AAPM TG-178 Gamma Stereotactic Radiosurgery Dosimetry and Quality Assurance - Steven Goetsch Purpose: AAPM Task Group 178 Gamma Stereotactic Radiosurgery Dosimetry and Quality Assurance was formed in August, 2008. The Task Group has 12 medical physicists, two physicians and two consultants. Methods: A round robin dosimetry intercomparison of proposed ionization chambers, electrometer and dosimetry phantoms was conducted over a 15 month period in 2011 and 2012 (Med Phys 42, 11, Nov, 2015). The data obtained at 9 institutions (with ten different Elekta Gamma Knife units) was analyzed by the lead author using several protocols. Results: The most consistent results were obtained using the Elekta ABS 16cm diameter phantom, with the TG-51 protocol modified as recommended by Alfonso et al (Med Phys 35, 11, Nov 2008). A key white paper (Med Phys, in press) sponsored by Elekta Corporation, was used to obtain correction factors for the ionization chambers and phantoms used in this intercomparison. Consistent results were obtained for both Elekta Gamma Knife Model 4C and Gamma Knife Perfexion units as measured with each of two miniature ionization chambers. Conclusion: The full report gives clinical history and background of gamma stereotactic radiosurgery, clinical examples and history, quality assurance recommendations and outline

  10. A new method for dosimetry with films radiochromic

    International Nuclear Information System (INIS)

    Mendez Carot, I.

    2013-01-01

    in this paper a new method is presented and the results of the comparison between the calibration is summarized based on a planning reference and calibration obtained from the irradiated fragments measure different dose levels multichannel compare dosimetry based on the weighted average dosimetry described by Micke et al.(present in the FilmQAPro software) and, finally, show different results obtained with the method proposed in several applications clinics. (Author)

  11. Participation of nurses in the execution of clinical research protocol about technological innovation

    Directory of Open Access Journals (Sweden)

    Luciane Patrícia Andreani Cabral

    2015-10-01

    Full Text Available AbstractOBJECTIVETo report the nurse's experience of inclusion in interdisciplinary clinical study about technological innovation, involving people with spinal cord injury.METHODDescriptive experience report. The empirical support was based on notes about perspectives and practice of clinical research, with a multi-professional nursing, physical education, physiotherapy and engineering staff.RESULTThe qualification includes the elaboration of the document for the Ethics Committee, familiarization among the members of staff and with the studied topic, and also an immersion into English. The nurse's knowledge gave support to the uptake of participants and time adequacy for data collection, preparation and assistance of the participants during the intervention and after collection. Nursing theories and processes have contributed to reveal risky diagnoses and the plan of care. It was the nurse's role to monitor the risk of overlapping methodological strictness to the human aspect. The skills for the clinical research must be the object of learning, including students in multidisciplinary researches.CONCLUSIONTo qualify the nurse for clinical research and to potentialize its caregiver essence, some changes are needed in the educational system, professional behavior, attitude and educational assistance.

  12. Interest of numerical dosimetry in radiation protection: mean of substitution or measurements consolidation?; Interet de la dosimetrie numerique en radioprotection: moyen de substitution ou de consolidation des mesures?

    Energy Technology Data Exchange (ETDEWEB)

    Lahaye, T.; Chau, Q. [Institut de Radioprotection et de Surete Nucleaire (IRSN/DPHD/SDOS), Service Dosimetrie, 92 - Fontenay-aux-Roses (France); Ferragut, A.; Gillot, J.Y. [SAPHYMO, 91 - Massy (France)

    2003-07-01

    The use of calculation codes allows to reduce the costs and the time limits. These codes brings to operators elements to reinforce their projected dosimetry. In the cases of accidental overexposure, the numerical dosimetry comes in complement of clinical and biological investigations to give an estimation as precise as possible of the received dose. For particular situations where it does not exist an adapted instrumentation, the numerical dosimetry can substitute to conventional techniques used by regulatory dosimetry (project for aviation personnel). (N.C.)

  13. Exploring a New Simulation Approach to Improve Clinical Reasoning Teaching and Assessment: Randomized Trial Protocol.

