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Sample records for comprehensive imrt program

  1. Internal Audit of a Comprehensive IMRT Program for Prostate Cancer: A Model for Centers in Developing Countries?

    International Nuclear Information System (INIS)

    Koh, Wee Yao; Ren Wei; Mukherjee, Rahul K.; Chung, Hans T.

    2009-01-01

    Purpose: With improving regional prosperity, significant capital investments have been made to rapidly expand radiotherapy capacity across Southeast Asia. Yet little has been reported on the implementation of adequate quality assurance (QA) in patient management. The objective of this study is to perform an in-depth QA assessment of our definitive intensity-modulated radiotherapy (IMRT) program for prostate cancer since its inception. Methods and Materials: The department's prostate IMRT program was modeled after that of University of California San Francisco. A departmental protocol consisting of radiotherapy volume/dose and hormone sequencing/duration and a set of 18 dose objectives to the target and critical organs were developed, and all plans were presented at the weekly departmental QA rounds. All patients treated with definitive IMRT for nonmetastatic prostate cancer were retrospectively reviewed. Protocol adherence, dosimetry data, toxicities, and outcomes were evaluated. Results: Since 2005, 76 patients received IMRT: 54 with whole-pelvis and 22 with prostate-only treatment. Of the 1,140 recorded dosimetric end points, 39 (3.3%) did not meet the protocol criteria. At QA rounds, no plans required a revision. Only one major protocol violation was observed. Two and two cases of Grade 3-4 acute and late toxicities, respectively, were observed. Five (8.8%) patients developed proctitis, but only one required argon laser therapy. Conclusions: Our comprehensive, practice-adapted QA measures appeared to ensure that we were able to consistently generate conforming IMRT plans with acceptable toxicities. These measures can be easily integrated into other clinics contemplating on developing such a program.

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

    International Nuclear Information System (INIS)

    Quan, Enzhuo M.; Li Xiaoqiang; Li Yupeng; Wang Xiaochun; Kudchadker, Rajat J.; Johnson, Jennifer L.; Kuban, Deborah A.; Lee, Andrew K.; Zhang Xiaodong

    2012-01-01

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

  3. Implementation of an integral program of quality assurance based on EPID to the IMRT

    International Nuclear Information System (INIS)

    Yannez Ruiz-Labrandera; Emilio; Gonzalez Perez, Y.

    2015-01-01

    We bring forward with this research the implementation of a procedure related to the assurance guaranty in the control of tue quality of IMRT treatment based on the technology of electronic portal images digital (EPID). For the sake of accomplishing quality controls, based in pylic digital images, we used like main tool the System of pylic digital images IviewGT TM with his application software. For the control of positioning of the multi-plates, we implemented a program in MATLAB, which yields the errors of positioning of the plates. For the dosimetric controls, the images obtained for the fields of treatment were climbed with the software ImageJ, and compared with the treatment planning systems (TPS) model Elekta's PrecisePlan ® for it we used the software Verisoft. We managed to implement a comprehensive program of quality control for IMRT. The positioning errors of the multiplates intervening bayouth's test younger errors of positioning under a 1m threw which the requisite is for the IMRT. The rest of the geometric proofs yielded favorable results inmail with them tolerance, same as the test Picket Fence. We verified 2 cases with the technique step and shoot, for it we verified 16 field, where gamma Index varied 85,8 - 98,9. It was checked the possibility to accomplish the quality controls for IMRT using pylic digital images, in our case checked itself himself I apply the Linac Elekta specify on the Ameijeiras. (Author)

  4. Comprehensive clinical study of concurrent chemotherapy breathing IMRT middle part of locally advanced esophageal cancer

    International Nuclear Information System (INIS)

    Jung, Jae Hong; Moon, Seong Kwon; Kim, Seung Chul

    2015-01-01

    The standard treatment of locally advanced type of mid-esophageal cancer is concurrent chemoradiation therapy (CRT). We evaluated the feasibility of chemotherapy with adding docetaxel to the classical basic regimens of cisplatin plus 5-fluorouracil (5-FU) and radiotherapy up to 70.2 Gy using dose escalations for esophageal cancer. It was possible to escalate radiation treatment dose up to 70.2 Gy by the respiratory-gated intensity- modulated radiotherapy (gated-IMRT) based on the 4DCT-simulation, with improving target coverage and normal tissue (ex., lung, heart, and spinal cord) sparing. This study suggested that the definitive chemo-radiotherapy with docetaxel, cisplatin, and 5-fluorouracil (i.e., DCF-R) and gating IMRT is tolerable and active in patients with locally advanced mid-esophageal cancer (AEC)

  5. Comprehensive School Alienation Program, Guidelines.

    Science.gov (United States)

    Hawaii State Dept. of Education, Honolulu. Office of Instructional Services.

    This document presents guidelines developed by the Hawaii State Department of Education's Comprehensive School Alienation Program to consolidate and strengthen the delivery of services to alienated students. It is intended to assist district staff, school administrators, and project personnel in planning and implementing program activities and…

  6. Constraint Programming for Context Comprehension

    DEFF Research Database (Denmark)

    Christiansen, Henning

    2014-01-01

    A close similarity is demonstrated between context comprehension, such as discourse analysis, and constraint programming. The constraint store takes the role of a growing knowledge base learned throughout the discourse, and a suitable con- straint solver does the job of incorporating new pieces...

  7. A comprehensive analysis of the IMRT dose delivery process using statistical process control (SPC)

    Energy Technology Data Exchange (ETDEWEB)

    Gerard, Karine; Grandhaye, Jean-Pierre; Marchesi, Vincent; Kafrouni, Hanna; Husson, Francois; Aletti, Pierre [Research Center for Automatic Control (CRAN), Nancy University, CNRS, 54516 Vandoeuvre-les-Nancy (France); Department of Medical Physics, Alexis Vautrin Cancer Center, 54511 Vandoeuvre-les-Nancy Cedex (France) and DOSIsoft SA, 94230 Cachan (France); Research Laboratory for Innovative Processes (ERPI), Nancy University, EA 3767, 5400 Nancy Cedex (France); Department of Medical Physics, Alexis Vautrin Cancer Center, 54511 Vandoeuvre-les-Nancy Cedex (France); DOSIsoft SA, 94230 Cachan (France); Research Center for Automatic Control (CRAN), Nancy University, CNRS, 54516 Vandoeuvre-les-Nancy, France and Department of Medical Physics, Alexis Vautrin Cancer Center, 54511 Vandoeuvre-les-Nancy Cedex (France)

    2009-04-15

    The aim of this study is to introduce tools to improve the security of each IMRT patient treatment by determining action levels for the dose delivery process. To achieve this, the patient-specific quality control results performed with an ionization chamber--and which characterize the dose delivery process--have been retrospectively analyzed using a method borrowed from industry: Statistical process control (SPC). The latter consisted in fulfilling four principal well-structured steps. The authors first quantified the short term variability of ionization chamber measurements regarding the clinical tolerances used in the cancer center ({+-}4% of deviation between the calculated and measured doses) by calculating a control process capability (C{sub pc}) index. The C{sub pc} index was found superior to 4, which implies that the observed variability of the dose delivery process is not biased by the short term variability of the measurement. Then, the authors demonstrated using a normality test that the quality control results could be approximated by a normal distribution with two parameters (mean and standard deviation). Finally, the authors used two complementary tools--control charts and performance indices--to thoroughly analyze the IMRT dose delivery process. Control charts aim at monitoring the process over time using statistical control limits to distinguish random (natural) variations from significant changes in the process, whereas performance indices aim at quantifying the ability of the process to produce data that are within the clinical tolerances, at a precise moment. The authors retrospectively showed that the analysis of three selected control charts (individual value, moving-range, and EWMA control charts) allowed efficient drift detection of the dose delivery process for prostate and head-and-neck treatments before the quality controls were outside the clinical tolerances. Therefore, when analyzed in real time, during quality controls, they should

  8. A comprehensive analysis of the IMRT dose delivery process using statistical process control (SPC).

    Science.gov (United States)

    Gérard, Karine; Grandhaye, Jean-Pierre; Marchesi, Vincent; Kafrouni, Hanna; Husson, François; Aletti, Pierre

    2009-04-01

    The aim of this study is to introduce tools to improve the security of each IMRT patient treatment by determining action levels for the dose delivery process. To achieve this, the patient-specific quality control results performed with an ionization chamber--and which characterize the dose delivery process--have been retrospectively analyzed using a method borrowed from industry: Statistical process control (SPC). The latter consisted in fulfilling four principal well-structured steps. The authors first quantified the short-term variability of ionization chamber measurements regarding the clinical tolerances used in the cancer center (+/- 4% of deviation between the calculated and measured doses) by calculating a control process capability (C(pc)) index. The C(pc) index was found superior to 4, which implies that the observed variability of the dose delivery process is not biased by the short-term variability of the measurement. Then, the authors demonstrated using a normality test that the quality control results could be approximated by a normal distribution with two parameters (mean and standard deviation). Finally, the authors used two complementary tools--control charts and performance indices--to thoroughly analyze the IMRT dose delivery process. Control charts aim at monitoring the process over time using statistical control limits to distinguish random (natural) variations from significant changes in the process, whereas performance indices aim at quantifying the ability of the process to produce data that are within the clinical tolerances, at a precise moment. The authors retrospectively showed that the analysis of three selected control charts (individual value, moving-range, and EWMA control charts) allowed efficient drift detection of the dose delivery process for prostate and head-and-neck treatments before the quality controls were outside the clinical tolerances. Therefore, when analyzed in real time, during quality controls, they should improve the

  9. Development of an IMRT quality assurance program using an amorphous silicon electronic portal imaging device

    International Nuclear Information System (INIS)

    Hunt, P.; Oliver, L.; Mallik, A.

    2000-01-01

    Full text: Quality Assurance (QA) for an intensity modulated radiotherapy (IMRT) megavoltage beam is a complex task. The positional accuracy of the MLC; its radiation leakage; the overall distribution of the dose delivered as compared to the treatment plan and; the accuracy of the calculated monitor units to deliver this dose, are all important parameters to clinically monitor. We are presently assessing the Varian version 6 software package with CadPlan, Helios with IMRT and inverse planning, VARiS Vision and the linear accelerator DMLC controller. Whilst conventional QA tools such as ionisation chamber and film measurements are used, these methods are inconvenient for directly monitoring an IMRT patient treatment. Varian Medical Systems has developed an improved electronic portal imaging device (EPID) with an amorphous silicon (a-Si) detector array. The A-Si has a sensitive area of 40x30cm and an improved image resolution of 512x384 pixels. Images are recorded at approximately 7-10 frames per second for an exposure rate of 100-600 MU/minute. Although the A-Si was designed as an EPID for a static treatment field, this new device could be a valuable IMRT QA tool for a range of different tests. Measurements taken on the RNSH and Varian prototype A-Si EPI devices showed a linear dose response for 6-18MeV X-ray energy. In addition to the Varian IAS2 internal software handlers, we have developed some image data handling programs to view and analyse these images in more detail. The software is primarily used to view the images; measure the reading in a region of interest or profile; or merge, overlay, add or subtract images during the analysis. The small pixel resolution provides a reliable, highly accurate means of measuring beam size, leaf position, MLC radiation leakage or profile intensity curves with a positional accuracy of 0.8mm. The images produced by an IMRT exposure is clearly discernible and appears consistent with the result expected. Step wedge images

  10. Dosimetry tools and techniques for IMRT

    International Nuclear Information System (INIS)

    Low, Daniel A.; Moran, Jean M.; Dempsey, James F.; Dong Lei; Oldham, Mark

    2011-01-01

    Intensity modulated radiation therapy (IMRT) poses a number of challenges for properly measuring commissioning data and quality assurance (QA) radiation dose distributions. This report provides a comprehensive overview of how dosimeters, phantoms, and dose distribution analysis techniques should be used to support the commissioning and quality assurance requirements of an IMRT program. The proper applications of each dosimeter are described along with the limitations of each system. Point detectors, arrays, film, and electronic portal imagers are discussed with respect to their proper use, along with potential applications of 3D dosimetry. Regardless of the IMRT technique utilized, some situations require the use of multiple detectors for the acquisition of accurate commissioning data. The overall goal of this task group report is to provide a document that aids the physicist in the proper selection and use of the dosimetry tools available for IMRT QA and to provide a resource for physicists that describes dosimetry measurement techniques for purposes of IMRT commissioning and measurement-based characterization or verification of IMRT treatment plans. This report is not intended to provide a comprehensive review of commissioning and QA procedures for IMRT. Instead, this report focuses on the aspects of metrology, particularly the practical aspects of measurements that are unique to IMRT. The metrology of IMRT concerns the application of measurement instruments and their suitability, calibration, and quality control of measurements. Each of the dosimetry measurement tools has limitations that need to be considered when incorporating them into a commissioning process or a comprehensive QA program. For example, routine quality assurance procedures require the use of robust field dosimetry systems. These often exhibit limitations with respect to spatial resolution or energy response and need to themselves be commissioned against more established dosimeters. A chain of

  11. 75 FR 32169 - Comprehensive Centers Program

    Science.gov (United States)

    2010-06-07

    ... of proposed waivers were supportive of the Comprehensive Centers program and the proposed waivers... Department to continue promoting this shared oversight by involving OSERS leadership in deliberations about... identification of the valuable contribution of OSERS leadership in supporting the Comprehensive Centers program...

  12. Evaluating Dynamic Analysis Techniques for Program Comprehension

    NARCIS (Netherlands)

    Cornelissen, S.G.M.

    2009-01-01

    Program comprehension is an essential part of software development and software maintenance, as software must be sufficiently understood before it can be properly modified. One of the common approaches in getting to understand a program is the study of its execution, also known as dynamic analysis.

  13. Eight years of IMRT quality assurance with ionization chambers and film dosimetry: experience of the montpellier comprehensive cancer center

    Directory of Open Access Journals (Sweden)

    Dubois Jean-Bernard

    2011-07-01

    Full Text Available Abstract Background To present the results of quality assurance (QA in IMRT of film dosimetry and ionization chambers measurements with an eight year follow-up. Methods All treatment plans were validated under the linear accelerator by absolute and relative measures obtained with ionization chambers (IC and with XomatV and EDR2 films (Kodak. Results The average difference between IC measured and computed dose at isocenter with the gantry angle of 0° was 0.07 ± 1.22% (average ± 1 SD for 2316 prostate, 1.33 ± 3.22% for 808 head and neck (h&n, and 0.37 ± 0.62% for 108 measurements of prostate bed fields. Pelvic treatment showed differences of 0.49 ± 1.86% in 26 fields for prostate cases and 2.07 ± 2.83% in 109 fields of anal canal. Composite measurement at isocenter for each patient showed an average difference with computed dose of 0.05 ± 0.87% for 386 prostate, 1.49 ± 1.86% for 158 h&n, 0.37 ± 0.34% for 23 prostate bed, 0.80 ± 0.28% for 4 pelvis, and 2.31 ± 0.56% for 17 anal canal cases. On the first 250 h&n analyzed by film in absolute dose, the average of the points crossing a gamma index 3% and 3 mm was 93%. This value reached 99% for the prostate fields. Conclusion More than 3500 beams were found to be within the limits defined as validated for treatment between 2001 and 2008.

  14. 76 FR 61103 - Medicare Program; Comprehensive Primary Care Initiative

    Science.gov (United States)

    2011-10-03

    ...] Medicare Program; Comprehensive Primary Care Initiative AGENCY: Centers for Medicare & Medicaid Services... organizations to participate in the Comprehensive Primary Care initiative (CPC), a multipayer model designed to... the Comprehensive Primary Care initiative or the application process. SUPPLEMENTARY INFORMATION: I...

  15. SU-F-T-227: A Comprehensive Patient Specific, Structure Specific, Pre-Treatment 3D QA Protocol for IMRT, SBRT and VMAT - Clinical Experience

    Energy Technology Data Exchange (ETDEWEB)

    Gueorguiev, G; Cotter, C; Young, M; Toomeh, D [Massachusetts General Hospital Boston MA (United States); University of Massachusetts Lowell Lowell, MA (United States); Khan, F; Crawford, B; Turcotte, J; Sharp, G [Massachusetts General Hospital Boston MA (United States); Mah’D, M [University of Massachusetts Lowell Lowell, MA (United States)

    2016-06-15

    Purpose: To present a 3D QA method and clinical results for 550 patients. Methods: Five hundred and fifty patient treatment deliveries (400 IMRT, 75 SBRT and 75 VMAT) from various treatment sites, planned on Raystation treatment planning system (TPS), were measured on three beam-matched Elekta linear accelerators using IBA’s COMPASS system. The difference between TPS computed and delivered dose was evaluated in 3D by applying three statistical parameters to each structure of interest: absolute average dose difference (AADD, 6% allowed difference), absolute dose difference greater than 6% (ADD6, 4% structure volume allowed to fail) and 3D gamma test (3%/3mm DTA, 4% structure volume allowed to fail). If the allowed value was not met for a given structure, manual review was performed. The review consisted of overlaying dose difference or gamma results with the patient CT, scrolling through the slices. For QA to pass, areas of high dose difference or gamma must be small and not on consecutive slices. For AADD to manually pass QA, the average dose difference in cGy must be less than 50cGy. The QA protocol also includes DVH analysis based on QUANTEC and TG-101 recommended dose constraints. Results: Figures 1–3 show the results for the three parameters per treatment modality. Manual review was performed on 67 deliveries (27 IMRT, 22 SBRT and 18 VMAT), for which all passed QA. Results show that statistical parameter AADD may be overly sensitive for structures receiving low dose, especially for the SBRT deliveries (Fig.1). The TPS computed and measured DVH values were in excellent agreement and with minimum difference. Conclusion: Applying DVH analysis and different statistical parameters to any structure of interest, as part of the 3D QA protocol, provides a comprehensive treatment plan evaluation. Author G. Gueorguiev discloses receiving travel and research funding from IBA for unrelated to this project work. Author B. Crawford discloses receiving travel funding from

  16. SU-C-BRD-01: Multi-Centre Collaborative Quality Assurance Program for IMRT Planning and Delivery: Year 3 Results

    International Nuclear Information System (INIS)

    McNiven, A; Jaffray, D; Letourneau, D

    2015-01-01

    Purpose: A multi-centre quality assurance program was developed to enable quality improvement by coupling measurement of intensity modulated radiotherapy (IMRT) planning and delivery performance for site-specific planning exercises with diagnostic testing. The third year of the program specifically assessed the quality of spine stereotactic body radiotherapy (SBRT) planning and delivery amongst the participating centres. Methods: A spine SBRT planning exercise (24 Gy in 2 fractions) was created and completed by participants prior to an on-site visit. The delivery portion of the on-site visit included spine SBRT plan delivery and diagnostic testing, which included portal image acquisition for quantification of phantom positioning error and multi-leaf collimator (MLC) calibration accuracy. The measured dose was compared to that calculated in the treatment planning system (TPS) using 3%/2mm composite analysis and 3%/3mm gamma analysis. Results: Fourteen institutions participated, creating 17 spine SBRT plans (15 VMAT and 2 IMRT). Three different TPS, two beam energies (6 MV and 6 MV FFF), and four MLC designs from two linac vendors were tested. Large variation in total monitor units (MU) per plan (2494–6462 MU) and dose-volume parameters was observed. The maximum point dose in the plans ranged from 116–149% and was dependent upon the TPS used. Pass rates for measured to planned dose comparison ranged from 89.4–100% and 97.3–100% for 3%/2mm and 3%/3mm criteria respectively. The largest measured MLC error did Result in one of the poorer pass rates. No direct correlation between phantom positioning error and pass rates overall. Conclusion: Significant differences were observed in the planning exercise for some plan and dose-volume parameters based on the TPS used. Standard evaluation criteria showed good agreement between planned and measured dose for all participants, however on an individual plan basis, diagnostic tests were able to identify contributing