    Science.gov (United States)

    Pennaforte, Thomas; Moussa, Ahmed; Loye, Nathalie; Charlin, Bernard; Audétat, Marie-Claude

    2016-02-17

    Helping trainees develop appropriate clinical reasoning abilities is a challenging goal in an environment where clinical situations are marked by high levels of complexity and unpredictability. The benefit of simulation-based education to assess clinical reasoning skills has rarely been reported. More specifically, it is unclear if clinical reasoning is better acquired if the instructor's input occurs entirely after or is integrated during the scenario. Based on educational principles of the dual-process theory of clinical reasoning, a new simulation approach called simulation with iterative discussions (SID) is introduced. The instructor interrupts the flow of the scenario at three key moments of the reasoning process (data gathering, integration, and confirmation). After each stop, the scenario is continued where it was interrupted. Finally, a brief general debriefing ends the session. System-1 process of clinical reasoning is assessed by verbalization during management of the case, and System-2 during the iterative discussions without providing feedback. The aim of this study is to evaluate the effectiveness of Simulation with Iterative Discussions versus the classical approach of simulation in developing reasoning skills of General Pediatrics and Neonatal-Perinatal Medicine residents. This will be a prospective exploratory, randomized study conducted at Sainte-Justine hospital in Montreal, Qc, between January and March 2016. All post-graduate year (PGY) 1 to 6 residents will be invited to complete one SID or classical simulation 30 minutes audio video-recorded complex high-fidelity simulations covering a similar neonatology topic. Pre- and post-simulation questionnaires will be completed and a semistructured interview will be conducted after each simulation. Data analyses will use SPSS and NVivo softwares. This study is in its preliminary stages and the results are expected to be made available by April, 2016. This will be the first study to explore a new

  14. A randomized controlled clinical trial evaluating quality of life when using a simple acupressure protocol in women with primary dysmenorrhea.

    Science.gov (United States)

    Bazarganipour, Fatemeh; Taghavi, Seyed-Abdolvahab; Allan, Helen; Hosseini, Nazafarin; Khosravi, Ahmad; Asadi, Rahimeh; Salari, Shohreh; Dehghani, Raziyeh; Jamshidi, Zahra; Rezaei, Marziyeh; Saberian, Mansoreh; Javedan, Fatemeh; Salari, Zahra; Miri, Fahimeh

    2017-10-01

    To evaluate a simple acupressure protocol in LIV3 and LI4 acupoints in women with primary dysmenorrhea. This paper reports a randomized, single blinded clinical trial. 90 young women with dysmenorrhea were recruited to three groups to receive 20min acupressure every day in either LIV3 or LI4, or placebo points. Acupressure was timed five days before menstruation for three successive menstrual cycles. On menstruation, each participant completed the Wong Baker faces pain scale, and the quality of life short form -12 (QOL SF-12). Intensity and duration of pain between the three groups in the second and third cycles during the intervention (pdysmenorrhea, and improve the QOL. Registration ID in IRCT: IRCT2016052428038N1. Copyright © 2017. Published by Elsevier Ltd.

  15. The utilization of Clinical Protocols and Therapeutic Guidelines and the rationalization of judicialization for the right to health

    Directory of Open Access Journals (Sweden)

    Clarice Seixas Duarte

    2017-08-01

    Full Text Available The article analyzes the adoption of the Clinical Protocols and Therapeutic Guidelines (CPTGs as an objective measure to be used by the courts in cases where the purpose is to offer positive benefits in terms of realization of the right to health. Such a benchmark can assist the judge in the task of deciding the legal situation of medication supplies, guaranteeing the prevalence of rationality as outlined in the formulation of related public policies and, consequently, the use of technical-political arguments in the distribution of healthcare goods and resources. However, this is not an absolute parameter, and the content of the CPTGs may be questioned, even judicially. With this, judicial action is used as an instrument of democratization and social control among public choices, which can impact health policy itself.

  16. Determining the Optimal Protocol for Measuring an Albuminuria Class Transition in Clinical Trials in Diabetic Kidney Disease

    DEFF Research Database (Denmark)

    Kröpelin, Tobias F; de Zeeuw, Dick; Remuzzi, Giuseppe

    2016-01-01

    Albuminuria class transition (normo- to micro- to macroalbuminuria) is used as an intermediate end point to assess renoprotective drug efficacy. However, definitions of such class transition vary between trials. To determine the most optimal protocol, we evaluated the approaches used in four...... effect increased (decreased precision) with stricter end point definitions, resulting in a loss of statistical significance. In conclusion, the optimal albuminuria transition end point for use in drug intervention trials can be determined with a single urine collection for albuminuria assessment per...... clinical trials testing the effect of renin-angiotensin-aldosterone system intervention on albuminuria class transition in patients with diabetes: the BENEDICT, the DIRECT, the ALTITUDE, and the IRMA-2 Trial. The definition of albuminuria class transition used in each trial differed from the definitions...

  17. Personnel photographic film dosimetry

    International Nuclear Information System (INIS)

    Keirim-Markus, I.B.