  17. SU-C-BRD-01: Multi-Centre Collaborative Quality Assurance Program for IMRT Planning and Delivery: Year 3 Results

    Energy Technology Data Exchange (ETDEWEB)

    McNiven, A; Jaffray, D; Letourneau, D [Princess Margaret Cancer Centre and Department of Radiation Oncology, University of Toronto, Toronto, ON (Canada)

    2015-06-15

    Purpose: A multi-centre quality assurance program was developed to enable quality improvement by coupling measurement of intensity modulated radiotherapy (IMRT) planning and delivery performance for site-specific planning exercises with diagnostic testing. The third year of the program specifically assessed the quality of spine stereotactic body radiotherapy (SBRT) planning and delivery amongst the participating centres. Methods: A spine SBRT planning exercise (24 Gy in 2 fractions) was created and completed by participants prior to an on-site visit. The delivery portion of the on-site visit included spine SBRT plan delivery and diagnostic testing, which included portal image acquisition for quantification of phantom positioning error and multi-leaf collimator (MLC) calibration accuracy. The measured dose was compared to that calculated in the treatment planning system (TPS) using 3%/2mm composite analysis and 3%/3mm gamma analysis. Results: Fourteen institutions participated, creating 17 spine SBRT plans (15 VMAT and 2 IMRT). Three different TPS, two beam energies (6 MV and 6 MV FFF), and four MLC designs from two linac vendors were tested. Large variation in total monitor units (MU) per plan (2494–6462 MU) and dose-volume parameters was observed. The maximum point dose in the plans ranged from 116–149% and was dependent upon the TPS used. Pass rates for measured to planned dose comparison ranged from 89.4–100% and 97.3–100% for 3%/2mm and 3%/3mm criteria respectively. The largest measured MLC error did Result in one of the poorer pass rates. No direct correlation between phantom positioning error and pass rates overall. Conclusion: Significant differences were observed in the planning exercise for some plan and dose-volume parameters based on the TPS used. Standard evaluation criteria showed good agreement between planned and measured dose for all participants, however on an individual plan basis, diagnostic tests were able to identify contributing

  18. Establishing a Comprehensive Wind Energy Program

    Energy Technology Data Exchange (ETDEWEB)

    Fleeter, Sanford [Purdue University

    2012-09-30

    This project was directed at establishing a comprehensive wind energy program in Indiana, including both educational and research components. A graduate/undergraduate course ME-514 - Fundamentals of Wind Energy has been established and offered and an interactive prediction of VAWT performance developed. Vertical axis wind turbines for education and research have been acquired, instrumented and installed on the roof top of a building on the Calumet campus and at West Lafayette (Kepner Lab). Computational Fluid Dynamics (CFD) calculations have been performed to simulate these urban wind environments. Also, modal dynamic testing of the West Lafayette VAWT has been performed and a novel horizontal axis design initiated. The 50-meter meteorological tower data obtained at the Purdue Beck Agricultural Research Center have been analyzed and the Purdue Reconfigurable Micro Wind Farm established and simulations directed at the investigation of wind farm configurations initiated. The virtual wind turbine and wind turbine farm simulation in the Visualization Lab has been initiated.

  19. A Comprehensive Child Development Program; Title XX, Final Report.

    Science.gov (United States)

    Whatley, Juanita T.

    This booklet describes the Comprehensive Child Day Care Program for the Atlanta Public School System, a Title XX Program. This program provided day care services for children of clients in various categories. The program goals for 1975-76 were geared toward providing comprehensive day care to encompass social services to the family and…

  20. CDC Best Practices for Comprehensive Tobacco Control Programs - 2007

    Data.gov (United States)

    U.S. Department of Health & Human Services — Centers for Disease Control and Prevention (CDC). Best Practices for Comprehensive Tobacco Control Programs. Funding. CDC's Best Practices for Comprehensive Tobacco...

  1. CDC Best Practices for Comprehensive Tobacco Control Programs - 2014

    Data.gov (United States)

    U.S. Department of Health & Human Services — Centers for Disease Control and Prevention (CDC). Best Practices for Comprehensive Tobacco Control Programs. Funding. CDC's Best Practices for Comprehensive Tobacco...

  2. A comprehensive program to minimize platelet outdating.

    Science.gov (United States)

    Fuller, Alice K; Uglik, Kristin M; Braine, Hayden G; King, Karen E

    2011-07-01

    Platelet (PLT) transfusions are essential for patients who are bleeding or have an increased risk of bleeding due to a decreased number or abnormal function of circulating PLTs. A shelf life of 5 days for PLT products presents an inventory management challenge. In 2006, greater than 10% of apheresis PLTs made in the United States outdated. It is imperative to have a sufficient number of products for patients requiring transfusion, but outdating PLTs is a financial burden and a waste of a resource. We present the approach used in our institution to anticipate inventory needs based on current patient census and usage. Strategies to predict usage and to identify changes in anticipated usage are examined. Annual outdating is reviewed for a 10-year period from 2000 through 2009. From January 1, 2000, through December 2009, there were 128,207 PLT transfusions given to 15,265 patients. The methods used to anticipate usage and adjust inventory resulted in an annual outdate rate of approximately 1% for the 10-year period reviewed. In addition we have not faced situations where inventory was inadequate to meet the needs of the patients requiring transfusions. We have identified three elements of our transfusion service that can minimize outdate: a knowledgeable proactive staff dedicated to PLT management, a comprehensive computer-based transfusion history for each patient, and a strong two-way relationship with the primary product supplier. Through our comprehensive program, based on the principles of providing optimal patient care, we have minimized PLT outdating for more than 10 years. © 2011 American Association of Blood Banks.

  3. Application programming in C# environment with recorded user software interactions and its application in autopilot of VMAT/IMRT treatment planning.

    Science.gov (United States)

    Wang, Henry; Xing, Lei

    2016-11-08

    An autopilot scheme of volumetric-modulated arc therapy (VMAT)/intensity-modulated radiation therapy (IMRT) planning with the guidance of prior knowl-edge is established with recorded interactions between a planner and a commercial treatment planning system (TPS). Microsoft (MS) Visual Studio Coded UI is applied to record some common planner-TPS interactions as subroutines. The TPS used in this study is a Windows-based Eclipse system. The interactions of our application program with Eclipse TPS are realized through a series of subrou-tines obtained by prerecording the mouse clicks or keyboard strokes of a planner in operating the TPS. A strategy to autopilot Eclipse VMAT/IMRT plan selection process is developed as a specific example of the proposed "scripting" method. The autopiloted planning is navigated by a decision function constructed with a reference plan that has the same prescription and similar anatomy with the case at hand. The calculation proceeds by alternating between the Eclipse optimization and the outer-loop optimization independent of the Eclipse. In the C# program, the dosimetric characteristics of a reference treatment plan are used to assess and modify the Eclipse planning parameters and to guide the search for a clinically sensible treatment plan. The approach is applied to plan a head and neck (HN) VMAT case and a prostate IMRT case. Our study demonstrated the feasibility of application programming method in C# environment with recorded interactions of planner-TPS. The process mimics a planner's planning process and automatically provides clinically sensible treatment plans that would otherwise require a large amount of manual trial and error of a planner. The proposed technique enables us to harness a commercial TPS by application programming via the use of recorded human computer interactions and provides an effective tool to greatly facilitate the treatment planning process. © 2016 The Authors.

  4. 42 CFR 441.106 - Comprehensive mental health program.

    Science.gov (United States)

    2010-10-01

    ... health and public welfare resources; including— (i) Community mental health centers; (ii) Nursing homes... 42 Public Health 4 2010-10-01 2010-10-01 false Comprehensive mental health program. 441.106... Comprehensive mental health program. (a) If the plan includes services in public institutions for mental...

  5. Evaluation tools of quality control for patients submitted to IMRT

    International Nuclear Information System (INIS)

    Lavor, Milton

    2011-01-01

    Intensity modulated radiation therapy (IMRT) is currently been implemented in a rapidly growing number of centers in Brazil. As consequence many institutions are now facing the problem of performing a comprehensive quality control program before and during the implementation of IMRT in the clinical routine practice. The aim of this work is to evaluate and propose a methodology for quality assurance in IMRT treatments. An ionization chamber and a two-dimensional array detector were performed to assess the absolute value of the total dose of all fields in one specific point. The relative total dose distribution of all fields was measured with a radiochromic film and a two-dimensional array at one depth in a phantom. A comparison between measured and calculated dose distributions was performed using the gamma-index method, assessing the percentage of points that meet the criteria of +-3% dose difference and +-3 mm distance to agreement. As a result of 113 tested IMRT beams using ionization chamber and 81 using two-dimensional array, the proposal was to take an action level of about +- 5% compared to the treatment planning systems and measurements, for the verification of the dose in a single point at the low gradient dose region. Analysis of the two-dimensional array measurements showed that the gamma value was <1 for 97.7% of the data and for the film the gamma value was <1 for 96.6% of the data. This can be concluded that for an accurate delivery of dose in 'sliding-window' IMRT with micro multileaf collimator, the absolute value of the total dose and the relative total dose distribution should be checked by absolute and relative dosimetry respectively. (author)

  6. Comprehensive quality management program for radiation oncology

    International Nuclear Information System (INIS)

    Dawson, J.; Roy, T.; Abrath, F.; Wu, T.; Gu, J.; McDonald, R.; Kim, H.; Haenchen, M.

    1994-01-01

    A quality management program for both external beam irradiation (electron and photon modes) and brachytherapy (high dose rate (HDR) and low dose rate (LDR) has been developed. The program follows current USA federal regulations for therapeutic administration of by-product materials. After implementation of the program, 54 HDR patients, 36 LDR brachytherapy patients and 311 external beam patients (including 30 stereotactic radiosurgery cases) were treated. The results of this program are presented

  7. Improving Reading Comprehension Skills through the SCRATCH Program

    Science.gov (United States)

    Papatga, Erdal; Ersoy, Ali

    2016-01-01

    The aim of this study was to reveal how reading comprehension skills of elementary fourth graders who have problems in reading comprehension can be improved by means of the SCRATCH program. The study was designed as a participant action research. It was carried out within a 15- week process at an elementary school with middle socio-economic level…

  8. A Comprehensive Wellness Program for International Students.

    Science.gov (United States)

    Fisher, Millard J.; Ozaki, Roger H.

    This document presents a model wellness program for international college students in the United States and strategies to aid them in staying healthy during their stay. It notes that, without parents or other support groups, international students run the risk of developing serious health problems because of inadequate diet and sleep, substandard…

  9. The NPP Isar comprehensive Aging Management Program

    International Nuclear Information System (INIS)

    Zander, Andre; Ertl, Stefan

    2012-01-01

    The majority of System, Structure and Components (SSC) in a nuclear power plants are designed to experience a service life, which is far above the intended design life. In most cases, only a small percentage of SSCs are subject to significant aging effects, which may affect the integrity or the function of the component. The process of aging management (AM) has the objective to monitor and control degradation effects which may compromise safety functions of the plant. And furthermore, to ensure, that testing and maintenance programs sufficiently provide preventive measures to control degradation effects. Safety-related aspects and the targeted high availability of the power plant as well as the requirements stipulated by German regulatory authorities prompted the operator of NPP ISAR to introduce an aging surveillance program. The NPP Isar as well as the German NPPs has to be following in the scope of aging management the KTA 1403 guideline. The NPP Isar surveillance program based on the KTA 1403 guideline covers the following aspects: - Scoping and screening of safety relevant Systems, Structures and Components (SSC); - Identification of possible degradation mechanisms for safety relevant SSC; - Ensure, that testing and maintenance programs sufficiently provide preventive measures to control degradation effects; - Transferability check of industry experience (internal and external events); - Annual preparation of an AM status report. (author)

  10. How Learning Logic Programming Affects Recursion Comprehension

    Science.gov (United States)

    Haberman, Bruria

    2004-01-01

    Recursion is a central concept in computer science, yet it is difficult for beginners to comprehend. Israeli high-school students learn recursion in the framework of a special modular program in computer science (Gal-Ezer & Harel, 1999). Some of them are introduced to the concept of recursion in two different paradigms: the procedural…

  11. Inverse planning IMRT

    International Nuclear Information System (INIS)

    Rosenwald, J.-C.

    2008-01-01

    The lecture addressed the following topics: Optimizing radiotherapy dose distribution; IMRT contributes to optimization of energy deposition; Inverse vs direct planning; Main steps of IMRT; Background of inverse planning; General principle of inverse planning; The 3 main components of IMRT inverse planning; The simplest cost function (deviation from prescribed dose); The driving variable : the beamlet intensity; Minimizing a 'cost function' (or 'objective function') - the walker (or skier) analogy; Application to IMRT optimization (the gradient method); The gradient method - discussion; The simulated annealing method; The optimization criteria - discussion; Hard and soft constraints; Dose volume constraints; Typical user interface for definition of optimization criteria; Biological constraints (Equivalent Uniform Dose); The result of the optimization process; Semi-automatic solutions for IMRT; Generalisation of the optimization problem; Driving and driven variables used in RT optimization; Towards multi-criteria optimization; and Conclusions for the optimization phase. (P.A.)

  12. Single-Arc IMRT?

    International Nuclear Information System (INIS)

    Bortfeld, Thomas; Webb, Steve

    2009-01-01

    The idea of delivering intensity-modulated radiation therapy (IMRT) with a multileaf collimator in a continuous dynamic mode during a single rotation of the gantry has recently gained momentum both in research and industry. In this note we investigate the potential of this Single-Arc IMRT technique at a conceptual level. We consider the original theoretical example case from Brahme et al that got the field of IMRT started. Using analytical methods, we derive deliverable intensity 'landscapes' for Single-Arc as well as standard IMRT and Tomotherapy. We find that Tomotherapy provides the greatest flexibility in shaping intensity landscapes and that it allows one to deliver IMRT in a way that comes close to the ideal case in the transverse plane. Single-Arc and standard IMRT make compromises in different areas. Only in relatively simple cases that do not require substantial intensity modulation will Single-Arc be dosimetrically comparable to Tomotherapy. Compared with standard IMRT, Single-Arc could be dosimetrically superior in certain cases if one is willing to accept the spreading of low dose values over large volumes of normal tissue. In terms of treatment planning, Single-Arc poses a more challenging optimization problem than Tomotherapy or standard IMRT. We conclude that Single-Arc holds potential as an efficient IMRT technique especially for relatively simple cases. In very complex cases, Single-Arc may unduly compromise the quality of the dose distribution, if one tries to keep the treatment time below 2 min or so. As with all IMRT techniques, it is important to explore the tradeoff between plan quality and the efficiency of its delivery carefully for each individual case. (note)

  13. Remodularizing Java programs for comprehension of features

    DEFF Research Database (Denmark)

    Olszak, Andrzej; Jørgensen, Bo Nørregaard

    2009-01-01

    . In absence of these mechanisms, feature implementations tend to be scattered and tangled in terms of object-oriented abstractions, making the code implementing features difficult to locate and comprehend. In this paper we present a semi-automatic method for feature-oriented remodularization of Java programs....... Our method uses execution traces to locate implementations of features, and Java packages to establish explicit feature modules. To evaluate usefulness of the approach, we present a case study where we apply our method to two real-world software systems. The obtained results indicate a significant...

  14. Evaluation of quality control tools for patients submitted to IMRT; Avaliacao das ferramentas de controle da qualidade para pacientes submetidos ao IMRT

    Energy Technology Data Exchange (ETDEWEB)

    Lavor, Milton; Rodrigues, Laura N.; Silva, Marco A., E-mail: miltonlavor@gmail.com [Universidade de Sao Paulo (HCFMRP/USP), Sao Paulo, SP (Brazil). Hospital das Clinicas. Servico de Radioterapia

    2013-04-15

    Intensity modulated radiation therapy (IMRT) is currently being implemented in a rapidly growing number of centers in Brazil. As consequence many institutions are now facing the problem of performing a comprehensive quality control program before and during the implementation of IMRT in the clinical practice. This paper proposes a methodology for quality control and presents the results and evaluations of the data obtained from the proposed methodology. Ionization chamber and two-dimensional array detector were performed in IMRT treatment planning in order to assess the absolute value of the total dose of all fields. The relative total dose distribution of all fields was measured with a radiochromic film and a two-dimensional array in a phantom. A comparison between measured and calculated dose distributions was performed using the gamma-index method, assessing the percentage of points that meet the criteria of ±3% dose difference and ±3mm distance to agreement. As a result and review of 113 tested IMRT beams using ionization chamber and 81 using two-dimensional array, the proposal was to take an action level of about ±5% compared to the treatment planning systems and measurements, for the verification of the dose in a single point at the low gradient dose region. Analysis of the two-dimensional array measurements showed that the gamma value was <1 for 97.7% of the data and for the film the gamma value was <1 for 96.6% of the data. This work can establish action levels required for quality control program proposed and implemented in the Department of Radiotherapy - Hospital das Clinicas in Sao Paulo that allows an accurate delivery of dose in 'sliding-window' IMRT with micro multi leaf collimator. (author)

  15. Improving reading comprehension skills through the SCRATCH program

    Directory of Open Access Journals (Sweden)

    Erdal Papatga

    2016-09-01

    Full Text Available The aim of this study was to reveal how reading comprehension skills of elementary fourth graders who have problems in reading comprehension can be improved by means of the SCRATCH program. The study was designed as a participant action research. It was carried out within a 15-week process at an elementary school with middle socio-economic level in the Eskisehir province in the fall term of the 2015-2016 school year. The participants of the study were eight fourth graders who had problems in reading comprehension and were selected based on the criterion sampling method. Different data gathering tools were employed in different stages of the study. These were the Informal Reading Inventory, readability assessment rubric, participant selection form and identification forms for developmental level in reading comprehension for the quantitative data, and observation notes, a researcher diary, video recordings, teacher and student observation notes, and the projects the students prepared using the SCRATCH program for the qualitative data. In the study, the analysis of the quantitative data was done with correlation analysis, and Kendall W Test that shows inter-rater reliability. In addition, the identification forms for developmental level in reading comprehension were used to reveal the improvement in reading comprehension skills, and the Informal Reading Inventory was employed to score these forms. On the other hand, the qualitative data were analysed through the thematic analysis method, and MAXQDA was used for the analysis. As a result of the analyses, it was found that the reading level of the eight students who had problems in reading comprehension went up from the anxiety level to the instructional level in some forms, and even to the independent reading level in other forms; in other words, there was an improvement in the reading comprehension skills of all eight students.

  16. Who Benefits from an Intensive Comprehensive Aphasia Program?

    Science.gov (United States)

    Babbitt, Edna M.; Worrall, Linda; Cherney, Leora R.

    2016-01-01

    Purpose: This article summarizes current outcomes from intensive comprehensive aphasia programs (ICAPs) and examines data from one ICAP to identify those who respond and do not respond to treatment. Methods: Participants were divided into 2 groups, responders and nonresponders, based on ±5-point change score on the Western Aphasia Battery-Revised…

  17. College Student Utilization of a Comprehensive Psychiatric Emergency Program

    Science.gov (United States)

    Mitchell, Sharon L.; Kader, Mahrin; Haggerty, Melinda Z.; Bakhai, Yogesh D.; Warren, Calvert G.

    2013-01-01

    The authors sought to identify college students at risk for experiencing a mental health crisis that warranted a psychiatric evaluation at a hospital and/or a psychiatric hospitalization. A retrospective chart review of college students evaluated at a comprehensive psychiatric emergency program during a 1-year period was conducted. Demographic…

  18. An analysis of tolerance levels in IMRT quality assurance procedures

    International Nuclear Information System (INIS)

    Basran, Parminder S.; Woo, Milton K.