    1981-01-01

    Technology of personnel photographic film dosimetry (PPD) based on the photographic effect of ionizing radiation is described briefly. Kinds of roentgen films used in PPD method are enumerated, compositions of a developer and fixing agents for these films are given [ru

  18. Dosimetry and Calibration Section

    International Nuclear Information System (INIS)

    Otto, T.

    1998-01-01

    The two tasks of the Dosimetry and Calibration Section at CERN are the Individual Dosimetry Service which assures the personal monitoring of about 5000 persons potentially exposed to ionizing radiation at CERN, and the Calibration Laboratory which verifies all the instruments and monitors. This equipment is used by the sections of the RP Group for assuring radiation protection around CERN's accelerators, and by the Environmental Section of TISTE. In addition, nearly 250 electronic and 300 quartz fibre dosimeters, employed in operational dosimetry, are calibrated at least once a year. The Individual Dosimetry Service uses an extended database (INDOS) which contains information about all the individual doses ever received at CERN. For most of 1997 it was operated without the support of a database administrator as the technician who had assured this work retired. The Software Support Section of TIS-TE took over the technical responsibility of the database, but in view of the many other tasks of this Section and the lack of personnel, only a few interventions for solving immediate problems were possible

  19. High frequency electromagnetic dosimetry

    CERN Document Server

    Sánchez-Hernández, David A

    2009-01-01

    Along with the growth of RF and microwave technology applications, there is a mounting concern about the possible adverse effects over human health from electromagnetic radiation. Addressing this issue and putting it into perspective, this groundbreaking resource provides critical details on the latest advances in high frequency electromagnetic dosimetry.

  20. Group: radiation dosimetry

    International Nuclear Information System (INIS)

    Caldas, L.V.E.

    1990-01-01

    The main activities of the radiation dosimetry group is described, including the calibration of instruments, sources and radioactive solutions and the determination of neutron flux; development, production and market dosimetric materials; development radiation sensor make the control of radiation dose received by IPEN workers; development new techniques for monitoring, etc. (C.G.C.)

  1. Glucinium dosimetry in beryl

    International Nuclear Information System (INIS)

    Kremer, M.

    1949-05-01

    The application of the method developed by Kolthoff and Sandell (1928) for the dosimetry of glucinium (beryllium) in beryl gives non-reproducible results with up to 20% discrepancies. This method recommends to separate beryllium and aluminium using 8 hydroxyquinoline and then to directly precipitate glucinium in the filtrate using ammonia. One possible reason of the problems generated by this method should be the formation of a volatile complex between beryllium and the oxine. This work shows that when the oxine is eliminated before the precipitation with ammonia the dosimetry of beryllium becomes accurate. The destruction of the oxine requires the dry evaporation of the filtrate, which is a long process. Thus the search for a reagent allowing the quantitative precipitation of beryllium in its solutions and in presence of oxine has been made. It has been verified also that the quantitative precipitation of the double beryllium and ammonium phosphate is not disturbed by the oxine in acetic buffer. This method, which gives good results, has also the advantage to separate beryllium from the alkaline-earth compounds still present in the filtrate. The report details the operation mode of the method: beryllium dosimetry using ammonium phosphate, aluminium-beryllium separation, application to beryl dosimetry (ore processing, insolubilization of silica, precipitation with ammonia, precipitation with oxine, precipitation of PO 4 NH 4 Gl, preciseness). (J.S.)

  2. Instrumentation in thermoluminescence dosimetry

    International Nuclear Information System (INIS)

    Julius, H.W.

    1986-01-01

    In the performance of a thermoluminescence dosimetry (TLD) system the equipment plays an important role. Crucial parameters of instrumentation in TLD are discussed in some detail. A review is given of equipment available on the market today - with some emphasis on automation - which is partly based on information from industry and others involved in research and development. (author)

  3. Solid state radiation dosimetry

    International Nuclear Information System (INIS)

    Moran, P.R.

    1976-01-01

    Important recent developments provide accurate, sensitive, and reliable radiation measurements by using solid state radiation dosimetry methods. A review of the basic phenomena, devices, practical limitations, and categories of solid state methods is presented. The primary focus is upon the general physics underlying radiation measurements with solid state devices

  4. Dosimetry and shielding

    International Nuclear Information System (INIS)

    Farinelli, U.

    1977-01-01

    Today, reactor dosimetry and shielding have wide areas of overlap as concerns both problems and methods. Increased interchange of results and know-how would benefit both. The areas of common interest include calculational methods, sensitivity studies, theoretical and experimental benchmarks, cross sections and other nuclear data, multigroup libraries and procedures for their adjustment, experimental techniques and damage functions. This paper reviews the state-of-the-art and the latest development in each of these areas as far as shielding is concerned, and suggests a number of interactions that could be profitable for reactor dosimetry. Among them, re-evaluation of the potentialities of calculational methods (in view of the recent developments) in predicting radiation environments of interest; the application of sensitivity analysis to dosimetry problems; a common effort in the field of theoretical benchmarks; the use of the shielding one-material propagation experiments as reference spectra for detector cross sections; common standardization of the detector nuclear data used in both fields; the setting up of a common (or compatible) multigroup structure and library applicable to shielding, dosimetry and core physics; the exchange of information and experience in the fields of cross section errors, correlations and adjustment; and the intercomparison of experimental techniques

  5. Thinking in clinical nursing practice: a study of critical care nurses' thinking applying the think-aloud, protocol analysis method.

    Science.gov (United States)

    Han, Kyung-Ja; Kim, Hesook Suzie; Kim, Mae-Ja; Hong, Kyung-Ja; Park, Sungae; Yun, Soon-Nyoung; Song, Misoon; Jung, Yoenyi; Kim, Haewon; Kim, Dong-Oak Debbie; Choi, Heejung; Kim, Kyungae

    2007-06-01

    The purpose of the paper is to discover the patterns and processes of decision-making in clinical nursing practice. A set of think-aloud data from five critical care nurses during 40 to 50 minutes of caregiving in intensive care units were obtained and analyzed by applying the procedures recommended by Ericsson and Simon for protocol analysis. Four thinking processes before acting were identified to constitute various sorts of thoughts in which the nurses were engaged during patient care: reviewing, validation, consideration, rationalization, and action. In addition, three patterns of sequential streaming of thinking (short, intermediate, long) were identified to reveal various ways the nurses dealt with clinical situations involving nursing tasks and responsibilities. This study specifies the initial categories of thoughts for each of the processes and various patterns with which these processes are sequentially combined, providing insights into the ways nurses think about problems and address their concerns. The findings suggest that the thinking in clinical practice involves more than focused decision-making and reasoning, and needs to be examined from a broader perspective.

  6. The United Kingdom's radiotherapy dosimetry audit network

    International Nuclear Information System (INIS)

    Thwaites, D.I.; Allahverdi, M.; Powley, S.K.; Nisbet, A.

    2003-01-01

    The first comprehensive national dosimetry intercomparison in the United Kingdom involving all UK radiotherapy centres was carried out in the late 1980s. Out of this a regular radiotherapy dosimetry audit network evolved in the early 1990s. The network is co-ordinated by the Institute of Physics and Engineering in Medicine and comprises eight co-operative regional groups. Audits are based on site visits using ionization chambers and epoxy resin water substitute phantoms. The basic audit methodology and phantom design follows that of the original national intercomparison exercise. However, most of the groups have evolved more complex methods, to extend the audit scope to include other parameters, other parts of the radiotherapy process and other treatment modalities. A number of the groups have developed phantoms to simulate various clinical treatment situations, enabling the sharing of phantoms and expertise between groups, but retaining a common base. Besides megavoltage external beam photon dosimetry, a number of the groups have also included the audit of kilovoltage X ray beams, electron beams and brachytherapy dosimetry. The National Physical Laboratory is involved in the network and carries out basic beam calibration audits to link the groups. The network is described and the methods and results are illustrated using the Scottish+ group as an example. (author)

  7. Yoga for Health Care in Korea: A Protocol for Systematic Review of Clinical Trials

    Directory of Open Access Journals (Sweden)

    Jiae Choi

    2016-08-01

    Sixteen electronic databases will be searched from the inception of the study until January 2016. All clinical evidences that evaluate any type of yoga and any type of control in individuals with any type of condition will be eligible. The methodological quality will be assessed using the Cochrane risk of bias tool for randomized clinical trials and the Newcastle–Ottawa scale for nonrandomized studies. Two authors will independently assess each study for eligibility and the risk of bias, and then they will extract the data. With its extensive, unbiased search of the Korean literature from various databases without any language restrictions, this systematic review will be useful for both practitioners in the field of yoga research as well as for patients.