    2008-01-01

    Increased use of intensity modulated radiation therapy (IMRT) has resulted in increased efforts in patient quality assurance (QA). Software and detector systems intended to streamline the IMRT quality assurance process often report metrics, such as percent discrepancies between measured and computed doses, which can be compared to benchmark or threshold values. The purpose of this work is to examine the relationships between two different types of IMRT QA processes in order to define, or refine, appropriate tolerances values. For 115 IMRT plans delivered in a 3 month period, we examine the discrepancies between (a) the treatment planning system (TPS) and results from a commercial independent monitor unit (MU) calculation program; (b) TPS and results from a commercial diode-array measurement system; and (c) the independent MU calculation and the diode-array measurements. Statistical tests were performed to assess significance in the IMRT QA results for different disease site and machine models. There is no evidence that the average total dose discrepancy in the monitor unit calculation depends on the disease site. Second, the discrepancies in the two IMRT QA methods are independent: there is no evidence that a better --or worse--monitor unit validation result is related to a better--or worse--diode-array measurement result. Third, there is marginal benefit in repeating the independent MU calculation with a more suitable dose point, if the initial IMRT QA failed a certain tolerance. Based on these findings, the authors conclude at some acceptable tolerances based on disease site and IMRT QA method. Specifically, monitor unit validations are expected to have a total dose discrepancy of 3% overall, and 5% per beam, independent of disease site. Diode array measurements are expected to have a total absolute dose discrepancy of 3% overall, and 3% per beam, independent of disease site. The percent of pixels exceeding a 3% and 3 mm threshold in a gamma analysis should be

  19. Tactical emergency medical support programs: a comprehensive statewide survey.

    Science.gov (United States)

    Bozeman, William P; Morel, Benjamin M; Black, Timothy D; Winslow, James E

    2012-01-01

    Specially trained tactical emergency medical support (TEMS) personnel provide support to law enforcement special weapons and tactics (SWAT) teams. These programs benefit law enforcement agencies, officers, suspects, and citizens. TEMS programs are increasingly popular, but there are wide variations in their organization and operation and no recent data on their prevalence. We sought to measure the current prevalence and specific characteristics of TEMS programs in a comprehensive fashion in a single southeastern state. North Carolina emergency medical services (EMS) systems have county-based central EMS oversight; each system was surveyed by phone and e-mail. The presence and selected characteristics of TEMS programs were recorded. U.S. Census data were used to measure the population impact of the programs. All of the 101 EMS systems statewide were successfully contacted. Thirty-three counties (33%) have TEMS programs providing medical support to 56 local law enforcement agencies as well as state and federal agencies. TEMS programs tend to be located in more populated urban and suburban areas, serving a population base of 5.9 million people, or 64% of the state's population. Tactical medics in the majority of these programs (29/33; 88%) are not sworn law enforcement officers. Approximately one-third of county-based EMS systems in North Carolina have TEMS programs. These programs serve almost two-thirds of the state's population base, using primarily nonsworn tactical medics. Comparison with other regions of the country will be useful to demonstrate differences in prevalence and program characteristics. Serial surveillance will help track trends and measure the growth and impact of this growing subspecialty field.

  20. Comprehensive Outpatient Rehabilitation Program: Hospital-Based Stroke Outpatient Rehabilitation.

    Science.gov (United States)

    Rice, Danielle; Janzen, Shannon; McIntyre, Amanda; Vermeer, Julianne; Britt, Eileen; Teasell, Robert

    2016-05-01

    Few studies have considered the effectiveness of outpatient rehabilitation programs for stroke patients. The objective of this study was to assess the effectiveness of a hospital-based interdisciplinary outpatient stroke rehabilitation program with respect to physical functioning, mobility, and balance. The Comprehensive Outpatient Rehabilitation Program provides a hospital-based interdisciplinary approach to stroke rehabilitation in Southwestern Ontario. Outcome measures from physiotherapy and occupational therapy sessions were available at intake and discharge from the program. A series of paired sample t-tests were performed to assess patient changes between time points for each outcome measure. A total of 271 patients met the inclusion criteria for analysis (56.1% male; mean age = 62.9 ± 13.9 years). Significant improvements were found between admission and discharge for the Functional Independence Measure, grip strength, Chedoke-McMaster Stroke Assessment, two-minute walk test, maximum walk test, Timed Up and Go, Berg Balance Scale, and one-legged stance (P rehabilitation program was effective at improving the physical functioning, mobility, and balance of individuals after a stroke. A hospital-based, stroke-specific rehabilitation program should be considered when patients continue to experience deficits after inpatient rehabilitation. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  1. IMRT plan verification in radiotherapy

    International Nuclear Information System (INIS)

    Vlk, P.

    2006-01-01

    This article describes the procedure for verification of IMRT (Intensity modulated radiation therapy) plan, which is used in the Oncological Institute of St. Elisabeth in Bratislava. It contains basic description of IMRT technology and developing a deployment plan for IMRT planning system CORVUS 6.0, the device Mimic (Multilammelar intensity modulated collimator) and the overall process of verifying the schedule created. The aim of verification is particularly good control of the functions of MIMIC and evaluate the overall reliability of IMRT planning. (author)

  2. Planning issues for IMRT

    International Nuclear Information System (INIS)

    Hoban, P.; Schneider, M.; Smee, R.

    2001-01-01

    Full text: Despite the 'inverse planning' stage of an intensity modulated radiotherapy (IMRT) treatment there remains a large number of variables that can, and must, be set manually. These variables can significantly affect the quality of the dose distribution arrived at by the optimisation. Clinical IMRT planning with the Radionics XPlan system for micro-multileaf collimator (MMLC) delivery has allowed for important lessons to be learned regarding the best beam and organ configurations prior to optimisation of beamlet weights. Important user-definable variables are beam directions, organ parameters (dose goals/penalties), and the margin (if any) around the planning target volume (PTV) used to aid coverage. Conventional stereotactic radiotherapy (SRT) treatments typically involve non-coplanar beams since there is often an advantage in terms of cranial organ at risk (OAR) sparing. IMRT can also benefit from such a configuration. The balance between target coverage and OAR sparing is largely controlled by user-defined goal doses and penalties. Once optimisation has been performed, intensity maps can be discretised into a selected number of levels. Less levels means less field segments and thus a shorter treatment time. Although IMRT beams attempt to spare structures which are in the 'beam's eye view' (BEV) of the target volume, sparing is greater if beams which minimise the involvement of OARs in their view are used. It has been found that the use of a margin is an effective way to ensure adequate PTV coverage. Alternatively the PTV penalties can be made larger. The best result is often obtained by the use of a 3-4 mm margin, whose penalty for underdosage is somewhat less than that for the PTV. Discretising the intensity maps to 4 or 5 levels is typically a good balance between shortening treatment time and not overly degrading the dose distribution. Beam configuration is still an important step in IMRT planning, even though optimisation of intensity maps is

  3. Retrospective analysis of outcomes from two intensive comprehensive aphasia programs.

    Science.gov (United States)

    Persad, Carol; Wozniak, Linda; Kostopoulos, Ellina

    2013-01-01

    Positive outcomes from intensive therapy for individuals with aphasia have been reported in the literature. Little is known about the characteristics of individuals who attend intensive comprehensive aphasia programs (ICAPs) and what factors may predict who makes clinically significant changes when attending such programs. Demographic data on participants from 6 ICAPs showed that individuals who attend these programs spanned the entire age range (from adolescence to late adulthood), but they generally tended to be middle-aged and predominantly male. Analysis of outcome data from 2 of these ICAPs found that age and gender were not significant predictors of improved outcome on measures of language ability or functional communication. However, time post onset was related to clinical improvement in functional communication as measured by the Communication Activities of Daily Living, second edition (CADL-2). In addition, for one sample, initial severity of aphasia was related to outcome on the Western Aphasia Battery-Revised, such that individuals with more severe aphasia tended to show greater recovery compared to those with mild aphasia. Initial severity of aphasia also was highly correlated with changes in CADL-2 scores. These results suggest that adults of all ages with aphasia in either the acute or chronic phase of recovery can continue to show positive improvements in language ability and functional communication with intensive treatment.

  4. Instruction of Research-Based Comprehension Strategies in Basal Reading Programs

    Science.gov (United States)

    Pilonieta, Paola

    2010-01-01

    Research supports using research-based comprehension strategies; however, comprehension strategy instruction is not highly visible in basal reading programs or classroom instruction, resulting in many students who struggle with comprehension. A content analysis examined which research-based comprehension strategies were presented in five…

  5. IMRT, IGRT, SBRT - Advances in the Treatment Planning and Delivery of Radiotherapy

    CERN Document Server

    Meyer, JL

    2011-01-01

    Over the last 4 years, IMRT, IGRT, SBRT: Advances in the Treatment Planning and Delivery of Radiotherapy has become a standard reference in the field. During this time, however, significant progress in high-precision technologies for the planning and delivery of radiotherapy in cancer treatment has called for a second edition to include these new developments. Thoroughly updated and extended, this new edition offers a comprehensive guide and overview of these new technologies and the many clinical treatment programs that bring them into practical use. Advances in intensity-modulated radiothera

  6. Economic Evaluation of a Comprehensive Teenage Pregnancy Prevention Program: Pilot Program

    Science.gov (United States)

    Rosenthal, Marjorie S.; Ross, Joseph S.; Bilodeau, RoseAnne; Richter, Rosemary S.; Palley, Jane E.; Bradley, Elizabeth H.

    2011-01-01

    Background Previous research has suggested that comprehensive teenage pregnancy prevention programs that address sexual education and life skills development and provide academic are effective in reducing births among enrolled teenagers. However, there have been limited data on costs and cost-effectiveness of such programs. Objectives To use a community-based participatory research approach, to develop estimates of the cost-benefit of the Pathways/Senderos Center, a comprehensive neighborhood-based program to prevent unintended pregnancies and promote positive development for adolescents. Methods Using data from 1997-2003, we conducted an in-time intervention analysis to determine program cost-benefit while teenagers were enrolled and then used an extrapolation analysis to estimate accyrred economibc benefits and cost-benefit up to age 30. Results The program operating costs totaled $3,228,152.59 and reduced the teenage childbearing rate from 94.10 to 40.00 per 1000 teenage females, averting $52,297.84 in total societal costs, with an economic benefit to society from program participation of $2,673,153.11. Therefore, total costs to society exceeded economic benefits by $559,677.05, or $1,599.08 per adolescent per year. In an extrapolation analysis, benefits to society exceed costs by $10,474.77 per adolescent per year by age 30 on average, with social benefits outweighing total social costs by age 20.1. Conclusions We estimate that this comprehensive teenage pregnancy prevention program would provide societal economic benefits once participants are young adults, suggesting the need to expand beyond pilot demonstrations and evaluate the long-range cost-effectiveness of similarly comprehensive programs when implemented more widely in high-risk neighborhoods. PMID:19896030

  7. Economic evaluation of a comprehensive teenage pregnancy prevention program: pilot program.

    Science.gov (United States)

    Rosenthal, Marjorie S; Ross, Joseph S; Bilodeau, Roseanne; Richter, Rosemary S; Palley, Jane E; Bradley, Elizabeth H

    2009-12-01

    Previous research has suggested that comprehensive teenage pregnancy prevention programs that address sexual education and life skills development and provide academic support are effective in reducing births among enrolled teenagers. However, there have been limited data on the costs and cost effectiveness of such programs. The study used a community-based participatory research approach to develop estimates of the cost-benefit of the Pathways/Senderos Center, a comprehensive neighborhood-based program to prevent unintended pregnancies and promote positive development for adolescents. Using data from 1997-2003, an in-time intervention analysis was conducted to determine program cost-benefit while teenagers were enrolled; an extrapolation analysis was then used to estimate accrued economic benefits and cost-benefit up to age 30 years. The program operating costs totaled $3,228,152.59 and reduced the teenage childbearing rate from 94.10 to 40.00 per 1000 teenage girls, averting $52,297.84 in total societal costs, with an economic benefit to society from program participation of $2,673,153.11. Therefore, total costs to society exceeded economic benefits by $559,677.05, or $1599.08 per adolescent per year. In an extrapolation analysis, benefits to society exceed costs by $10,474.77 per adolescent per year by age 30 years on average, with social benefits outweighing total social costs by age 20.1 years. This comprehensive teenage pregnancy prevention program is estimated to provide societal economic benefits once participants are young adults, suggesting the need to expand beyond pilot demonstrations and evaluate the long-range cost effectiveness of similarly comprehensive programs when they are implemented more widely in high-risk neighborhoods.

  8. Above reproach: developing a comprehensive ethics and compliance program.

    Science.gov (United States)

    Yuspeh, A; Whalen, K; Cecelic, J; Clifton, S; Cobb, L; Eddy, M; Fainter, J; Packard, J; Postal, S; Steakley, J; Waddey, P

    1999-01-01

    How can a healthcare organization improve the public's confidence in the conduct of its business operations? What can it do to ensure that it can thrive despite being the subject of public and governmental scrutiny and doubt? Healthcare providers must establish standards of conduct that are above reproach and ensure that those standards are clearly articulated and strictly adhered to. This article describes the merits of a comprehensive ethics and compliance program, suggests five basic elements of such a program--organizational support/structure, setting standards, creating awareness, establishing a mechanism for reporting exceptions, and monitoring and auditing--and then demonstrates how those elements should be applied in several high-risk areas. Fundamentally, an ethics and compliance program has two purposes: to ensure that all individuals in an organization observe pertinent laws and regulations in their work; and to articulate a broader set of aspirational ethical standards that are well-understood within the organization and become a practical guideline for organization members making decisions that raise ethical concerns. Every ethics and compliance program should contain certain fundamental aspects. First, the effort must have the active support of the most senior management in the organization. To instill a commitment to ethics and compliance absent a clear and outspoken commitment to such purposes by organization leaders is simply impossible. Second, an ethics and compliance program is fundamentally about organizational culture--about instilling a commitment to observe the law and, more generally, to do the right thing. Third, ethics and compliance are responsibilities of operating management (sometimes called line management). Although staff such as compliance officers are obligated to provide the necessary resources for a successful program and to design the program, such staff officers cannot achieve implementation and execution. Only operating

  9. IMRT in hypopharyngeal tumors

    Energy Technology Data Exchange (ETDEWEB)

    Studer, G.; Luetolf, U.M.; Davis, J.B.; Glanzmann, C. [Dept. of Radiation Oncology, Univ. Hospital, Zurich (Switzerland)

    2006-06-15

    Background and purpose: intensity-modulated radiation therapy (IMRT) data on hypopharyngeal cancer (HC) are scant. In this study, the authors report on early results in an own HC patient cohort treated with IMRT. A more favorable outcome as compared to historical data on conventional radiation techniques was expected. Patients and methods: 29 consecutive HC patients were treated with simultaneous integrated boost (SIB) IMRT between 01/2002 and 07/2005 (mean follow-up 16 months, range 4-44 months). Doses of 60-71 Gy with 2.0-2.2 Gy/fraction were applied. 26/29 patients were definitively irradiated, 86% received simultaneous cisplatin-based chemotherapy. 60% presented with locally advanced disease (T3/4 Nx, Tx N2c/3). Mean primary tumor volume measured 36.2 cm{sup 3} (4-170 cm{sup 3}), mean nodal volume 16.6 cm{sup 3} (0-97 cm{sup 3}). Results: 2-year actuarial local, nodal, distant control, and overall disease-free survival were 90%, 93%, 93%, and 90%, respectively. In 2/4 patients with persistent disease (nodal in one, primary in three), salvage surgery was performed. The mean dose to the spinal cord (extension of > 5-15 mm) was 26 Gy (12-38 Gy); the mean maximum (point) dose was 44.4 Gy (26-58.9 Gy). One grade (G) 3 dysphagia and two G4 reactions (laryngeal fibrosis, dysphagia), both following the schedule with 2.2 Gy per fraction, have been observed so far. Larynx preservation was achieved in 25/26 of the definitively irradiated patients (one underwent a salvage laryngectomy); 23 had no or minimal dysphagia (G0-1). Conclusion: excellent early disease control and high patient satisfaction with swallowing function in HC following SIB IMRT were observed; these results need to be confirmed based on a longer follow-up period. In order to avoid G4 reactions, SIB doses of < 2.2 Gy/fraction are recommended for large tumors involving laryngeal structures. (orig.)

  10. Healthy Start: a comprehensive health education program for preschool children.

    Science.gov (United States)

    Williams, C L; Squillace, M M; Bollella, M C; Brotanek, J; Campanaro, L; D'Agostino, C; Pfau, J; Sprance, L; Strobino, B A; Spark, A; Boccio, L

    1998-01-01

    Healthy Start is a 3-year demonstration and education research project designed to evaluate the effectiveness of a multidimensional cardiovascular (CV) risk reduction intervention in preschool centers over a 3-year period of time. Two primary interventions are employed. The first is the preschool food service intervention program designed to reduce the total fat in preschool meals and snacks to less than 30% of calories and reduce the saturated fat to less than 10% of calories. The second major intervention is a comprehensive preschool health education curriculum, focused heavily on nutrition. Effectiveness of the intervention will be determined through evaluation of changes in dietary intake of preschool children at school meals and snacks, especially with respect to intake of total and saturated fat. Evaluation of the education component will include assessment of program implementation by teachers, assessment of changes in nutrition knowledge by preschool children, and assessment of changes in home meals that children consume (total and saturated fat content). Blood cholesterol will be evaluated semiannually to evaluate changes that may be due to modification of dietary intake. Growth and body fatness will also be assessed. While substantial efforts have targeted CV risk reduction and health education for elementary school children, similar efforts aimed at preschool children have been lacking. The rationale for beginning CV risk reduction programs for preschool children is based upon the premise that risk factors for heart disease are prevalent by 3 years of age and tend to track over time, most commonly hypercholesterolemia and obesity, both related to nutrition. Since the behavioral antecedents for nutritional risk factors begin to be established very early in life, it is important to develop and evaluate new educational initiatives such as Healthy Start, aimed at the primary prevention of cardiovascular risk factors in preschool children. The purpose of this

  11. Emphasizing Conformal Avoidance Versus Target Definition for IMRT Planning in Head-and-Neck Cancer

    International Nuclear Information System (INIS)

    Harari, Paul M.; Song Shiyu; Tome, Wolfgang A.

    2010-01-01

    Purpose: To describe a method for streamlining the process of elective nodal volume definition for head-and-neck (H and N) intensity-modulated radiotherapy (IMRT) planning. Methods and Materials: A total of 20 patients who had undergone curative-intent RT for H and N cancer underwent comprehensive treatment planning using three distinct, plan design techniques: conventional three-field design, target-defined IMRT (TD-IMRT), and conformal avoidance IMRT (CA-IMRT). For each patient, the conventional three-field design was created first, thereby providing the 'outermost boundaries' for subsequent IMRT design. In brief, TD-IMRT involved physician contouring of the gross tumor volume, high- and low-risk clinical target volume, and normal tissue avoidance structures on consecutive 1.25-mm computed tomography images. CA-IMRT involved physician contouring of the gross tumor volume and normal tissue avoidance structures only. The overall physician time for each approach was monitored, and the resultant plans were rigorously compared. Results: The average physician working time for the design of the respective H and N treatment contours was 0.3 hour for the conventional three-field design plan, 2.7 hours for TD-IMRT, and 0.9 hour for CA-IMRT. Dosimetric analysis confirmed that the largest volume of tissue treated to an intermediate (50 Gy) and high (70 Gy) dose occurred with the conventional three-field design followed by CA-IMRT and then TD-IMRT. However, for the two IMRT approaches, comparable results were found in terms of salivary gland and spinal cord protection. Conclusion: CA-IMRT for H and N treatment offers an alternative to TD-IMRT. The overall time for physician contouring was substantially reduced (approximately threefold), yielding a more standardized elective nodal volume. Because of the complexity of H and N IMRT target design, CA-IMRT might ultimately prove a safer and more reliable method to export to general radiation oncology practitioners, particularly

  12. An evaluation of the nursing success program: reading comprehension, graduation rates, and diversity.

    Science.gov (United States)

    Symes, Lene; Tart, Kathryn; Travis, Lucille

    2005-01-01

    The Nursing Success Program was developed to enhance retention of baccalaureate nursing students. Reading comprehension scores are used to identify students who are at risk for failure and direct them into the retention program that addresses their skill deficits. To evaluate the program, the authors assessed reading comprehension, graduation rates, and ethnic diversity.