  8. Clinical grade purification and expansion of NK cell products for an optimized manufacturing protocol

    Directory of Open Access Journals (Sweden)

    Ulrike eKoehl

    2013-05-01

    Full Text Available Allogeneic Natural Killer (NK cells are used for adoptive immunotherapy after stem cell transplantation. In order to overcome technical limitations in NK cell purification and activation, the following study investigates the impact of different variables on NK cell recovery, cytotoxicity and T cell depletion during GMP-grade NK cell selection. 40 NK cell products were derived from 54 unstimulated donor leukaphereses using immunomagnetic CD3 T-cell depletion, followed by a CD56 cell enrichment step. For T cell depletion, either the depletion 2.1 program in single or double procedure (D2.1 1depl, n=18; D2.1 2depl, n=13 or the faster depletion 3.1 (D3.1, n=9 was used on the CliniMACS instrument. 17 purified NK cell products were activated in vitro by IL-2 for 12 days. The whole process resulted in a median number of 7.59x10e8 CD56+CD3- cells with both purity and viability of 94%, respectively. The T-cell depletion was significantly better using D2.1 1depl/2depl compared to D3.1 (log 4.6/log 4.9 vs. log 3.7; p<0.01 and double procedure in two stages led always to residual T cells below 0.1%. In contrast D3.1 was superior to D2.1 1depl/2depl with regard to recovery of CD56+CD3- NK cells (68% vs 41%/38%. Concomitant monocytes and especially IL-2 activation led to increased NK cell activity against malignant target cells compared to unstimulated NK cells, which correlated with both up-regulation of natural cytotoxicity receptors and intracellular signaling. Overall, wide variations in the NK cell expansion rate and the distribution of NK cell subpopulations were found. In conclusion, our results indicate that GMP-grade purification of NK cells might be improved by a sequential processing of T cell depletion program D2.1 and D3.1. In addition NK cell expansion protocols need to be further optimized.

  9. Dosimetry for synchrotron stereotactic radiotherapy: Monte Carlo simulations and radiosensitive gels; Dosimetrie pour la radiotherapie stereotaxique en rayonnement synchrotron: calculs Monte-Carlo et gels radiosensibles

    Energy Technology Data Exchange (ETDEWEB)

    Boudou, C

    2006-09-15

    High grade gliomas are extremely aggressive brain tumours. Specific techniques combining the presence of high atomic number elements within the tumour to an irradiation with a low x-rays (below 100 keV) beam from a synchrotron source were proposed. For the sake of clinical trials, the use of treatment planning system has to be foreseen as well as tailored dosimetry protocols. Objectives of this thesis work were (1) the development of a dose calculation tools based on Monte Carlo code for particles transport and (2) the implementation of an experimental method for the three dimensional verification of the dose delivered. The dosimetric tool is an interface between tomography images from patient or sample and the M.C.N.P.X. general purpose code. Besides, dose distributions were measured through a radiosensitive polymer gel, providing acceptable results compared to calculations.

  10. Impact of missing attenuation and scatter corrections on 99m Tc-MAA SPECT 3D dosimetry for liver radioembolization using the patient relative calibration methodology: A retrospective investigation on clinical images.

    Science.gov (United States)

    Botta, Francesca; Ferrari, Mahila; Chiesa, Carlo; Vitali, Sara; Guerriero, Francesco; Nile, Maria Chiara De; Mira, Marta; Lorenzon, Leda; Pacilio, Massimiliano; Cremonesi, Marta

    2018-04-01

    To investigate the clinical implication of performing pre-treatment dosimetry for 90 Y-microspheres liver radioembolization on 99m Tc-MAA SPECT images reconstructed without attenuation or scatter correction and quantified with the patient relative calibration methodology. Twenty-five patients treated with SIR-Spheres ® at Istituto Europeo di Oncologia and 31 patients treated with TheraSphere ® at Istituto Nazionale Tumori were considered. For each acquired 99m Tc-MAA SPECT, four reconstructions were performed: with attenuation and scatter correction (AC_SC), only attenuation (AC_NoSC), only scatter (NoAC_SC) and without corrections (NoAC_NoSC). Absorbed dose maps were calculated from the activity maps, quantified applying the patient relative calibration to the SPECT images. Whole Liver (WL) and Tumor (T) regions were drawn on CT images. Injected Liver (IL) region was defined including the voxels receiving absorbed dose >3.8 Gy/GBq. Whole Healthy Liver (WHL) and Healthy Injected Liver (HIL) regions were obtained as WHL = WL - T and HIL = IL - T. Average absorbed dose to WHL and HIL were calculated, and the injection activity was derived following each Institute's procedure. The values obtained from AC_NoSC, NoAC_SC and NoAC_NoSC images were compared to the reference value suggested by AC_SC images using Bland-Altman analysis and Wilcoxon paired test (5% significance threshold). Absorbed-dose maps were compared to the reference map (AC_SC) in global terms using the Voxel Normalized Mean Square Error (%VNMSE), and at voxel level by calculating for each voxel the normalized difference with the reference value. The uncertainty affecting absorbed dose at voxel level was accounted for in the comparison; to this purpose, the voxel counts fluctuation due to Poisson and reconstruction noise was estimated from SPECT images of a water phantom acquired and reconstructed as patient images. NoAC_SC images lead to activity prescriptions not significantly different from the