  13. Intensive comprehensive aphasia programs: an international survey of practice.

    Science.gov (United States)

    Rose, Miranda L; Cherney, Leora R; Worrall, Linda E

    2013-01-01

    In response to the need to simultaneously address multiple domains of the International Classification of Functioning, Disability and Health (ICF) in aphasia therapy and to incorporate intensive treatment doses consistent with principles of neuroplasticity, a potentially potent treatment option termed intensive comprehensive aphasia programs (ICAPs) has been developed. To conduct an international survey of ICAPs to determine the extent of their use and to explore current ICAP practices. A 32-item online survey was distributed internationally through Survey Monkey between May and August 2012. The survey addressed ICAP staffing, philosophy, values, funding, admission criteria, activities, family involvement, outcome measures, and factors considered important to success. Twelve ICAPs responded: 8 from the United States, 2 from Canada, and 1 each from Australia and the United Kingdom. The majority of ICAPs are affiliated with university programs and are funded through participant self-pay. ICAPs emphasize individualized treatment goals and evidence-based practices, with a focus on applying the principles of neuroplasticity related to repetition and intensity of treatment. On average, 6 people with aphasia attend each ICAP, for 4 days per week for 4 weeks, receiving about 100 hours of individual, group, and computer-based treatment. Speech-language pathologists, students, and volunteers staff the majority of ICAPs. ICAPs are increasing in number but remain a rare service delivery option. They address the needs of individuals who want access to intensive treatment and are interested in making significant changes to their communication skills and psychosocial well-being in a short period of time. Their efficacy and cost-effectiveness require future investigation.

  14. Clinician perspectives of an intensive comprehensive aphasia program.

    Science.gov (United States)

    Babbitt, Edna M; Worrall, Linda E; Cherney, Leora R

    2013-01-01

    Intensive comprehensive aphasia programs (ICAPs) have increased in number in recent years in the United States and abroad. To describe the experiences of clinicians working in an ICAP. A phenomenological approach was taken. Seven clinicians from 3 ICAPs were interviewed in person or on the phone. Their interviews were transcribed and coded for themes relating to their experiences. Clinicians described 3 major themes. The first theme related to the intensity component of the ICAP that allowed clinicians to provide in-depth treatment and gave them a different perspective with regard to providing treatment and the potential impact on the person with aphasia. The second theme of rewards for the clinicians included learning and support, seeing progress, and developing relationships with their clients and family members. Third, challenges were noted, including the time involved in learning new therapy techniques, patient characteristics such as chronicity of the aphasia, and the difficulty of returning to work in typical clinical settings after having experienced an ICAP. Although there is a potential for bias with the small sample size, this pilot study gives insight into the clinician perspective of what makes working in an ICAP both worthwhile and challenging.

  15. A School with Solutions: Implementing a Solution-Focused/Adlerian-Based Comprehensive School Counseling Program.

    Science.gov (United States)

    LaFountain, Rebecca M.; Garner, Nadine E.

    This book explains how counselors can integrate the theories of solution focused and Adlerian counseling into a comprehensive developmental counseling curriculum. Following an introduction in Chapter 1, Chapter 2 explains how support needs to be developed among the staff to implement a comprehensive school program. The comprehensive developmental…

  16. Facilitating programming comprehension for novice learners with multimedia approach: A preliminary investigation

    Science.gov (United States)

    Annamalai, Subashini; Salam, Sobihatun Nur Abdul

    2017-10-01

    This research paper presents the preliminary investigation on the use of an interactive multimedia courseware named MAFPro, to facilitate C Programming lessons for novice learners. The courseware utilizes the elements of multimedia that focus on enhancing learners' programming comprehension. Among the aspects that were examined were the students' programming comprehension and their perceived motivation of MAFPro. This study was carried out in a survey design method with the participation of 30 undergraduates who are novice learners. The data analysis indicates that the multimedia courseware, MAFPro that has been used in the C programming classroom has a significant difference on the undergraduates' programming comprehension. The students also perceived MAFPro as motivating and engaging.

  17. Stereotactic IMRT using a MMLC

    International Nuclear Information System (INIS)

    Hoban, P.; Short, R.; Biggs, D.; Rose, A.; Smee, R.; Schneider, M.

    2001-01-01

    Full text: The leaf width of the multileaf collimator (MLC) used for intensity modulated radiotherapy (IMRT ) largely determines the resolution of the intensity maps that define the entire profile of each beam. In turn it is this resolution, and consequently the achievable degree of beam modulation, that determines the ability to conform the 3D dose distribution to complex target volumes. As such, the leaf width is of more importance than in fixed-field MLC treatments where only the beam edges are affected.A Radionics micro-multileaf collimator (MMLC) with 4 mm leaf width, attached to a Siemens Primus linear accelerator, is in use for stereotactic IMRT at PbWH. Treatment planning is performed with the XPlan system including an integrated IMRT module. Cases treated have so far been with conventional fractionation, including both malignant and benign cranial lesions. Meningiomas in particular often require a complex dose distribution because of their en-plaque nature and/or proximity to the brainstem. Stereotactic localisation and fixation is with the Gill-Thomas-Cosman head-ring or Head and Neck localiser. Cases are typically planned both for fixed-field treatment and IMRT, with IMRT being used if significant benefit is seen. IMRT treatment with the Siemens MLC is also an option. A quality assurance system has been set up, including a flowchart/checklist and phantom dosimetry using TLDs. As expected, treatment plans show IMRT with the MMLC to consistently be the best option dosimetrically. In particular, for a given target coverage there is always better sparing of nearby organs at risk (OARs) with MMLC rather than MLC-based IMRT. Adjustments such as the inclusion of a margin around the target volume or an increase in the penalty for target underdosage improve coverage for MLC plans but generally at the expense of increased OAR involvement. MMLC IMRT treatments commonly require 30-50 fields and can be delivered in approximately 10-15 minutes using an autosequence

  18. Planner concepts in IMRT planning

    International Nuclear Information System (INIS)

    Sahoo, Suvendu Kr.; Rath, A.K.; Patnaik, S.; Mishra, S.K.

    2008-01-01

    IMRT is the most sophisticated, innovative, three- dimensional conformal radiation treatment that delivers highly focused radiation with minimal impact to surrounding normal tissue. As it is a computer control technique, the planar should have adequate knowledge to execute the plan in proper way other wise it is very difficult to get the optimal plan. In this article we want to high light, planner should have the basic concepts before starting the IMRT planning

  19. A comprehensive monitoring program for North American shorebirds

    Science.gov (United States)

    Howe, Marshall; Bart, Jon; Brown, Stephen; Elphick, Chris; Gill, Robert E.; Harrington, Brian A.; Hickey, Catherine; Morrison, Guy; Skagen, Susan K.; Warnock, Nils

    2000-01-01

    Anthropogenic changes to the biosphere, including widespread degradation and losses of habitats and ecosystems, are causing rapid and profound changes to bird and other wildlife populations throughout the world. Such changes have led to increasing risks and rates of extinction. As a consequence, information on how bird populations are changing is becoming increasingly important to wildlife conservationists and managers. Early detection of population change is crucial for setting wildlife planning and management priorities. For example, information on population size, population vulnerability, and population change has been central to international conservation strategies such as the Ramsar Convention, the Western Hemisphere (Bonn) Convention, and the Western Hemisphere Shorebird Reserve Network. Measuring population size or change is also crucial for evaluating the effectiveness of population management programs implemented by wildlife agencies both locally and regionally.Although the concept of determining population size is simple, practical difficulties can be enormous and costly to overcome. In the United States, $4 billion will be spent in year 2000 to census the human population, possibly one of the most easily counted of all vertebrates. By contrast, the portion of the FY 2000 budget of the U.S. Department of the Interior allotted for tracking populations of all migratory birds (> 600 species) is less than $5 million (.0125% of the human census figure). This falls far short of the amount required to provide adequate, science-based information about bird populations and population change to wildlife managers.The gap between current ability and need is especially noteworthy for shorebirds. There are 72 species, subspecies, or distinct populations of shorebirds in North America. Even though most of these have received less conservation attention than such groups as waterfowl, colonial waterbirds, or songbirds, recent independent evaluation of data collected for

  20. The German Program and International Education: A Comprehensive Model.

    Science.gov (United States)

    McConeghy, Patrick M.

    1990-01-01

    Argues for a comprehensive approach toward teaching German as a second language in response to students' needs to acquire a global perspective. Rather than stressing only syntax, grammar, and vocabulary, German language education should also attempt to teach sensitivity to, knowledge of, and insight into German culture. (JL)

  1. An IMRT dose distribution study using commercial verification software

    International Nuclear Information System (INIS)

    Grace, M.; Liu, G.; Fernando, W.; Rykers, K.

    2004-01-01

    Full text: The introduction of IMRT requires users to confirm that the isodose distributions and relative doses calculated by their planning system match the doses delivered by their linear accelerators. To this end the commercially available software, VeriSoft TM (PTW-Freiburg, Germany) was trialled to determine if the tools and functions it offered would be of benefit to this process. The CMS Xio (Computer Medical System) treatment planning system was used to generate IMRT plans that were delivered with an upgraded Elekta SL15 linac. Kodak EDR2 film sandwiched in RW3 solid water (PTW-Freiburg, Germany) was used to measure the IMRT fields delivered with 6 MV photons. The isodose and profiles measured with the film generally agreed to within ± 3% or ± 3 mm with the planned doses, in some regions (outside the IMRT field) the match fell to within ± 5%. The isodose distributions of the planning system and the film could be compared on screen and allows for electronic records of the comparison to be kept if so desired. The features and versatility of this software has been of benefit to our IMRT QA program. Furthermore, the VeriSoft TM software allows for quick and accurate, automated planar film analysis.Copyright (2004) Australasian College of Physical Scientists and Engineers in Medicine

  2. Method Improving Reading Comprehension In Primary Education Program Students

    Science.gov (United States)

    Rohana

    2018-01-01

    This study aims to determine the influence of reading comprehension skills of English for PGSD students through the application of SQ3R learning method. The type of this research is Pre-Experimental research because it is not yet a real experiment, there are external variables that influence the formation of a dependent variable, this is because there is no control variable and the sample is not chosen randomly. The research design is used is one-group pretest-post-test design involving one group that is an experimental group. In this design, the observation is done twice before and after the experiment. Observations made before the experiment (O1) are called pretests and the post-experimental observation (O2) is called posttest. The difference between O1 and O2 ie O2 - O1 is the effect of the treatment. The results showed that there was an improvement in reading comprehension skills of PGSD students in Class M.4.3 using SQ3R method, and better SQ3R enabling SQ3R to improve English comprehension skills.

  3. Software for simulating IMRT protocol

    Energy Technology Data Exchange (ETDEWEB)

    Fonseca, Thelma C.F.; Campos, Tarcisio P.R. de, E-mail: tcff@ufmg.b, E-mail: campos@nuclear.ufmg.b [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Dept. de Engenharia Nuclear

    2009-07-01

    The Intensity Modulated Radiation Therapy - IMRT is an advanced technique to cancer treatment widely used on oncology around the world. The present paper describes the SOFT-RT software which is a tool for simulating IMRT protocol. Also, it will be present a cerebral tumor case of studied in which three irradiation windows with distinct orientation were applied. The SOFT-RT collect and export data to MCNP code. This code simulates the photon transport on the voxel model. Later, a out-module from SOFT-RT import the results and express the dose-response superimposing dose and voxel model in a tree-dimensional graphic representation. The present paper address the IMRT software and its function as well a cerebral tumor case of studied is showed. The graphic interface of the SOFT-RT illustrates the example case. (author)

  4. Software for simulating IMRT protocol

    International Nuclear Information System (INIS)

    Fonseca, Thelma C.F.; Campos, Tarcisio P.R. de

    2009-01-01

    The Intensity Modulated Radiation Therapy - IMRT is an advanced technique to cancer treatment widely used on oncology around the world. The present paper describes the SOFT-RT software which is a tool for simulating IMRT protocol. Also, it will be present a cerebral tumor case of studied in which three irradiation windows with distinct orientation were applied. The SOFT-RT collect and export data to MCNP code. This code simulates the photon transport on the voxel model. Later, a out-module from SOFT-RT import the results and express the dose-response superimposing dose and voxel model in a tree-dimensional graphic representation. The present paper address the IMRT software and its function as well a cerebral tumor case of studied is showed. The graphic interface of the SOFT-RT illustrates the example case. (author)

  5. Comprehensive Social Service Programs for Handicapped Citizens through Title XX.

    Science.gov (United States)

    Roten, Shelby Jean

    Reviewed are present and potential services and social programs for handicapped children in Mississippi through purchase of service contracts under Title XX of the Social Security Act. Sections cover the following topics: background and purpose of Title XX which gives states greater control over social service programs, planning state supported…

  6. A Comprehensive Inclusion Program for Kindergarten Children with Autism Spectrum Disorder

    Science.gov (United States)

    Sainato, Diane M.; Morrison, Rebecca S.; Jung, Sunhwa; Axe, Judah; Nixon, Patricia A.

    2015-01-01

    To date, reports of empirically validated comprehensive intervention programs for children with autism spectrum disorder (ASD) have been limited to preschool-age children. We examined the effects of a model inclusive kindergarten program for children with ASD. Forty-one children received instruction in an inclusive kindergarten program with their…

  7. Image guided IMRT dosimetry using anatomy specific MOSFET configurations.

    Science.gov (United States)

    Amin, Md Nurul; Norrlinger, Bern; Heaton, Robert; Islam, Mohammad

    2008-06-23

    We have investigated the feasibility of using a set of multiple MOSFETs in conjunction with the mobile MOSFET wireless dosimetry system, to perform a comprehensive and efficient quality assurance (QA) of IMRT plans. Anatomy specific MOSFET configurations incorporating 5 MOSFETs have been developed for a specially designed IMRT dosimetry phantom. Kilovoltage cone beam computed tomography (kV CBCT) imaging was used to increase the positional precision and accuracy of the detectors and phantom, and so minimize dosimetric uncertainties in high dose gradient regions. The effectiveness of the MOSFET based dose measurements was evaluated by comparing the corresponding doses measured by an ion chamber. For 20 head and neck IMRT plans the agreement between the MOSFET and ionization chamber dose measurements was found to be within -0.26 +/- 0.88% and 0.06 +/- 1.94% (1 sigma) for measurement points in the high dose and low dose respectively. A precision of 1 mm in detector positioning was achieved by using the X-Ray Volume Imaging (XVI) kV CBCT system available with the Elekta Synergy Linear Accelerator. Using the anatomy specific MOSFET configurations, simultaneous measurements were made at five strategically located points covering high dose and low dose regions. The agreement between measurements and calculated doses by the treatment planning system for head and neck and prostate IMRT plans was found to be within 0.47 +/- 2.45%. The results indicate that a cylindrical phantom incorporating multiple MOSFET detectors arranged in an anatomy specific configuration, in conjunction with image guidance, can be utilized to perform a comprehensive and efficient quality assurance of IMRT plans.

  8. Effectiveness of Comprehensive Tobacco Control Programs in Reducing Teenage Smoking: A Review

    OpenAIRE

    Wakefield, Melanie A PhD; Chaloupka, Frank J. PhD

    1999-01-01

    This review focuses on the extent to which comprehensive, statewide, tobacco control programs in the United States have induced change in teenage smoking or made progress towards this goal and under what circumstances such programs are likely to be most effective. The sources for this review include published journal articles, reports and documents, rather than any primary data analysis. We review evidence for the extent to which individual strategies that comprise a comprehensive tobacco con...

  9. Peripheral doses from pediatric IMRT

    International Nuclear Information System (INIS)

    Klein, Eric E.; Maserang, Beth; Wood, Roy; Mansur, David

    2006-01-01

    Peripheral dose (PD) data exist for conventional fields (≥10 cm) and intensity-modulated radiotherapy (IMRT) delivery to standard adult-sized phantoms. Pediatric peripheral dose reports are limited to conventional therapy and are model based. Our goal was to ascertain whether data acquired from full phantom studies and/or pediatric models, with IMRT treatment times, could predict Organ at Risk (OAR) dose for pediatric IMRT. As monitor units (MUs) are greater for IMRT, it is expected IMRT PD will be higher; potentially compounded by decreased patient size (absorption). Baseline slab phantom peripheral dose measurements were conducted for very small field sizes (from 2 to 10 cm). Data were collected at distances ranging from 5 to 72 cm away from the field edges. Collimation was either with the collimating jaws or the multileaf collimator (MLC) oriented either perpendicular or along the peripheral dose measurement plane. For the clinical tests, five patients with intracranial or base of skull lesions were chosen. IMRT and conventional three-dimensional (3D) plans for the same patient/target/dose (180 cGy), were optimized without limitation to the number of fields or wedge use. Six MV, 120-leaf MLC Varian axial beams were used. A phantom mimicking a 3-year-old was configured per Center for Disease Control data. Micro (0.125 cc) and cylindrical (0.6 cc) ionization chambers were appropriated for the thyroid, breast, ovaries, and testes. The PD was recorded by electrometers set to the 10 -10 scale. Each system set was uniquely calibrated. For the slab phantom studies, close peripheral points were found to have a higher dose for low energy and larger field size and when MLC was not deployed. For points more distant from the field edge, the PD was higher for high-energy beams. MLC orientation was found to be inconsequential for the small fields tested. The thyroid dose was lower for IMRT delivery than that predicted for conventional (ratio of IMRT/cnventional ranged from

  10. Comparison of dental health of patients with head and neck cancer receiving IMRT vs conventional radiation.

    Science.gov (United States)

    Duarte, Victor M; Liu, Yuan F; Rafizadeh, Sassan; Tajima, Tracey; Nabili, Vishad; Wang, Marilene B

    2014-01-01

    To analyze the dental health of patients with head and neck cancer who received comprehensive dental care after intensity-modulated radiation therapy (IMRT) compared with radiation therapy (RT). Historical cohort study. Veteran Affairs (VA) hospital. In total, 158 patients at a single VA hospital who were treated with RT or IMRT between 2003 and 2011 were identified. A complete dental evaluation was performed prior to radiation treatment, including periodontal probing, tooth profile, cavity check, and mobility. The dental treatment plan was formulated to eliminate current and potential dental disease. The rates of dental extractions, infections, caries, mucositis, xerostomia, and osteoradionecrosis (ORN) were analyzed, and a comparison was made between patients treated with IMRT and those treated with RT. Of the 158 patients, 99 were treated with RT and 59 were treated with IMRT. Compared with those treated with IMRT, significantly more patients treated with RT exhibited xerostomia (46.5% vs 16.9%; P radiation treatment (32.2% vs 11.1%; P = .002; OR, 3.8; 95% CI, 1.65-8.73). Patients who were treated with IMRT had fewer instances of dental disease, more salivary flow, and fewer requisite posttreatment extractions compared with those treated with RT. The number of posttreatment extractions has been reduced with the advent of IMRT and more so with a complete dental evaluation prior to treatment.

  11. A comprehensive hip fracture program reduces complication rates and mortality

    DEFF Research Database (Denmark)

    Pedersen, Susanne Juhl; Moltke, Finn Borgbjerg; Schousboe, B.

    2008-01-01

    community dwellers before the fracture and 159 (29.7%) were admitted from nursing homes. INTERVENTION: The fast-track treatment and care program included a switch from systemic opiates to a local femoral nerve catheter block; an earlier assessment by the anesthesiologist; and more-systematic approach...

  12. A Multilevel Evaluation of a Comprehensive Child Abuse Prevention Program

    Science.gov (United States)

    Lawson, Michael A.; Alameda-Lawson, Tania; Byrnes, Edward C.

    2012-01-01

    Objectives: The purpose of this study is to examine the extent to which participation in a county-wide prevention program leads to improvements in protective factors associated with child abuse prevention (CAP) and whether improvements in measured protective factors relate to decreased odds of child abuse. Method: Using multilevel growth modeling,…

  13. A methodology for comprehensive strategic planning and program prioritization

    Science.gov (United States)

    Raczynski, Christopher Michael

    2008-10-01

    This process developed in this work, Strategy Optimization for the Allocation of Resources (SOAR), is a strategic planning methodology based off Integrated Product and Process Development and systems engineering techniques. Utilizing a top down approach, the process starts with the creation of the organization vision and its measures of effectiveness. These measures are prioritized based on their application to external world scenarios which will frame the future. The programs which will be used to accomplish this vision are identified by decomposing the problem. Information is gathered on the programs as to the application, cost, schedule, risk, and other pertinent information. The relationships between the levels of the hierarchy are mapped utilizing subject matter experts. These connections are then utilized to determine the overall benefit of the programs to the vision of the organization. Through a Multi-Objective Genetic Algorithm a tradespace of potential program portfolios can be created amongst which the decision maker can allocate resources. The information and portfolios are presented to the decision maker through the use of a Decision Support System which collects and visualizes all the data in a single location. This methodology was tested utilizing a science and technology planning exercise conducted by the United States Navy. A thorough decomposition was defined and technology programs identified which had the potential to provide benefit to the vision. The prioritization of the top level capabilities was performed through the use of a rank ordering scheme and a previous naval application was used to demonstrate a cumulative voting scheme. Voting was performed utilizing the Nominal Group Technique to capture the relationships between the levels of the hierarchy. Interrelationships between the technologies were identified and a MOGA was utilized to optimize portfolios with respect to these constraints and information was placed in a DSS. This

  14. The Adopt-a-School Service-Learning Program: Igniting Comprehensive School Physical Activity Programs through School and University Partnerships

    Science.gov (United States)

    Linker, Jenny M.; Ford, Kristen M.; Knutson, Julie M.; Goplen, Hailey A.

    2018-01-01

    Physical educators have been identified as ideal school champions to lead comprehensive school physical activity program (CSPAP) efforts within their schools. As such, they should be adequately prepared to take on this role. Faculty from three physical and health education teacher education programs have collaboratively developed the…

  15. THE EFFECT OF A READING COMPREHENSION SOFTWARE PROGRAM ON STUDENT ACHIEVEMENT IN MATHEMATICS

    Directory of Open Access Journals (Sweden)

    David E. Proudfoot

    2016-06-01

    Full Text Available In an effort to increase student achievement, research was conducted to determine the degree in which a reading comprehension software program effected the reading and math abilities of fourth and fifth grade students. Cognitive and educational studies were examined to select a reading comprehension software program as an intervention that would produce positive results in reading comprehension and possibly transfer positive results to achievement in other academic areas, specifically in math. The effects of the intervention were measured by assigning subjects to an experimental group. The total sample consisted of 39 students who were deficient in reading comprehension, and also exposed a significant weakness with word problem items on mathematical assessments. Four instruments were used to collect data before and after the treatment to measure student achievement. To determine the degree to which the software program effected student achievement, data from the four instruments were analyzed using SPSS software. A paired-samples dependent t test and a Pearson Product Moment Correlation Coefficient was computed with ratio level data to test for a correlation between increased math scores and reading comprehension scores. Results yielded statistically significant and positive results in increasing reading comprehension skills that could possibly benefit students in reading and understanding mathematical problems. Results did not conclusively support that the increase of reading-comprehension skills had a collateral effect on students scoring higher with math word problems. The results are conducive to providing insight to educational leaders who plan to implement software as a means for increasing student achievement.

  16. A Comprehensive Multi-Media Program to Prevent Smoking among Black Students.

    Science.gov (United States)

    Kaufman, Joy S.; And Others

    1994-01-01

    Implemented program to decrease incidence of new smokers among black adolescents. Program combined school-based curriculum with comprehensive media intervention. There were two experimental conditions: one group participated in school-based intervention and was prompted to participate in multimedia intervention; other group had access to…

  17. Effects of Comprehensive, Multiple High-Risk Behaviors Prevention Program on High School Students

    Science.gov (United States)

    Collier, Crystal

    2013-01-01

    The purpose of this mixed methods study was to examine the effect of a multiple high-risk behaviors prevention program applied comprehensively throughout an entire school-system involving universal, selective, and indicated levels of students at a local private high school during a 4-year period. The prevention program was created based upon the…

  18. Case Study of an Institutionalized Urban Comprehensive School Physical Activity Program

    Science.gov (United States)

    Doolittle, Sarah A.; Rukavina, Paul B.

    2014-01-01

    This single case study (Yin, 2009) compares an established urban physical education/ sport/physical activity program with two models: Comprehensive School Physical Activity Program/CSPAP (AAHPERD, 2013; CDC, 2013); and Lawson's propositions (2005) for sport, exercise and physical education for empowerment and community development to determine…

  19. Resource List--Using Evidence-Based Programs as the Foundation of Comprehensive Sex Education

    Science.gov (United States)

    Advocates for Youth, 2015

    2015-01-01

    Decades of research have identified dozens of programs that are effective in helping young people reduce their risk for pregnancy, HIV, and STDs. These evidence-based programs utilize strategies that include the provision of accurate, honest information about abstinence as well as contraception and can serve as the foundation for comprehensive sex…

  20. The Effects of Appeal on Children's Comprehension and Recall of Content in Educational Television Programs

    Science.gov (United States)

    Gabrelian, Natalie; Blumberg, Fran C.; Hogan, Tracy M.

    2009-01-01

    This exploratory study investigated the effects of audience appeal on fourth-graders' (n = 25) and fifth-graders' (n = 24) comprehension of and selective attention to narrative and academic content in educational program segments. Students were shown two program segments that focused on one of two math concepts, perimeter or scale, and that were…

  1. Comprehensive School Physical Activity Programs: Recommendations for Physical Education Teacher Education

    Science.gov (United States)

    Zhang, Xiaoxia; Gu, Xiangli; Zhang, Tao; Keller, Jean; Chen, Senlin

    2018-01-01

    Comprehensive school physical activity programs (CSPAPs) aim to promote physical activity and healthy lifestyles among school-age children and adolescents. Physical educators are highly qualified individuals taking on the role of certified physical activity leaders. Physical education teacher education (PETE) programs should consider preparing…

  2. Deaf Education Teacher Preparation: A Phenomenological Case Study of a Graduate Program with a Comprehensive Philosophy

    Science.gov (United States)

    Engler, Karen S.; MacGregor, Cynthia J.

    2018-01-01

    At a time when deaf education teacher preparation programs are declining in number, little is known about their actual effectiveness. A phenomenological case study of a graduate-level comprehensive deaf education teacher preparation program at a midwestern university explored empowered and enabled learning of teacher candidates using the Missouri…

  3. A comprehensive program of nuclear engineering and science education

    International Nuclear Information System (INIS)

    Bereznai, G.; Lewis, B.

    2014-01-01

    The University of Ontario Institute of Technology offers undergraduate degrees in nuclear engineering, nuclear power, health physics and radiation science, graduate degrees (masters as well as doctorate) in nuclear engineering, and graduate diplomas that encompass a wide range of nuclear engineering and technology topics. Professional development programs tailored to specific utility needs are also offered, and the sharing of course material between the professional development and university education courses has strengthened both approaches to ensuring the high qualification levels required of professionals in the nuclear industry. (author)

  4. Developing a comprehensive scale to assess college multicultural programming.

    Science.gov (United States)

    Mallinckrodt, Brent; Miles, Joseph R; Bhaskar, Tripti; Chery, Nicole; Choi, Gahee; Sung, Mi-Ra

    2014-01-01

    A barrier to assessing effectiveness of multicultural programming is lack of a relatively brief instrument to measure the wide range of intended outcomes. A frequent goal of programming is to increase cultural empathy, but this is rarely the only intended outcome. We conducted focus groups of campus administrators, student affairs staff, and undergraduate instructors who identified a full range of racial/ethnic multicultural competencies that undergraduates should possess. An 84-item pool generated from these focus groups was combined with the 31-item Scale of Ethnocultural Empathy (SEE; Wang et al., 2003). These 115 items, together with instruments used to gauge concurrent validity, were administered to White undergraduate students in introductory psychology courses at the midpoint (n = 602) and end (n = 676) of fall semester. Exploratory factor analysis suggested 6 subscales for the Everyday Multicultural Competencies/Revised SEE (EMC/RSEE): (a) Cultural Openness and Desire to Learn; (b) Resentment and Cultural Dominance; (c) Anxiety and Lack of Multicultural Self-Efficacy; (d) Empathic Perspective-Taking; (e) Awareness of Contemporary Racism and Privilege; and (f) Empathic Feeling and Acting as an Ally. Item response theory principles guided final selection of subscale items. Analyses suggested good factor stability, reliability, and discriminant validity of the 48-item EMC/RSEE in these undergraduate samples. EMC/RSEE subscales were not strongly correlated with a measure of impression management and were significantly associated with measures of Openness to Diversity Challenge, and Universal-Diverse Orientation. (c) 2014 APA, all rights reserved.

  5. Monte Carlo simulations to replace film dosimetry in IMRT verification

    International Nuclear Information System (INIS)

    Goetzfried, Thomas; Trautwein, Marius; Koelbi, Oliver; Bogner, Ludwig; Rickhey, Mark

    2011-01-01

    Patient-specific verification of intensity-modulated radiation therapy (IMRT) plans can be done by dosimetric measurements or by independent dose or monitor unit calculations. The aim of this study was the clinical evaluation of IMRT verification based on a fast Monte Carlo (MC) program with regard to possible benefits compared to commonly used film dosimetry. 25 head-and-neck IMRT plans were recalculated by a pencil beam based treatment planning system (TPS) using an appropriate quality assurance (QA) phantom. All plans were verified both by film and diode dosimetry and compared to MC simulations. The irradiated films, the results of diode measurements and the computed dose distributions were evaluated, and the data were compared on the basis of gamma maps and dose-difference histograms. Average deviations in the high-dose region between diode measurements and point dose calculations performed with the TPS and MC program were 0.7 ± 2.7% and 1.2 ± 3.1%, respectively. For film measurements, the mean gamma values with 3% dose difference and 3 mm distance-to-agreement were 0.74 ± 0.28 (TPS as reference) with dose deviations up to 10%. Corresponding values were significantly reduced to 0.34 ± 0.09 for MC dose calculation. The total time needed for both verification procedures is comparable, however, by far less labor intensive in the case of MC simulations. The presented study showed that independent dose calculation verification of IMRT plans with a fast MC program has the potential to eclipse film dosimetry more and more in the near future. Thus, the linac-specific QA part will necessarily become more important. In combination with MC simulations and due to the simple set-up, point-dose measurements for dosimetric plausibility checks are recommended at least in the IMRT introduction phase. (orig.)

  6. 34 CFR 403.161 - How must funds be used under the Comprehensive Career Guidance and Counseling Programs?

    Science.gov (United States)

    2010-07-01

    ... Guidance and Counseling Programs? 403.161 Section 403.161 Education Regulations of the Offices of the... the Special Programs? Comprehensive Career Guidance and Counseling Programs § 403.161 How must funds be used under the Comprehensive Career Guidance and Counseling Programs? (a) A State shall use not...

  7. Restricted Field IMRT Dramatically Enhances IMRT Planning for Mesothelioma

    International Nuclear Information System (INIS)

    Allen, Aaron M.; Schofield, Deborah; Hacker, Fred; Court, Laurence E.; Czerminska, Maria M.S.

    2007-01-01

    Purpose: To improve the target coverage and normal tissue sparing of intensity-modulated radiotherapy (IMRT) for mesothelioma after extrapleural pneumonectomy. Methods and Materials: Thirteen plans from patients previously treated with IMRT for mesothelioma were replanned using a restricted field technique. This technique was novel in two ways. It limited the entrance beams to 200 o around the target and three to four beams per case had their field apertures restricted down to the level of the heart or liver to further limit the contralateral lung dose. New constraints were added that included a mean lung dose of <9.5 Gy and volume receiving ≥5 Gy of <55%. Results: In all cases, the planning target volume coverage was excellent, with an average of 97% coverage of the planning target volume by the target dose. No change was seen in the target coverage with the new technique. The heart, kidneys, and esophagus were all kept under tolerance in all cases. The average mean lung dose, volume receiving ≥20 Gy, and volume receiving ≥5 Gy with the new technique was 6.6 Gy, 3.0%, and 50.8%, respectively, compared with 13.8 Gy, 15%, and 90% with the previous technique (p < 0.0001 for all three comparisons). The maximal value for any case in the cohort was 8.0 Gy, 7.3%, and 57.5% for the mean lung dose, volume receiving ≥20 Gy, and volume receiving ≥5 Gy, respectively. Conclusion: Restricted field IMRT provides an improved method to deliver IMRT to a complex target after extrapleural pneumonectomy. An upcoming Phase I trial will provide validation of these results

  8. Comprehensive yogic breathing program improves quality of life in patients with diabetes

    Directory of Open Access Journals (Sweden)

    Viveka P Jyotsna

    2012-01-01

    Full Text Available Objective: To assess the effect of a comprehensive yogic breathing program on glycemic control and quality of life (QOL in patients with diabetes. Materials and Methods: This is a prospective randomized controlled intervention trial. Patients having HbA1c between 6 and 9% for at least 3 months with lifestyle modification and oral antidiabetic medication were included. They were followed-up and randomized at 6 months into two groups: one group receiving standard treatment of diabetes and the other group receiving standard treatment of diabetes and taught and told to regularly practice the comprehensive yogic breathing program (Sudarshan Kriya Yoga and Pranayam. Change in fasting and post-prandial blood sugars, glycated hemoglobin and QOL as assessed by the World Health Organization QOL WHOQOL BREF questionnaire were assessed. Results: There was a trend toward improvement in glycemic control in the group practicing the comprehensive yogic breathing program compared with the group following standard treatment alone, although this was not significant. There was significant improvement in physical, psychological and social domains and total QOL post-intervention in the group practicing the comprehensive yogic breathing program as compared with the group following standard treatment alone. Conclusion: There was significant improvement in the QOL and a non-significant trend toward improvement in glycemic control in the group practicing the comprehensive yogic breathing program compared with the group that was following standard treatment alone.

  9. Comprehensive adolescent health programs that include sexual and reproductive health services: a systematic review.

    Science.gov (United States)

    Kågesten, Anna; Parekh, Jenita; Tunçalp, Ozge; Turke, Shani; Blum, Robert William

    2014-12-01

    We systematically reviewed peer-reviewed and gray literature on comprehensive adolescent health (CAH) programs (1998-2013), including sexual and reproductive health services. We screened 36 119 records and extracted articles using predefined criteria. We synthesized data into descriptive characteristics and assessed quality by evidence level. We extracted data on 46 programs, of which 19 were defined as comprehensive. Ten met all inclusion criteria. Most were US based; others were implemented in Egypt, Ethiopia, and Mexico. Three programs displayed rigorous evidence; 5 had strong and 2 had modest evidence. Those with rigorous or strong evidence directly or indirectly influenced adolescent sexual and reproductive health. The long-term impact of many CAH programs cannot be proven because of insufficient evaluations. Evaluation approaches that take into account the complex operating conditions of many programs are needed to better understand mechanisms behind program effects.

  10. Comprehensive resurvey program to prevent radiological incidents at a national laboratory

    International Nuclear Information System (INIS)

    Lipton, W.V.; Hunckler, C.A.

    1978-01-01

    A comprehensive resurvey program in a general purpose research building at Argonne National Laboratory is being implemented. The program was designed to prevent radiological incidents by increasing the awareness of Health Physics personnel of radiological hazards, initiating corrective actions, and providing information for improving routine survey schedules, and for establishing manpower requirements. The following aspects of the program are described: scheduling, surveys, records, follow-up, and statistics

  11. Comprehensive bidding strategies with genetic programming/finite state automata

    International Nuclear Information System (INIS)

    Richter, C.W. Jr.; Sheble, G.B.; Ashlock, D.

    1999-01-01

    This research is an extension of the authors' previous work in double auctions aimed at developing bidding strategies for electric utilities which trade electricity competitively. The improvements detailed in this paper come from using data structures which combine genetic programming and finite state automata termed GP-Automata. The strategies developed by the method described here are adaptive--reacting to inputs--whereas the previously developed strategies were only suitable in the particular scenario for which they had been designed. The strategies encoded in the GP-Automata are tested in an auction simulator. The simulator pits them against other distribution companies (distcos) and generation companies (gencos), buying and selling power via double auctions implemented in regional commodity exchanges. The GP-Automata are evolved with a genetic algorithm so that they possess certain characteristics. In addition to designing successful bidding strategies (whose usage would result in higher profits) the resulting strategies can also be designed to imitate certain types of trading behaviors. The resulting strategies can be implemented directly in on-line trading, or can be used as realistic competitors in an off-line trading simulator

  12. Tolerance limits and methodologies for IMRT measurement-based verification QA: Recommendations of AAPM Task Group No. 218.

    Science.gov (United States)

    Miften, Moyed; Olch, Arthur; Mihailidis, Dimitris; Moran, Jean; Pawlicki, Todd; Molineu, Andrea; Li, Harold; Wijesooriya, Krishni; Shi, Jie; Xia, Ping; Papanikolaou, Nikos; Low, Daniel A

    2018-04-01

    Patient-specific IMRT QA measurements are important components of processes designed to identify discrepancies between calculated and delivered radiation doses. Discrepancy tolerance limits are neither well defined nor consistently applied across centers. The AAPM TG-218 report provides a comprehensive review aimed at improving the understanding and consistency of these processes as well as recommendations for methodologies and tolerance limits in patient-specific IMRT QA. The performance of the dose difference/distance-to-agreement (DTA) and γ dose distribution comparison metrics are investigated. Measurement methods are reviewed and followed by a discussion of the pros and cons of each. Methodologies for absolute dose verification are discussed and new IMRT QA verification tools are presented. Literature on the expected or achievable agreement between measurements and calculations for different types of planning and delivery systems are reviewed and analyzed. Tests of vendor implementations of the γ verification algorithm employing benchmark cases are presented. Operational shortcomings that can reduce the γ tool accuracy and subsequent effectiveness for IMRT QA are described. Practical considerations including spatial resolution, normalization, dose threshold, and data interpretation are discussed. Published data on IMRT QA and the clinical experience of the group members are used to develop guidelines and recommendations on tolerance and action limits for IMRT QA. Steps to check failed IMRT QA plans are outlined. Recommendations on delivery methods, data interpretation, dose normalization, the use of γ analysis routines and choice of tolerance limits for IMRT QA are made with focus on detecting differences between calculated and measured doses via the use of robust analysis methods and an in-depth understanding of IMRT verification metrics. The recommendations are intended to improve the IMRT QA process and establish consistent, and comparable IMRT QA

  13. The Solid* toolset for software visual analytics of program structure and metrics comprehension : From research prototype to product

    NARCIS (Netherlands)

    Reniers, Dennie; Voinea, Lucian; Ersoy, Ozan; Telea, Alexandru

    2014-01-01

    Software visual analytics (SVA) tools combine static program analysis and fact extraction with information visualization to support program comprehension. However, building efficient and effective SVA tools is highly challenging, as it involves extensive software development in program analysis,

  14. Comprehensive care programs for patients with multiple chronic conditions: a systematic literature review.

    Science.gov (United States)

    de Bruin, Simone R; Versnel, Nathalie; Lemmens, Lidwien C; Molema, Claudia C M; Schellevis, François G; Nijpels, Giel; Baan, Caroline A

    2012-10-01

    To provide insight into the characteristics of comprehensive care programs for patients with multiple chronic conditions and their impact on patients, informal caregivers, and professional caregivers. Systematic literature search in multiple electronic databases for English language papers published between January 1995 and January 2011, supplemented by reference tracking and a manual search on the internet. Wagner's chronic care model (CCM) was used to define comprehensive care. After inclusion, the methodological quality of each study was assessed. A best-evidence synthesis was applied to draw conclusions. Forty-two publications were selected describing thirty-three studies evaluating twenty-eight comprehensive care programs for multimorbid patients. Programs varied in the target patient groups, implementation settings, number of included interventions, and number of CCM components to which these interventions related. Moderate evidence was found for a beneficial effect of comprehensive care on inpatient healthcare utilization and healthcare costs, health behavior of patients, perceived quality of care, and satisfaction of patients and caregivers. Insufficient evidence was found for a beneficial effect of comprehensive care on health-related quality of life in terms of mental functioning, medication use, and outpatient healthcare utilization and healthcare costs. No evidence was found for a beneficial effect of comprehensive care on cognitive functioning, depressive symptoms, functional status, mortality, quality of life in terms of physical functioning, and caregiver burden. Because of the heterogeneity of comprehensive care programs, it is as yet too early to draw firm conclusions regarding their effectiveness. More rigorous evaluation studies are necessary to determine what constitutes best care for the increasing number of people with multiple chronic conditions. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  15. 76 FR 13143 - Striving Readers Comprehensive Literacy Grant Program; Office of Elementary and Secondary...