  11. EXACKTE2: Exploiting the clinical consultation as a knowledge transfer and exchange environment: a study protocol

    Directory of Open Access Journals (Sweden)

    Ouimet Mathieu

    2009-03-01

    Full Text Available Abstract Background While the evidence suggests that the way physicians provide information to patients is crucial in helping patients decide upon a course of action, the field of knowledge translation and exchange (KTE is silent about how the physician and the patient influence each other during clinical interactions and decision-making. Consequently, based on a novel relationship-centered model, EXACKTE2 (EXploiting the clinicAl Consultation as a Knowledge Transfer and Exchange Environment, this study proposes to assess how patients and physicians influence each other in consultations. Methods We will employ a cross-sectional study design involving 300 pairs of patients and family physicians from two primary care practice-based research networks. The consultation between patient and physician will be audio-taped and transcribed. Following the consultation, patients and physicians will complete a set of questionnaires based on the EXACKTE2 model. All questionnaires will be similar for patients and physicians. These questionnaires will assess the key concepts of our proposed model based on the essential elements of shared decision-making (SDM: definition and explanation of problem; presentation of options; discussion of pros and cons; clarification of patient values and preferences; discussion of patient ability and self-efficacy; presentation of doctor knowledge and recommendation; and checking and clarifying understanding. Patients will be contacted by phone two weeks later and asked to complete questionnaires on decisional regret and quality of life. The analysis will be conducted to compare the key concepts in the EXACKTE2 model between patients and physicians. It will also allow the assessment of how patients and physicians influence each other in consultations. Discussion Our proposed model, EXACKTE2, is aimed at advancing the science of KTE based on a relationship process when decision-making has to take place. It fosters a new KTE

  12. Alzheimer’s disease multiple intervention trial (ADMIT: study protocol for a randomized controlled clinical trial

    Directory of Open Access Journals (Sweden)

    Callahan Christopher M

    2012-06-01

    Full Text Available Abstract Background Given the current lack of disease-modifying therapies, it is important to explore new models of longitudinal care for older adults with dementia that focus on improving quality of life and delaying functional decline. In a previous clinical trial, we demonstrated that collaborative care for Alzheimer’s disease reduces patients’ neuropsychiatric symptoms as well as caregiver stress. However, these improvements in quality of life were not associated with delays in subjects’ functional decline. Trial design Parallel randomized controlled clinical trial with 1:1 allocation. Participants A total of 180 community-dwelling patients aged ≥45 years who are diagnosed with possible or probable Alzheimer’s disease; subjects must also have a caregiver willing to participate in the study and be willing to accept home visits. Subjects and their caregivers are enrolled from the primary care and geriatric medicine practices of an urban public health system serving Indianapolis, Indiana, USA. Interventions All patients receive best practices primary care including collaborative care by a dementia care manager over two years; this best practices primary care program represents the local adaptation and implementation of our prior collaborative care intervention in the urban public health system. Intervention patients also receive in-home occupational therapy delivered in twenty-four sessions over two years in addition to best practices primary care. The focus of the occupational therapy intervention is delaying functional decline and helping both subjects and caregivers adapt to functional impairments. The in-home sessions are tailored to the specific needs and goals of each patient-caregiver dyad; these needs are expected to change over the course of the study. Objective To determine whether best practices primary care plus home-based occupational therapy delays functional decline among patients with Alzheimer’s disease compared

  13. Textbook of dosimetry. 4. ed.

    International Nuclear Information System (INIS)

    Ivanov, V.I.