    Science.gov (United States)

    2011-03-10

    ... learning program environments that engage and motivate children and youth in speaking, listening, reading... and grade-level mastery of (A) oral language skills, both listening and speaking, (B) phonological..., fluently, and with comprehension, relying on knowledge of the vocabulary in those texts and of the...

  16. An Investigation of Classroom Practices in Teaching Listening Comprehension at English Education Program

    Science.gov (United States)

    Siregar, Nurhafni

    2017-01-01

    The objective of this study is to investigate how the classroom practice in teaching listening comprehension at English Education Program of STKIP Tapanuli Selatan in 2016/2017 Academic Year is. The informants of this research were all of second semester students of STKIP Tapanuli Selatan in 2016/2017 academic year and a lecturer of listening…

  17. Toward Active Living: "Comprehensive School Physical Activity Program" Research and Implications

    Science.gov (United States)

    Chen, Senlin; Gu, Xiangli

    2018-01-01

    Comprehensive school physical activity program (CSPAP) holds much promise as a solution for youth PA promotion, due to its strong theoretical and political support. In this article, we review the current research on CSPAP. Fifty-four published articles that met the inclusion criteria were identified and retrieved using direct library database…

  18. Youth Leadership Development: Perceptions and Preferences of Urban Students Enrolled in a Comprehensive Agriculture Program

    Science.gov (United States)

    Anderson, James C., II; Kim, Eunyoung

    2009-01-01

    This descriptive study explores the perceptions of and preferences for leadership development by students enrolled in a comprehensive urban agriculture program. A total of 284 students from the Chicago High School for Agricultural Sciences participated in the study. The results of the study showed that the average respondent was involved in a…

  19. Development of Reading Comprehension Skills among Students with Intellectual Disabilities Using Technologically-Based Reading Programs

    Science.gov (United States)

    Macklin, Ella M.

    2016-01-01

    This research paper reported the results from research conducted regarding technologically-based reading comprehension programs for students who have intellectual disabilities. It provided evidence-based research and theoretical bases for learning (i.e. Zone of Generativity, Constructivism, Self-Efficacy) on the issue of these students not being…

  20. Sound Effects for Children's Comprehension of Variably-Paced Television Programs.

    Science.gov (United States)

    Calvert, Sandra L.; Scott, M. Catherine

    In this study, children's selective attention to, and comprehension of, variably-paced television programs were examined as a function of sound effects. Sixty-four children, equally distributed by sex and by preschool and fourth grades, were randomly assigned to one of four treatment conditions which crossed two levels of sound effects (presence…

  1. A Call to Action: Addressing the Childhood Obesity Epidemic through Comprehensive School Counseling Programs

    Science.gov (United States)

    Belser, Christopher T.; Morris, Jessica A.; Hasselbeck, Jennifer M.

    2012-01-01

    The need for school-based interventions targeting the childhood obesity epidemic has been well documented. The risk factors associated with childhood obesity are physical, mental, psychosocial, academic, and economic. With training in developing comprehensive programs and interventions, professional school counselors are positioned to assist…

  2. Comprehension-Driven Program Analysis (CPA) for Malware Detection in Android Phones

    Science.gov (United States)

    2015-07-01

    Android source . 3.1.2.2 Analyzers An analyzer conforms to specifications defined by the Security Toolbox. Specifically an analyzer encapsulates a...COMPREHENSION-DRIVEN PROGRAM ANALYSIS (CPA) FOR MALWARE DETECTION IN ANDROID PHONES IOWA STATE UNIVERSITY JULY 2015 FINAL...average 1 hour per response, including the time for reviewing instructions, searching existing data sources , gathering and maintaining the data needed

  3. 78 FR 8535 - Medicare Program: Comprehensive End-Stage Renal Disease Care Model Announcement

    Science.gov (United States)

    2013-02-06

    ... develop and test innovative health care payment and service delivery models that show promise of reducing... test innovative payment and service delivery models that reduce spending under Medicare, Medicaid or...] Medicare Program: Comprehensive End-Stage Renal Disease Care Model Announcement AGENCY: Centers for...

  4. The Role of Classroom Teacher Social Capital in a Comprehensive School Physical Activity Program

    Science.gov (United States)

    Jordan, Michelle E.; Lorenz, Kent; Stylianou, Michalis; Kulinna, Pamela Hodges

    2018-01-01

    This study examined classroom teachers' involvement in a yearlong Comprehensive School Physical Activity Programs (CSPAP) implemented in one K-8 rural U.S. school district. Its purpose was to describe patterns of social interaction among teachers, administrators, and families associated with the intervention (i.e., social capital) and whether…

  5. Completion report : Effect of Comprehensive Yogic Breathing program on type 2 diabetes: A randomized control trial

    Directory of Open Access Journals (Sweden)

    V P Jyotsna

    2014-01-01

    Full Text Available Background: Yoga has been shown to be benefi cial in diabetes in many studies, though randomized control trials are few. The aim of this randomized control trial was to see the effect of Sudarshan Kriya and related practices (comprehensive yogic breathing program on quality of life, glycemic control, and cardiac autonomic functions in diabetes. Diabetes mellitus is a risk factor for sudden cardiac death. Cardiac autonomic neuropathy has been implicated in the causation of sudden cardiac death. Therefore, a maneuver to prevent progression of cardiac autonomic neuropathy holds signifi cance. Materials and Methods: A total of 120 patients of diabetes on oral medication and diet and exercise advice were randomized into two groups: (1 Continued to receive standard treatment for diabetes. (2 Patients administered comprehensive yogic breathing program and monitored to regularly practice yoga in addition to standard treatment of diabetes. At 6 months, quality of life and postprandial plasma glucose signifi cantly improved in the group practicing yoga compared to baseline, but there was no significant improvement in the fasting plasma glucose and glycated hemoglobin. Results: On per protocol analysis, sympathetic cardiac autonomic functions signifi cantly improved from baseline in the group practicing comprehensive yogic breathing. Conclusion: This randomized control trial points towards the beneficial effect of yogic breathing program in preventing progression of cardiac neuropathy. This has important implications as cardiac autonomic neuropathy has been considered as one of the factors for sudden cardiac deaths.Keywords: comprehensive yogic breathing program, diabetes mellitus, cardiac autonomic function

  6. A Comprehensive Substance Abuse Counselor Education Program: From Specialty Certificate to Ph.D.

    Science.gov (United States)

    Goodwin, Lloyd R., Jr.

    2006-01-01

    East Carolina University has one of the few comprehensive substance abuse counselor education (SACE) programs in the nation that offers an undergraduate, master's, and doctoral level of preparation in substance abuse counseling. This article describes the evolution of this SACE from its beginning in 1972 to its current status. This comprehensive…

  7. Tomotherapy: IMRT and tomographic verification

    International Nuclear Information System (INIS)

    Mackie, T.R.

    2000-01-01

    Full text: External beam radiation therapy delivery began around the turn of the century with the use of one or a few kilovoltage beams directed to the presumed site of the tumor. Often the treatment lasted until erythema dose was reached. Delivering the beams rotationally allowed the dose to be focused on the tumor and the skin to be spared. With the advent of megavoltage radiation therapy in the 1950's, using Co-60 teletherapy and betatrons, the treatment could once again be delivered from only a few beam directions and the dose to the skin would be kept below tolerance. Fields were shaped by lead blocks and later by custom-made blocks fabricated from low-melting temperature heavy metal. Linear accelerators did not fundamentally change the way in which radiation was delivered. It is likely that this delivery paradigm would not have changed had it not been for the advent of computers. Brahme and Cormack showed in the late 1980's that highly conformal treatments could be delivered with non-uniform intensity beams. At that time the only way in which the intensity modulated beams could be delivered was using custom-milled compensators. Fabricating and using compensators for multiple fields is time-consuming and labor-intensive. Serial tomotherapy was the first successful delivery method for IMRT and went back to the earlier practice of rotation therapy. The NOMOS Peacock system uses a binary (on-off) multileaf collimator (MLC) system to modulate a fan beam of radiation. It uses an optimization system to determine when leaves should be opened and closed. The system delivers two beam slices at once and the couch is indexed to the next slices by precisely translating the couch. This approach was first used in 1994 and to-date has treated several thousand patients. Prior to the advent of IMRT, accelerator vendors introduced the multileaf collimator (MLC) to provide field shaping without the need to fabricate custom blocking. Most new linear accelerator purchases today

  8. The use of IMRT in Germany

    International Nuclear Information System (INIS)

    Frenzel, Thorsten; Kruell, Andreas

    2015-01-01

    Intensity modulated radiotherapy (IMRT) is frequently used, but there are no data about current frequency regarding specific tumor sites and equipment used for quality assurance (QA). An online survey about IMRT was executed from April to October 2014 by the collaborative IMRT working group (AK IMRT) of the German Association of Medical Physicists (DGMP). A total of 23 German institutions took part in the survey. Most reports came from users working with Elekta, Varian, and Siemens treatment machines, but also from TomoTherapy and BrainLab. Most frequent IMRT technology was volumetric modulated arc therapy (58.37 %: VMAT/''rapid arc''), followed by step-and-shoot IMRT (14.66 %), dynamic MLC (dMLC: 14.53 %), TomoTherapy (9.25 %), and 3.2 % other techniques. Different commercial hard- and software solutions are available for QA, whereas many institutes still develop their own phantoms. Data of 26,779 patients were included in the survey; 44 % were treated using IMRT techniques. IMRT was most frequently used for anal cancer, (whole) craniospinal irradiation, head and neck cancer, prostate cancer, other tumors in the pelvic region, gynecological tumors (except for breast cancer), and brain tumors. An estimated 10 % of all patients treated in 2014 with radiation in Germany were included in the survey. It is representative for the members of the AK IMRT. IMRT may be on the way to replace other treatment techniques. However, many scientific questions are still open. In particular, it is unclear when the IMRT technique should not be used. (orig.) [de

  9. SIFT: A method to verify the IMRT fluence delivered during patient treatment using an electronic portal imaging device

    International Nuclear Information System (INIS)

    Vieira, Sandra C.; Dirkx, Maarten L.P.; Heijmen, Ben J.M.; Boer, Hans C.J. de

    2004-01-01

    Purpose: Radiotherapy patients are increasingly treated with intensity-modulated radiotherapy (IMRT) and high tumor doses. As part of our quality control program to ensure accurate dose delivery, a new method was investigated that enables the verification of the IMRT fluence delivered during patient treatment using an electronic portal imaging device (EPID), irrespective of changes in patient geometry. Methods and materials: Each IMRT treatment field is split into a static field and a modulated field, which are delivered in sequence. Images are acquired for both fields using an EPID. The portal dose image obtained for the static field is used to determine changes in patient geometry between the planning CT scan and the time of treatment delivery. With knowledge of these changes, the delivered IMRT fluence can be verified using the portal dose image of the modulated field. This method, called split IMRT field technique (SIFT), was validated first for several phantom geometries, followed by clinical implementation for a number of patients treated with IMRT. Results: The split IMRT field technique allows for an accurate verification of the delivered IMRT fluence (generally within 1% [standard deviation]), even if large interfraction changes in patient geometry occur. For interfraction radiological path length changes of 10 cm, deliberately introduced errors in the delivered fluence could still be detected to within 1% accuracy. Application of SIFT requires only a minor increase in treatment time relative to the standard IMRT delivery. Conclusions: A new technique to verify the delivered IMRT fluence from EPID images, which is independent of changes in the patient geometry, has been developed. SIFT has been clinically implemented for daily verification of IMRT treatment delivery

  10. Fluence complexity for IMRT field and simplification of IMRT verification

    International Nuclear Information System (INIS)

    Hanushova, Tereza; Vondarchek, Vladimir

    2013-01-01

    Intensity Modulated Radiation Therapy (IMRT) requires dosimetric verification of each patient’s plan, which is time consuming. This work deals with the idea of minimizing the number of fields for control, or even replacing plan verification by machine quality assurance (QA). We propose methods for estimation of fluence complexity in an IMRT field based on dose gradients and investigate the relation between results of gamma analysis and this quantity. If there is a relation, it might be possible to only verify the most complex field of a plan. We determine the average fluence complexity in clinical fields and design a test fluence corresponding to this amount of complexity which might be used in daily QA and potentially replace patient-related verification. Its applicability is assessed in clinical practice. The relation between fluence complexity and results of gamma analysis has been confirmed for plans but not for single fields. There is an agreement between the suggested test fluence and clinical fields in the average gamma parameter. A critical value of average gamma has been specified for the test fluence as a criterion for distinguishing between poorly and well deliverable plans. It will not be possible to only verify the most complex field of a plan but verification of individual plans could be replaced by a morning check of the suggested test fluence, together with a well-established set of QA tests. (Author)

  11. Creating a comprehensive customer service program to help convey critical and acute results of radiology studies.

    Science.gov (United States)

    Towbin, Alexander J; Hall, Seth; Moskovitz, Jay; Johnson, Neil D; Donnelly, Lane F

    2011-01-01

    Communication of acute or critical results between the radiology department and referring clinicians has been a deficiency of many radiology departments. The failure to perform or document these communications can lead to poor patient care, patient safety issues, medical-legal issues, and complaints from referring clinicians. To mitigate these factors, a communication and documentation tool was created and incorporated into our departmental customer service program. This article will describe the implementation of a comprehensive customer service program in a hospital-based radiology department. A comprehensive customer service program was created in the radiology department. Customer service representatives were hired to answer the telephone calls to the radiology reading rooms and to help convey radiology results. The radiologists, referring clinicians, and customer service representatives were then linked via a novel workflow management system. This workflow management system provided tools to help facilitate the communication needs of each group. The number of studies with results conveyed was recorded from the implementation of the workflow management system. Between the implementation of the workflow management system on August 1, 2005, and June 1, 2009, 116,844 radiology results were conveyed to the referring clinicians and documented in the system. This accounts for more than 14% of the 828,516 radiology cases performed in this time frame. We have been successful in creating a comprehensive customer service program to convey and document communication of radiology results. This program has been widely used by the ordering clinicians as well as radiologists since its inception.

  12. [Effects of a coaching program on comprehensive lifestyle modification for women with gestational diabetes mellitus].

    Science.gov (United States)

    Ko, Jung Mi; Lee, Jong Kyung

    2014-12-01

    The purpose of this study was to investigate the effects of using a Coaching Program on Comprehensive Lifestyle Modification with pregnant women who have gestational diabetes. The research design for this study was a non-equivalent control group quasi-experimental study. Pregnant women with gestational diabetes were recruited from D women's hospital located in Gyeonggi Province from April to October, 2013. Participants in this study were 34 for the control group and 34 for the experimental group. The experimental group participated in the Coaching Program on Comprehensive Lifestyle Modification. The program consisted of education, small group coaching and telephone coaching over 4weeks. Statistical analysis was performed using the SPSS 21.0 program. There were significant improvements in self-care behavior, and decreases in depression, fasting blood sugar and HbA1C in the experimental group compared to the control group. However, no significant differences were found between the two groups for knowledge of gestational diabetes mellitus. The Coaching Program on Comprehensive Lifestyle Modification used in this study was found to be effective in improving self-care behavior and reducing depression, fasting blood sugar and HbA1C, and is recommended for use in clinical practice as an effective nursing intervention for pregnant women with gestational diabetes.

  13. Cardiac autonomic function in patients with diabetes improves with practice of comprehensive yogic breathing program

    Directory of Open Access Journals (Sweden)

    Viveka P Jyotsna

    2013-01-01

    Full Text Available Background: The aim of this study was to observe the effect comprehensive yogic breathing (Sudarshan Kriya Yoga [SKY] and Pranayam had on cardiac autonomic functions in patients with diabetes. Materials and Methods: This is a prospective randomized controlled intervention trial. Cardiac autonomic functions were assessed in 64 diabetics. Patients were randomized into two groups, one group receiving standard therapy for diabetes and the other group receiving standard therapy for diabetes and comprehensive yogic breathing program. Standard therapy included dietary advice, brisk walking for 45 min daily, and administration of oral antidiabetic drugs. Comprehensive yogic breathing program was introduced to the participants through a course of 12 h spread over 3 days. It was an interactive session in which SKY, a rhythmic cyclical breathing, preceded by Pranayam is taught under the guidance of a certified teacher. Cardiac autonomic function tests were done before and after 6 months of intervention. Results: In the intervention group, after practicing the breathing techniques for 6 months, the improvement in sympathetic functions was statistically significant (P 0.04. The change in sympathetic functions in the standard therapy group was not significant (P 0.75.Parasympathetic functions did not show any significant change in either group. When both parasympathetic and sympathetic cardiac autonomic functions were considered, there was a trend toward improvement in patients following comprehensive yogic breathing program (P 0.06. In the standard therapy group, no change in cardiac autonomic functions was noted (P 0.99. Conclusion: Cardiac autonomic functions improved in patients with diabetes on standard treatment who followed the comprehensive yogic breathing program compared to patients who were on standard therapy alone.

  14. Dosimetric verification of IMRT plans

    International Nuclear Information System (INIS)

    Bulski, W.; Cheimicski, K.; Rostkowska, J.

    2012-01-01

    Intensity modulated radiotherapy (IMRT) is a complex procedure requiring proper dosimetric verification. IMRT dose distributions are characterized by steep dose gradients which enable to spare organs at risk and allow for an escalation of the dose to the tumor. They require large number of radiation beams (sometimes over 10). The fluence measurements for individual beams are not sufficient for evaluation of the total dose distribution and to assure patient safety. The methods used at the Centre of Oncology in Warsaw are presented. In order to measure dose distributions in various cross-sections the film dosimeters were used (radiographic Kodak EDR2 films and radiochromic Gafchromic EBT films). The film characteristics were carefully examined. Several types of tissue equivalent phantoms were developed. A methodology of comparing measured dose distributions against the distributions calculated by treatment planning systems (TPS) was developed and tested. The tolerance level for this comparison was set at 3% difference in dose and 3 mm in distance to agreement. The so called gamma formalism was used. The results of these comparisons for a group of over 600 patients are presented. Agreement was found in 87 % of cases. This film dosimetry methodology was used as a benchmark to test and validate the performance of commercially available 2D and 3D matrices of detectors (ionization chambers or diodes). The results of these validations are also presented. (authors)

  15. Impacting Children’s Health and Academic Performance through Comprehensive School Physical Activity Programming

    Directory of Open Access Journals (Sweden)

    Timothy A. BRUSSEAU

    2015-06-01

    Full Text Available Physical activity is associated with numerous academic and health benefits. Furthermore, schools have been identified as an ideal location to promote physical activity as most youth attend school regularly from ages 5-18. Unfortunately, in an effort to increase academic learning time, schools have been eliminating traditional activity opportunities including physical education and recess. To combat physical inactivity in you, numerous organizations are promoting a Comprehensive School Physical Activity Program to encourage academic achievement and overall health. Comprehensive School Physical Activity Programs include five components and should be centered around 1 quality physical education, 2 physical activity before and after school, 3 physical activity during school (both recess and classroom activity, 4 staff involvement, and 5 family and community engagement.

  16. Dosimetry audit for a multi-centre IMRT head and neck trial

    International Nuclear Information System (INIS)

    Clark, Catharine H.; Hansen, Vibeke Nordmark; Chantler, Hannah; Edwards, Craig; James, Hayley V.; Webster, Gareth; Miles, Elizabeth A.; Guerrero Urbano, M. Teresa; Bhide, Shree A.; Bidmead, A. Margaret; Nutting, Christoper M.

    2009-01-01

    Background and purpose: PARSPORT was a multi-centre randomised trial in the UK which compared Intensity-Modulated Radiotherapy (IMRT) and conventional radiotherapy (CRT) for patients with head and neck cancer. The dosimetry audit goals were to verify the plan delivery in participating centres, ascertain what tolerances were suitable for head and neck IMRT trials and develop an IMRT credentialing program. Materials and methods: Centres enrolling patients underwent rigorous quality assurance before joining the trial. Following this each centre was visited for a dosimetry audit, which consisted of treatment planning system tests, fluence verification films, combined field films and dose point measurements. Results: Mean dose point measurements were made at six centres. For the primary planning target volume (PTV) the differences with the planned values for the IMRT and CRT arms were -0.6% (1.8% to -2.4%) and 0.7% (2.0% to -0.9%), respectively. Ninety-four percent of the IMRT fluence films for individual fields passed gamma criterion of 3%/3 mm and 75% of the films for combined fields passed gamma criterion 4%/3 mm (no significant difference between dynamic delivery and step and shoot delivery). Conclusions: This audit suggests that a 3% tolerance could be applied for PTV point doses. For dose distributions tolerances of 3%/3 mm on individual fields and 4%/3 mm for combined fields are proposed for multi-centre head and neck IMRT trials.

  17. A study of the international trend and comprehensive enhancement program on the Nuclear Power Plant safety

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Soon Hong; Cho, Nam Jin; Paek, Won Phil [Korea Advanced Institute of Science and Technology, Taejon (Korea, Republic of)

    1990-12-15

    The objectives of this study are as follows : overview of the international trend related to the safety of Nuclear Power Plant(NPPs), study of the present status of NPP safety in Korea in aspects of design, construction and operation, suggestion of the comprehensive program to improve NPP safety in Korea. The results of this study can contribute to improve the safety of existing and future NPPs, and to establish the severe accident policy in Korea.

  18. A study of the international trend and comprehensive enhancement program on the Nuclear Power Plant safety

    International Nuclear Information System (INIS)

    Jang, Soon Hong; Cho, Nam Jin; Paek, Won Phil

    1990-12-01

    The objectives of this study are as follows : overview of the international trend related to the safety of Nuclear Power Plant(NPPs), study of the present status of NPP safety in Korea in aspects of design, construction and operation, suggestion of the comprehensive program to improve NPP safety in Korea. The results of this study can contribute to improve the safety of existing and future NPPs, and to establish the severe accident policy in Korea

  19. Comprehensive Legislative Reform to Protect the Integrity of the 340B Drug Discount Program.

    Science.gov (United States)

    Zeta, Lowell M

    2015-01-01

    The 40B Drug Discount Program (340B Program) is a federally facilitated program that requires drug manufacturers to provide steep discounts on outpatient prescription drugs to qualifying safety net health care providers. The federal program is intended as a safeguard to ensure access to affordable drugs to the indigeut. However, over the last two decades safety net health care providers have exploited financial incentives under the 340B Program at the expense of drug manufacturers and patients, including the most needy and vulnerable populations-they are committed to serve. Although the federal government has been applauded for increasing effortsto combat health care fraud and abuse including recovering $3.3 billion in 2014, federal officials and the general public have paid markedly less attention to pervasive abuse of the 340B Program. In 2014, drug purchases of 340B-designated drugs totaled $7 billion and are expected to increase to $12 billion: by 2016 as a result of the expansion of the program under the Affordable Care Act. The 340B Program has completely lost its way, and comprehensive legislation is necessary to realign the program with its intent.

  20. Beam position optimisation for IMRT

    International Nuclear Information System (INIS)

    Holloway, L.; Hoban, P.

    2001-01-01

    Full text: The introduction of IMRT has not generally resulted in the use of optimised beam positions because to find the global solution of the problem a time consuming stochastic optimisation method must be used. Although a deterministic method may not achieve the global minimum it should achieve a superior dose distribution compared to no optimisation. This study aimed to develop and test such a method. The beam optimisation method developed relies on an iterative process to achieve the desired number of beams from a large initial number of beams. The number of beams is reduced in a 'weeding-out' process based on the total fluence which each beam delivers. The process is gradual, with only three beams removed each time (following a small number of iterations), ensuring that the reduction in beams does not dramatically affect the fluence maps of those remaining. A comparison was made between the dose distributions achieved when the beams positions were optimised in this fashion and when the beams positions were evenly distributed. The method has been shown to work quite effectively and efficiently. The Figure shows a comparison in dose distribution with optimised and non optimised beam positions for 5 beams. It can be clearly seen that there is an improvement in the dose distribution delivered to the tumour and a reduction in the dose to the critical structure with beam position optimisation. A method for beam position optimisation for use in IMRT optimisations has been developed. This method although not necessarily achieving the global minimum in beam position still achieves quite a dramatic improvement compared with no beam position optimisation and is very efficiently achieved. Copyright (2001) Australasian College of Physical Scientists and Engineers in Medicine

  1. Building the basis for a comprehensive radiation protection program for a multi-program laboratory

    International Nuclear Information System (INIS)

    Copenhaver, E.D.

    1987-01-01

    An explicit, workplace-specific training has been developed, implemented, and documented for all radiation workers. In addition to the radiation worker personnel located at reactors, accelerators, radiochemical laboratories, and waste treatment areas, we have trained other personnel who work in areas where a lesser potential for radiological/chemical exposure exists. These workforces include construction crews, site restoration crews, contracted special services such as scoping and site characterization teams, and short-term visitors. We are developing a comprehensive, integrated approach to radiation protection training suited for a multi-purpose research laboratory. 9 refs., 1 fig., 1 tab

  2. 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

  3. Physics acceptance and QA procedures for IMRT

    International Nuclear Information System (INIS)

    LoSasso, T.; Ling, C.

    2001-01-01

    Full text: Intensity modulated radiation therapy (IMRT) may improve tumor control without compromising normal tissues by facilitating higher, more conformal tumor doses relative to 3D CRT. Intensity modulation (IM) is now possible with inverse planning and radiation delivery using dynamic multileaf collimation. Compared to 3D CRT, certain components in the IMRT process are more obscure to the user. Thus, special quality assurance procedures are required. Hardware and software are still relatively new to many users, and the potential for error is unknown. The relationship between monitor unit (MU) setting and radiation dose for IM beams is much more complex than for non-IM fields. The leaf sequence computer files, which control the MLC position as a function of MU, are large and do not lend themselves to simple manual verification. The 'verification' port film for each IM treatment field, usually obtained with the MLC set at the extreme leaf positions for that field to outline the entire irradiated area, does not verify the intensity modulation pattern. Finally, in IMRT using DMLC (the so-called sliding window technique), a small error in the window (or gap) width will lead to a significant dose error. In earlier papers, we provided an evaluation of the mechanical and dosimetric aspects in the use of a MLC in the dynamic mode. Mechanical tolerances are significantly tighter for DMLC than for static MLC treatments. Transmission through the leaves and through rounded leaf ends and head scatter were shown to be significant to the accuracy of radiation dose delivery using DMLC. With these considerations, we concluded that the present DMLC hardware and software are effective for routine clinical implementation, provided that a carefully designed routine QA procedure is followed to assure the normality of operation. In our earlier studies, an evaluation of the long-term stability of DMLC operation had not yet been performed. This paper describes the current status of our

  4. Significant reduction of repeat teen pregnancy in a comprehensive young parent program.

    Science.gov (United States)

    Omar, H A; Fowler, A; McClanahan, K K

    2008-10-01

    To describe a comprehensive, multidisciplinary approach to teen mothers and their children that significantly reduces repeat pregnancies. Retrospective review of repeat teen pregnancy data. Young Parent Program (YPP) at a university-based health center. 1386 teen mothers between the ages of 11 and 19 who participated in the YPP for at least three years. Comprehensive Care: for both teen mother and her baby, including prenatal and postnatal care, preventive care, reproductive services, mental health, and acute care visits. Family counseling and similar services were also provided to siblings of the teen. CONTINUITY OF CARE: Patients are seen by the same staff and attending physicians on each visit. The treatment team includes physicians, nurses, social worker, nutritionist, and psychologist, all of whom are available to provide care at each visit. Flexible hours: Including evening clinic to allow teens to attend school or work during the day. Financial incentive: Patients with no insurance are given free contraceptives and a "no charge" clinic visit. Extensive contraceptive counseling is provided prior to start of contraceptive use and at every clinic visit. Routine telephone and/or mail reminders of appointments Rate of repeat teen pregnancy. Only 11(.79%) had repeat pregnancies. Older youth appeared more likely to repeat a pregnancy. Comprehensive intervention for teen mothers can be very successful in reducing repeat teen pregnancy in those teens who participate consistently in the program over a period of years.

  5. Overview of IMRT - definitions and basic concepts

    International Nuclear Information System (INIS)

    Mackie, T.R.

    2008-01-01

    A detailed advanced outline of the title topic is presented. Summary is formulated as follows: (i) Conventional MLC, developed for block replacement, require corrections and careful QA when when used for IMRT; (ii) There are both advantages and disadvantages of static or dynamic MLC delivery; (iii) Tomotherapy uses binary MLC systems specifically designed for IMRT; (iv) There are two types of optimization, grid of beamlets and direct aperture methods; (v) Optimization is controlled by objective functions. (P.A.)

  6. A national dosimetric audit of IMRT

    International Nuclear Information System (INIS)

    Budgell, Geoff; Berresford, Joe; Trainer, Michael; Bradshaw, Ellie; Sharpe, Peter; Williams, Peter

    2011-01-01

    Background and purpose: A dosimetric audit of IMRT has been carried out within the UK between June 2009 and March 2010 in order to provide an independent check of safe implementation and to identify problems in the modelling and delivery of IMRT. Methods and materials: A mail based audit involving film and alanine dosimeters was utilized. Measurements were made for each individual field in an IMRT plan isocentrically in a flat water-equivalent phantom at a depth of 5 cm. The films and alanine dosimeters were processed and analysed centrally; additional ion chamber measurements were made by each participating centre. Results: 57 of 62 centres participated, with a total of 78 plans submitted. For the film measurements, all 176 fields from the less complex IMRT plans (including prostate and breast plans) achieved over 95% pixels passing a gamma criterion of 3%/3 mm within the 20% isodose. For the more complex IMRT plans (mainly head and neck) 8/245 fields (3.3%) achieved less than 95% pixels passing a 4%/4 mm gamma criterion. Of the alanine measurements, 4/78 (5.1%) of the measurements differed by >5% from the dose predicted by the treatment planning system. Three of these were large deviations of -77.1%, -29.1% and 14.1% respectively. Excluding the three measurements outside 10%, the mean difference was 0.05% with a standard deviation of 1.5%. The out of tolerance results have been subjected to further investigations. Conclusions: A dosimetric audit has been successfully carried out of IMRT implementation by over 90% of UK radiotherapy departments. The audit shows that modelling and delivery of IMRT is accurate, suggesting that the implementation of IMRT has been carried out safely.

  7. Physical Education Preservice Teachers' Perceptions About Preparation for Comprehensive School Physical Activity Programs.

    Science.gov (United States)

    Kwon, Ja Youn; Kulinna, Pamela Hodges; van der Mars, Hans; Koro-Ljungberg, Mirka; Amrein-Beardsley, Audrey; Norris, Jason

    2018-06-01

    Physical educators may be the responsible people for implementing comprehensive school physical activity programs (CSPAPs) in schools. However, it is unclear whether physical education teacher education (PETE) programs provide the relevant learning opportunities to preservice teachers for CSPAP implementation. The purpose of this study was to understand preservice teachers' perspectives and experiences of CSPAP preparation in their PETE programs. Fourteen PETE students from 6 different universities participated and shared their experiences in PETE programs. Data were collected through a short survey, 1 formal interview, field images, document gathering, and an additional survey to follow up the interview. Descriptive statistics, constant comparison, and analytic induction techniques were used to analyze the data. Participants' familiarity with CSPAPs was related to positive opinions about the role of physical educators in CSPAPs. Three common themes were revealed: (a) introducing CSPAP via courses, (b) the lack of programwide hands-on experiences for CSPAP, and (c) limited preparation for social skills with stakeholders. Participants' perceptions of the role of physical educators as physical activity leaders had been expanded during their training. The participating PETE programs integrated CSPAP components in the existing courses to introduce CSPAP, while there was a lack of sufficient practical opportunities to learn how to implement (aspects of) a CSPAP. Participants felt they were insufficiently prepared to promote and implement expanded physical activity programming beyond physical education classes in schools. The majority of the PETE preservice teachers wanted more practical CSPAP experiences in their programs.

  8. The effect of a comprehensive handwashing program on absenteeism in elementary schools.

    Science.gov (United States)

    Guinan, Maryellen; McGuckin, Maryanne; Ali, Yusef

    2002-06-01

    Handwashing is one of the most important factors in controlling the spread of micro-organisms and in preventing the development of infections. The objective of this study was to determine the effectiveness of a comprehensive handwashing program on absenteeism in elementary grades. Two hundred ninety students from 5 independent schools were enrolled in the study. Each test classroom had a control classroom, and only the test classroom received the intervention (education program and hand sanitizer). Absenteeism data were collected for 3 months. The number of absences was 50.6% lower in the test group (P hand hygiene program that combines education and use of a hand sanitizer in the classroom can lower absenteeism and be cost-effective.

  9. IMRT delivery verification using a spiral phantom

    International Nuclear Information System (INIS)

    Richardson, Susan L.; Tome, Wolfgang A.; Orton, Nigel P.; McNutt, Todd R.; Paliwal, Bhudatt R.

    2003-01-01

    In this paper we report on the testing and verification of a system for IMRT delivery quality assurance that uses a cylindrical solid water phantom with a spiral trajectory for radiographic film placement. This spiral film technique provides more complete dosimetric verification of the entire IMRT treatment than perpendicular film methods, since it samples a three-dimensional dose subspace rather than using measurements at only one or two depths. As an example, the complete analysis of the predicted and measured spiral films is described for an intracranial IMRT treatment case. The results of this analysis are compared to those of a single field perpendicular film technique that is typically used for IMRT QA. The comparison demonstrates that both methods result in a dosimetric error within a clinical tolerance of 5%, however the spiral phantom QA technique provides a more complete dosimetric verification while being less time consuming. To independently verify the dosimetry obtained with the spiral film, the same IMRT treatment was delivered to a similar phantom in which LiF thermoluminescent dosimeters were arranged along the spiral trajectory. The maximum difference between the predicted and measured TLD data for the 1.8 Gy fraction was 0.06 Gy for a TLD located in a high dose gradient region. This further validates the ability of the spiral phantom QA process to accurately verify delivery of an IMRT plan

  10. A comprehensive dosimetric study of pancreatic cancer treatment using three-dimensional conformal radiation therapy (3DCRT), intensity-modulated radiation therapy (IMRT), volumetric-modulated radiation therapy (VMAT), and passive-scattering and modulated-scanning proton therapy (PT)

    Energy Technology Data Exchange (ETDEWEB)

    Ding, Xuanfeng; Dionisi, Francesco; Tang, Shikui; Ingram, Mark; Hung, Chun-Yu; Prionas, Evangelos; Lichtenwalner, Phil; Butterwick, Ian; Zhai, Huifang; Yin, Lingshu; Lin, Haibo; Kassaee, Alireza; Avery, Stephen, E-mail: stephen.avery@uphs.upenn.edu

    2014-07-01

    With traditional photon therapy to treat large postoperative pancreatic target volume, it often leads to poor tolerance of the therapy delivered and may contribute to interrupted treatment course. This study was performed to evaluate the potential advantage of using passive-scattering (PS) and modulated-scanning (MS) proton therapy (PT) to reduce normal tissue exposure in postoperative pancreatic cancer treatment. A total of 11 patients with postoperative pancreatic cancer who had been previously treated with PS PT in University of Pennsylvania Roberts Proton Therapy Center from 2010 to 2013 were identified. The clinical target volume (CTV) includes the pancreatic tumor bed as well as the adjacent high-risk nodal areas. Internal (iCTV) was generated from 4-dimensional (4D) computed tomography (CT), taking into account target motion from breathing cycle. Three-field and 4-field 3D conformal radiation therapy (3DCRT), 5-field intensity-modulated radiation therapy, 2-arc volumetric-modulated radiation therapy, and 2-field PS and MS PT were created on the patients’ average CT. All the plans delivered 50.4 Gy to the planning target volume (PTV). Overall, 98% of PTV was covered by 95% of the prescription dose and 99% of iCTV received 98% prescription dose. The results show that all the proton plans offer significant lower doses to the left kidney (mean and V{sub 18} {sub Gy}), stomach (mean and V{sub 20} {sub Gy}), and cord (maximum dose) compared with all the photon plans, except 3-field 3DCRT in cord maximum dose. In addition, MS PT also provides lower doses to the right kidney (mean and V{sub 18} {sub Gy}), liver (mean dose), total bowel (V{sub 20} {sub Gy} and mean dose), and small bowel (V{sub 15} {sub Gy} absolute volume ratio) compared with all the photon plans and PS PT. The dosimetric advantage of PT points to the possibility of treating tumor bed and comprehensive nodal areas while providing a more tolerable treatment course that could be used for dose

  11. A comprehensive dosimetric study of pancreatic cancer treatment using three-dimensional conformal radiation therapy (3DCRT), intensity-modulated radiation therapy (IMRT), volumetric-modulated radiation therapy (VMAT), and passive-scattering and modulated-scanning proton therapy (PT)

    International Nuclear Information System (INIS)

    Ding, Xuanfeng; Dionisi, Francesco; Tang, Shikui; Ingram, Mark; Hung, Chun-Yu; Prionas, Evangelos; Lichtenwalner, Phil; Butterwick, Ian; Zhai, Huifang; Yin, Lingshu; Lin, Haibo; Kassaee, Alireza; Avery, Stephen

    2014-01-01

    With traditional photon therapy to treat large postoperative pancreatic target volume, it often leads to poor tolerance of the therapy delivered and may contribute to interrupted treatment course. This study was performed to evaluate the potential advantage of using passive-scattering (PS) and modulated-scanning (MS) proton therapy (PT) to reduce normal tissue exposure in postoperative pancreatic cancer treatment. A total of 11 patients with postoperative pancreatic cancer who had been previously treated with PS PT in University of Pennsylvania Roberts Proton Therapy Center from 2010 to 2013 were identified. The clinical target volume (CTV) includes the pancreatic tumor bed as well as the adjacent high-risk nodal areas. Internal (iCTV) was generated from 4-dimensional (4D) computed tomography (CT), taking into account target motion from breathing cycle. Three-field and 4-field 3D conformal radiation therapy (3DCRT), 5-field intensity-modulated radiation therapy, 2-arc volumetric-modulated radiation therapy, and 2-field PS and MS PT were created on the patients’ average CT. All the plans delivered 50.4 Gy to the planning target volume (PTV). Overall, 98% of PTV was covered by 95% of the prescription dose and 99% of iCTV received 98% prescription dose. The results show that all the proton plans offer significant lower doses to the left kidney (mean and V 18 Gy ), stomach (mean and V 20 Gy ), and cord (maximum dose) compared with all the photon plans, except 3-field 3DCRT in cord maximum dose. In addition, MS PT also provides lower doses to the right kidney (mean and V 18 Gy ), liver (mean dose), total bowel (V 20 Gy and mean dose), and small bowel (V 15 Gy absolute volume ratio) compared with all the photon plans and PS PT. The dosimetric advantage of PT points to the possibility of treating tumor bed and comprehensive nodal areas while providing a more tolerable treatment course that could be used for dose escalation and combining with radiosensitizing

  12. Implementing a Death with Dignity program at a comprehensive cancer center.

    Science.gov (United States)

    Loggers, Elizabeth Trice; Starks, Helene; Shannon-Dudley, Moreen; Back, Anthony L; Appelbaum, Frederick R; Stewart, F Marc

    2013-04-11

    The majority of Death with Dignity participants in Washington State and Oregon have received a diagnosis of terminal cancer. As more states consider legislation regarding physician-assisted death, the experience of a comprehensive cancer center may be informative. We describe the implementation of a Death with Dignity program at Seattle Cancer Care Alliance, the site of care for the Fred Hutchinson-University of Washington Cancer Consortium, a comprehensive cancer center in Seattle that serves the Pacific Northwest. Institution-level data were compared with publicly available statewide data from Oregon and Washington. A total of 114 patients inquired about our Death with Dignity program between March 5, 2009, and December 31, 2011. Of these, 44 (38.6%) did not pursue the program, and 30 (26.3%) initiated the process but either elected not to continue or died before completion. Of the 40 participants who, after counseling and upon request, received a prescription for a lethal dose of secobarbital (35.1% of the 114 patients who inquired about the program), all died, 24 after medication ingestion (60% of those obtaining prescriptions). The participants at our center accounted for 15.7% of all participants in the Death with Dignity program in Washington (255 persons) and were typically white, male, and well educated. The most common reasons for participation were loss of autonomy (97.2%), inability to engage in enjoyable activities (88.9%), and loss of dignity (75.0%). Eleven participants lived for more than 6 months after prescription receipt. Qualitatively, patients and families were grateful to receive the lethal prescription, whether it was used or not. Overall, our Death with Dignity program has been well accepted by patients and clinicians.