    1999-01-01

    This textbook of dosimetry is devoted to the students in physics and technical physics of high education institutions, confronted with different application of atomic energy as well as with protection of population and environment against ionizing radiations. Atomic energy is highly beneficial for man but unfortunately incorporates potential dangers which manifest in accidents, the source of which is either insufficient training of the personnel, a criminal negligence or insufficient reliability of the nuclear facilities. The majority of the incident and accident events have had as origin the personnel errors. This was the case with both the 'Three Miles Island' (1979) and Chernobyl (1986) NPP accidents. The dosimetry science acquires a vital significance in accident situations since the data obtained by its procedures are essential in choosing the correct immediate actions, behaviour tactics, orientation of liquidation of accident consequences as well as in ensuring the health of population. An important accent is placed in this manual on clarification of the nature of physical processes taken place in dosimetric detectors, in establishing the relation between radiation field characteristics and the detector response as well as in defining different dosimetric quantities. The terminology and the units of physical quantities is based on the international system of units. The book contains the following 15 chapters: 1. Ionizing radiation field; 2. Radiation doses; 3. Physical bases of gamma radiation dosimetry; 4. Ionization dosimetric detectors; 5. Semiconductor dosimetric detectors; 6. Scintillation detection in the gamma radiation dosimetry; 7. Luminescent methods in dosimetry; 8. The photographic and chemical methods of gamma radiation dosimetry; 9. Neutron dosimetry; 10. Dosimetry of high intensity radiation; 11. Dosimetry of high energy Bremsstrahlung; 12. Measurement of the linear energy transfer; 13. Microdosimetry; 14. Dosimetry of incorporated

  14. Absolute and relative dosimetry for ELIMED

    Energy Technology Data Exchange (ETDEWEB)

    Cirrone, G. A. P.; Schillaci, F.; Scuderi, V. [INFN, Laboratori Nazionali del Sud, Via Santa Sofia 62, Catania, Italy and Institute of Physics Czech Academy of Science, ELI-Beamlines project, Na Slovance 2, Prague (Czech Republic); Cuttone, G.; Candiano, G.; Musumarra, A.; Pisciotta, P.; Romano, F. [INFN, Laboratori Nazionali del Sud, Via Santa Sofia 62, Catania (Italy); Carpinelli, M. [INFN Sezione di Cagliari, c/o Dipartimento di Fisica, Università di Cagliari, Cagliari (Italy); Leonora, E.; Randazzo, N. [INFN-Sezione di Catania, Via Santa Sofia 64, Catania (Italy); Presti, D. Lo [INFN-Sezione di Catania, Via Santa Sofia 64, Catania, Italy and Università di Catania, Dipartimento di Fisica e Astronomia, Via S. Sofia 64, Catania (Italy); Raffaele, L. [INFN, Laboratori Nazionali del Sud, Via Santa Sofia 62, Catania, Italy and INFN-Sezione di Catania, Via Santa Sofia 64, Catania (Italy); Tramontana, A. [INFN, Laboratori Nazionali del Sud, Via Santa Sofia 62, Catania, Italy and Università di Catania, Dipartimento di Fisica e Astronomia, Via S. Sofia 64, Catania (Italy); Cirio, R.; Sacchi, R.; Monaco, V. [INFN, Sezione di Torino, Via P.Giuria, 1 10125 Torino, Italy and Università di Torino, Dipartimento di Fisica, Via P.Giuria, 1 10125 Torino (Italy); Marchetto, F.; Giordanengo, S. [INFN, Sezione di Torino, Via P.Giuria, 1 10125 Torino (Italy)

    2013-07-26

    The definition of detectors, methods and procedures for the absolute and relative dosimetry of laser-driven proton beams is a crucial step toward the clinical use of this new kind of beams. Hence, one of the ELIMED task, will be the definition of procedures aiming to obtain an absolute dose measure at the end of the transport beamline with an accuracy as close as possible to the one required for clinical applications (i.e. of the order of 5% or less). Relative dosimetry procedures must be established, as well: they are necessary in order to determine and verify the beam dose distributions and to monitor the beam fluence and the energetic spectra during irradiations. Radiochromic films, CR39, Faraday Cup, Secondary Emission Monitor (SEM) and transmission ionization chamber will be considered, designed and studied in order to perform a fully dosimetric characterization of the ELIMED proton beam.

  15. Organisation and management of the first clinical trial of BNCT in Europe (EORTC Protocol 11961)

    International Nuclear Information System (INIS)

    Sauerwein, W.; Rassow, J.; Hideghety, K.; Sack, H.; Moss, R.; Stecher-Rasmussen, F.; Wolbers, J.G.

    1999-01-01

    Boron Neutron Capture Therapy is based on the ability of the isotope 10 B to capture thermal neutrons and to disintegrate instantaneously producing high LET particles. The only neutron beam available in Europe for such a treatment is based at the European High Flux Reactor HFR at Petten (The Netherlands). The European Commission, owners of the reactor, decided that the potential benefit of the facility should be opened to all European citizens and therefore insisted on a multinational approach to perform the first clinical trial in Europe on BNCT. This precondition had to be respected as well as the national laws and regulations. Together with the Dutch authorities actions were undertaken to overcome the obvious legal problems. Furthermore, the clinical trial at Petten takes place in a nuclear research reactor, which apart from being conducted in a non-hospital environment, is per se known to be dangerous. It was therefore of the utmost importance that special attention is given to safety, beyond normal rules, and to the training of staff. In itself, the trial is an unusual Phase I study, introducing a new drug with a new irradiation modality, with really an unknown dose-effect relationship. This trial must follow optimal procedures, which underscore the quality and qualified manner of performance. (orig.)

  16. Dosimetry practices at the Radiation Technology Centre (Ghana)

    International Nuclear Information System (INIS)

    Emi-Reynolds, G.; Banini, G.K.; Ennison, I.

    1997-01-01

    Dosimetry practices undertaken to support research and pilot scale gamma irradiation activities at the Radiation Technology Centre of the Ghana Atomic Energy Commission are presented. The Fricke dosemeter was used for calibrating the gamma field of the gammacell-220. The Fricke system and the gammacell-220 were then used to calibrate the ethanol chlorobenzene (ECB) dosemeter. The Fricke and ECB dosemeter systems have become routine dosemeters at the centre. Dosimetry work has covered a wide range of research specimens and pilot scale products to establish the relevant irradiation protocol and parameters for routine treatment. These include yams, pineapple explants, blood for feeding tsetseflies, cocoa bud wood and cassava sticks. Pilot scale dosimetry studies on maize, medical devices like intravenous infusion sets and surgical gauze have also been completed. The results and observations made on some of these products are reported. (author). 4 refs., 5 figs

  17. The physics of small megavoltage photon beam dosimetry.

    Science.gov (United States)

    Andreo, Pedro

    2018-02-01

    The increased interest during recent years in the use of small megavoltage photon beams in advanced radiotherapy techniques has led to the development of dosimetry recommendations by different national and international organizations. Their requirement of data suitable for the different clinical options available, regarding treatment units and dosimetry equipment, has generated a considerable amount of research by the scientific community during the last decade. The multiple publications in the field have led not only to the availability of new invaluable data, but have also contributed substantially to an improved understanding of the physics of their dosimetry. This work provides an overview of the most important aspects that govern the physics of small megavoltage photon beam dosimetry. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. Protocol for a randomised controlled trial for Reducing Arthritis Fatigue by clinical Teams (RAFT) using cognitive-behavioural approaches.

    Science.gov (United States)

    Hewlett, S; Ambler, N; Almeida, C; Blair, P S; Choy, E; Dures, E; Hammond, A; Hollingworth, W; Kirwan, J; Plummer, Z; Rooke, C; Thorn, J; Tomkinson, K; Pollock, J

    2015-08-06

    will be submitted to the National Institute for Health and Care Excellence, Clinical Commissioning Groups and all UK rheumatology departments. 52709998; Protocol v3 09.02.2015. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  19. Background dose subtraction in personnel dosimetry

    International Nuclear Information System (INIS)

    Picazo, T.; Llorca, N.; Alabau, J.

    1997-01-01

    In this paper it is proposed to consider the mode of the frequency distribution of the low dose dosemeters from each clinic that uses X rays as the background environmental dose that should be subtracted from the personnel dosimetry to evaluate the doses due to practice. The problems and advantages of this indirect method to estimate the environmental background dose are discussed. The results for 60 towns are presented. (author)

  20. International Study to Predict Optimized Treatment for Depression (iSPOT-D, a randomized clinical trial: rationale and protocol

    Directory of Open Access Journals (Sweden)

    Cooper Nicholas J

    2011-01-01

    Full Text Available Abstract Background Clinically useful treatment moderators of Major Depressive Disorder (MDD have not yet been identified, though some baseline predictors of treatment outcome have been proposed. The aim of iSPOT-D is to identify pretreatment measures that predict or moderate MDD treatment response or remission to escitalopram, sertraline or venlafaxine; and develop a model that incorporates multiple predictors and moderators. Methods/Design The International Study to Predict Optimized Treatment - in Depression (iSPOT-D is a multi-centre, international, randomized, prospective, open-label trial. It is enrolling 2016 MDD outpatients (ages 18-65 from primary or specialty care practices (672 per treatment arm; 672 age-, sex- and education-matched healthy controls. Study-eligible patients are antidepressant medication (ADM naïve or willing to undergo a one-week wash-out of any non-protocol ADM, and cannot have had an ina