  13. Incorporating person centred care principles into an ongoing comprehensive cancer management program: An experiential account

    Directory of Open Access Journals (Sweden)

    Vallath Nandini

    2011-01-01

    Full Text Available Recent research indicates a definite positive impact on treatment outcomes when an integrative approach that focuses on symptom control and quality of life is provided along with the standard therapeutic regimens. However implementation or practice of this approach is not seen widely due to the culture of medical training and practice. This article presents the initial development of a program for incorporating integrative care principles into an ongoing comprehensive cancer care program at a tertiary centre. The key purpose of the program being to develop, facilitate, and establish comprehensive and holistic processes including palliative care principles, that would positively enhance the quantity and quality of life of the person with disease, as well as create an environment that reflects and sustains this approach. The vision, objectives, goals, strategies, activities and results within the 7 months of implementation are documented. The new learnings gained during the process have also been noted in the hope that the model described may be used to conceptualize similar care giving facilities in other centres.

  14. A Video-Based CALL Program for Proficient and Less-Proficient L2 Learners' Comprehension Ability, Incidental Vocabulary Acquisition

    Science.gov (United States)

    Lin, Lu-Fang

    2010-01-01

    This study investigates first whether news video in a computer-assisted language learning (CALL) program can foster second language (L2) comprehension and incidental acquisition of adjectives, nouns, and verbs. Second, this study examines the relationship between the participants' vocabulary acquisition and their video comprehension. The…

  15. Progress and Impact. A Report of Programs Funded for 1995-96 by the Comprehensive Health Education Act of 1990.

    Science.gov (United States)

    Terrill, Jerry L.; Connell, Karen

    During the 1995-96 school year, the Colorado Department of Education supported Comprehensive Health Education Programs as authorized by the Comprehensive Health Education Act of 1990. This report summarizes the projects funded under that grant along with additional observations and recommendations regarding the operation of such grants. Grant…

  16. A Program Based on the Pragmatic Theory to Develop Grammatical Structure Comprehension Skills for Foreign Learners of Arabic

    Science.gov (United States)

    Elsamman, Marwan

    2014-01-01

    This study aimed at designing a program based on the Pragmatic theory to develop grammatical structure comprehension skills for foreign learners of Arabic and examining its effectiveness. Hence, the problem of the study has been summarized in the weakness of grammatical structure comprehension skills for foreign learners of Arabic and in the need…

  17. The Effects of Visual Cues and Learners' Field Dependence in Multiple External Representations Environment for Novice Program Comprehension

    Science.gov (United States)

    Wei, Liew Tze; Sazilah, Salam

    2012-01-01

    This study investigated the effects of visual cues in multiple external representations (MER) environment on the learning performance of novices' program comprehension. Program codes and flowchart diagrams were used as dual representations in multimedia environment to deliver lessons on C-Programming. 17 field independent participants and 16 field…

  18. A comprehensive joint replacement program for total knee arthroplasty: a descriptive study

    Directory of Open Access Journals (Sweden)

    Prefontaine Paul

    2008-11-01

    Full Text Available Abstract Background Total knee arthroplasty (TKA is a commonly performed surgical procedure in the US. It is important to have a comprehensive inpatient TKA program which maximizes outcomes while minimizing adverse events. The purpose of this study was to describe a TKA program – the Joint Replacement Program (JRP – and report post-surgical outcomes. Methods 74 candidates for a primary TKA were enrolled in the JRP. The JRP was designed to minimize complications and optimize patient-centered outcomes using a team approach including the patient, patient's family, and a multidisciplinary team of health professionals. The JRP consisted of a pre-operative class, standard pathways for medical care, comprehensive peri-operative pain management, aggressive physical therapy (PT, and proactive discharge planning. Measures included functional tests, knee range of motion (ROM, and medical record abstraction of patient demographics, length of stay, discharge disposition, and complications over a 6-month follow-up period. Results All patients achieved medical criteria for hospital discharge. The patients achieved the knee flexion ROM goal of 90° (91.7 ± 5.4°, but did not achieve the knee extension ROM goal of 0° (2.4 ± 2.6°. The length of hospital stay was two days for 53% of the patients, with 39% and 7% discharged in three and four days, respectively. All but three patients were discharged home with functional independence. 68% of these received outpatient physical therapy compared with 32% who received home physical therapy immediately after discharge. Two patients ( Conclusion The comprehensive JRP for TKA was associated with satisfactory clinical outcomes, short lengths of stay, a high percentage of patients discharged home with outpatient PT, and minimal complications. This JRP may represent an efficient, effective and safe protocol for providing care after a TKA.

  19. The effect of comprehensive sexual education program on sexual health knowledge and sexual attitude among college students in southwest China

    NARCIS (Netherlands)

    Chi, X.; Hawk, S.T.; Winter, S.; Meeus, W.H.J.

    2015-01-01

    The purpose of this study was to evaluate whether a comprehensive sexual education program for college students in Southwest China (a) improved sexual health knowledge in reproduction, contraception, condom use, sexually transmitted diseases, and HIV; (b) increased accepting attitudes toward

  20. Effectiveness of comprehensive care programs for patients with multiple chronic conditions or frailty : A systematic literature review

    NARCIS (Netherlands)

    Hopman, Petra; De Bruin, Simone R.; Forjaz, Maria João; Rodriguez-blazquez, Carmen; Tonnara, Giuseppe; Lemmens, Lidwien C.; Onder, Graziano; Baan, Caroline A.; Rijken, Mieke

    2016-01-01

    Objective To describe comprehensive care programs targeting multimorbid and/or frail patients and to estimate their effectiveness regarding improvement of patient and caregiver related outcomes, healthcare utilization and costs. Methods Systematic search in six electronic databases for scientific

  1. The effect of comprehensive sexual education program on sexual health knowledge and sexual attitude among college students in Southwest China

    NARCIS (Netherlands)

    Chi, Xinli; Hawk, Skyler T; Winter, Sam; Meeus, Wim

    The purpose of this study was to evaluate whether a comprehensive sexual education program for college students in Southwest China (a) improved sexual health knowledge in reproduction, contraception, condom use, sexually transmitted diseases, and HIV; (b) increased accepting attitudes toward

  2. An Investigation of Classroom Practices in Teaching Listening Comprehension at English Education Program

    Directory of Open Access Journals (Sweden)

    Nurhafni Siregar

    2017-12-01

    Full Text Available The objective of this study is to investigate how the classroom practice in teaching listening comprehension at English Education Program of STKIP Tapanuli Selatan in 2016/2017 Academic Year is. The informants of this research were all of second semester students of STKIP Tapanuli Selatan in 2016/2017 academic year and a lecturer of listening comprehension at STKIP Tapanuli Selatan (63 students and one lecturer. A descriptive study was used to achieve the objective of the study. The sample was taken by cluster sampling. The data were collected by using interview to know how the lecturer carried out the teaching practice of listening, and questionnaire  for the students and observation were used to find out how the calssroom activities were conducted. The descriptive analysis was used to anayse the data. Based on the data analysis, it was found that: (1 the lecturer carried out listening activities into four parts, they are preparation, prediction stage, listening, and post listening, and (2 the practice of teaching listening was effective related to the teaching pedagogical procedures in teaching listening comprehension. although there were some points that should be practice further. Based on the findings, it was recomended that the lecturer and the students may apply the less activities that had not been done.

  3. Systematization and sophistication of a comprehensive sensitivity analysis program. Phase 2

    International Nuclear Information System (INIS)

    Oyamada, Kiyoshi; Ikeda, Takao

    2004-02-01

    This study developed minute estimation by adopting comprehensive sensitivity analytical program for reliability of TRU waste repository concepts in a crystalline rock condition. We examined each components and groundwater scenario of geological repository and prepared systematic bases to examine the reliability from the point of comprehensiveness. Models and data are sophisticated to examine the reliability. Based on an existing TRU waste repository concepts, effects of parameters to nuclide migration were quantitatively classified. Those parameters, that will be decided quantitatively, are such as site character of natural barrier and design specification of engineered barriers. Considering the feasibility of those figures of specifications, reliability is re-examined on combinations of those parameters within a practical range. Future issues are; Comprehensive representation of hybrid geosphere model including the fractured medium and permeable matrix medium. Sophistication of tools to develop the reliable combinations of parameters. It is significant to continue this study because the disposal concepts and specification of TRU nuclides containing waste on various sites shall be determined rationally and safely through these studies. (author)

  4. Dose tracking and dose auditing in a comprehensive computed tomography dose-reduction program.

    Science.gov (United States)

    Duong, Phuong-Anh; Little, Brent P

    2014-08-01

    Implementation of a comprehensive computed tomography (CT) radiation dose-reduction program is a complex undertaking, requiring an assessment of baseline doses, an understanding of dose-saving techniques, and an ongoing appraisal of results. We describe the role of dose tracking in planning and executing a dose-reduction program and discuss the use of the American College of Radiology CT Dose Index Registry at our institution. We review the basics of dose-related CT scan parameters, the components of the dose report, and the dose-reduction techniques, showing how an understanding of each technique is important in effective auditing of "outlier" doses identified by dose tracking. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Comprehensive review of an accelerated nursing program: a quality improvement project.

    Science.gov (United States)

    Nugent, Elinor; LaRocco, Susan

    2014-01-01

    Accelerated second-degree programs are designed to provide entry into baccalaureate nursing program for people who have achieved bachelor's degree in another field. These programs were often designed to respond to nursing shortages at local and national levels. Programs commonly use a cohort model and move students through an intensive structure combining classroom and clinical requirement with a 2-year period. The accelerated second-degree nursing program, Accelerated Entry Level to Nursing program at our small liberal arts college, was considered to be successful. The program had excellent graduation rates and National Council Licensure Examination for Registered Nurses pass rates, indicating that the program was preparing the graduate to thrive in the practice setting. The program had been in existence for more than 7 years, with highly competitive admissions and high student satisfaction. The objective of this study was to provide a quality improvement assessment process to capture quantitative and qualitative information about the graduates. This information would be used to inform our own nursing education department and would provide metrics and information for nurse leaders regarding the rigor of these programs and the potential of graduates. Continuous quality improvement is a vital component in nursing education as well as in the clinical setting. With this in mind, a comprehensive review was undertaken by the nursing faculty during the eighth year of the highly successful accelerated nursing program in a small liberal arts college. This quality improvement project was designed to review existing metrics and to collect additional data through survey and focus groups in order to capture experiences of the program graduates. Graduates of the accelerated program from 2005 to 2011 were included in this study. Faculty who teach in the program participated in focus groups. From 2005 to 2011, there have been a total of 196 graduates in 8 cohorts; 194 surveys

  6. A Correlational Study of a Reading Comprehension Program and Attrition Rates of ESL Nursing Students in Texas.

    Science.gov (United States)

    Donnell, Wendy M

    The purpose of this study was to examine the associations between English as a second language (ESL), a reading comprehension program, and attrition rates of nursing students. Higher attrition rates of ESL nursing students are an assumption, seemingly based on anecdotal evidence. Data reflecting ESL student attrition should be measured and analyzed so that students can be identified prior to attrition. A secondary analysis of a large database of 27 initial licensure programs in Texas was completed. Data analysis identified that ESL students who used a reading comprehension program were almost twice as likely to be off track or out of the program as ESL students who did not use the program. Nurse educators need to evaluate student profile characteristics in a comprehensive way when determining risk of attrition.

  7. Comprehensive care program for elderly patients over 65 years with hip fracture.

    Science.gov (United States)

    Fernández-Moyano, A; Fernández-Ojeda, R; Ruiz-Romero, V; García-Benítez, B; Palmero-Palmero, C; Aparicio-Santos, R

    2014-01-01

    To report the health outcomes of a multidisciplinary care program for patients over 65 years with hip fracture. We have developed a care coordination model for the comprehensive care of hip fracture patients. It establishes what, who, when, how and where orthopedists, internists, family physicians, emergency, intensive care, physiotherapists, anesthetists, nurses and workers social intervene. All elderly patients over 65 years admitted with the diagnosis of hip fracture (years 2006 to 2010) were retrospectively evaluated. One thousand episodes of hip fracture, corresponding to 956 patients, were included. Mean age was 82 years and mean stay 6.7 days. This was reduced by 1.14 days during the 5 years of the program. A total of 85.1% were operated on before 72 yours, and 91.2% during the program. Incidence of surgical site infection was 1.5%. In-hospital mortality was 4.5%, (24.2% at 12 months). Readmissions at one years was 14.9%. Independence for basic activity of daily living was achieved by 40% of the patients. This multidisciplinary care program for hip fracture patients is associated with positive health outcomes, with a high percentage of patients treated early (more than 90%), reduced mean stay (less than 7 days), incidence of surgical site infections, readmissions and inpatient mortality and at one year, as well as adequate functional recovery. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  8. Development and implementation of a comprehensive quality assurance program at a community endoscopy facility.

    Science.gov (United States)

    Hilsden, Robert Jay; Rostom, Alaa; Dubé, Catherine; Pontifex, Darlene; McGregor, S Elizabeth; Bridges, Ronald J

    2011-10-01

    Quality assurance (QA) is a process that includes the systematic evaluation of a service, institution of improvements and ongoing evaluation to ensure that effective changes were made. QA is a fundamental component of any organized colorectal cancer screening program. However, it should play an equally important role in opportunistic screening. Establishing the processes and procedures for a comprehensive QA program can be a daunting proposition for an endoscopy unit. The present article describes the steps taken to establish a QA program at the Forzani & MacPhail Colon Cancer Screening Centre (Calgary, Alberta) - a colorectal cancer screening centre and nonhospital endoscopy unit that is dedicated to providing colorectal cancer screening-related colonoscopies. Lessons drawn from the authors' experience may help others develop their own initiatives. The Global Rating Scale, a quality assessment and improvement tool developed for the gastrointestinal endoscopy services of the United Kingdom's National Health Service, was used as the framework to develop the QA program. QA activities include monitoring the patient experience through surveys, creating endoscopist report cards on colonoscopy performance, tracking and evaluating adverse events and monitoring wait times.

  9. Development and Implementation of a Comprehensive Quality Assurance Program at a Community Endoscopy Facility

    Directory of Open Access Journals (Sweden)

    Robert J Hilsden

    2011-01-01

    Full Text Available Quality assurance (QA is a process that includes the systematic evaluation of a service, institution of improvements and ongoing evaluation to ensure that effective changes were made. QA is a fundamental component of any organized colorectal cancer screening program. However, it should play an equally important role in opportunistic screening. Establishing the processes and procedures for a comprehensive QA program can be a daunting proposition for an endoscopy unit. The present article describes the steps taken to establish a QA program at the Forzani & MacPhail Colon Cancer Screening Centre (Calgary, Alberta – a colorectal cancer screening centre and nonhospital endoscopy unit that is dedicated to providing colorectal cancer screening-related colonoscopies. Lessons drawn from the authors’ experience may help others develop their own initiatives. The Global Rating Scale, a quality assessment and improvement tool developed for the gastrointestinal endoscopy services of the United Kingdom’s National Health Service, was used as the framework to develop the QA program. QA activities include monitoring the patient experience through surveys, creating endoscopist report cards on colonoscopy performance, tracking and evaluating adverse events and monitoring wait times.

  10. Martin Marietta Paducah Gaseous Diffusion Plant comprehensive earthquake emergency management program

    International Nuclear Information System (INIS)

    1990-01-01

    Recognizing the value of a proactive, integrated approach to earthquake preparedness planning, Martin Marietta Energy Systems, Inc. initiated a contract in June 1989 with Murray State University, Murray, Kentucky, to develop a comprehensive earthquake management program for their Gaseous Diffusion Plant in Paducah, Kentucky. The overall purpose of the program is to mitigate the loss of life and property in the event of a major destructive earthquake. The program includes four distinct (yet integrated) components: an emergency management plan, with emphasis on the catastrophic earthquake; an Emergency Operations Center Duty Roster Manual; an Integrated Automated Emergency Management Information System (IAEMIS); and a series of five training program modules. The PLAN itself is comprised of four separate volumes: Volume I -- Chapters 1--3; Volume II -- Chapters 4--6, Volume III -- Chapter 7, and Volume IV -- 23 Appendices. The EOC Manual (which includes 15 mutual aid agreements) is designated as Chapter 7 in the PLAN and is a ''stand alone'' document numbered as Volume III. This document, Volume I, provides an introduction, summary and recommendations, and the emergency operations center direction and control

  11. Navigating Return to Work and Breastfeeding in a Hospital with a Comprehensive Employee Lactation Program.

    Science.gov (United States)

    Froh, Elizabeth B; Spatz, Diane L

    2016-11-01

    The Surgeon General's Call to Action to Support Breastfeeding details the need for comprehensive employer lactation support programs. Our institution has an extensive employee lactation program, and our breastfeeding initiation and continuation rates are statistically significantly higher than state and national data, with more than 20% of our employees breastfeeding for more than 1 year. The objective of this research was complete secondary data analysis of qualitative data collected as part of a larger study on breastfeeding outcomes. In the larger study, 545 women who returned to work full or part time completed an online survey with the ability to provide free text qualitative data and feedback regarding their experiences with breastfeeding after return to work. Qualitative data were pulled from the online survey platform. The responses to these questions were analyzed using conventional content analysis by the research team (2 PhD-prepared nurse researchers trained and experienced in qualitative methodologies and 1 research assistant) in order to complete a thematic analysis of the survey data. Analysis of the data yielded 5 major themes: (1) positive reflections, (2) nonsupportive environment/work culture, (3) supportive environment/work culture, (4) accessibility of resources, and (5) internal barriers. The themes that emerged from this research clearly indicate that even in a hospital with an extensive employee lactation program, women have varied experiences-some more positive than others. Returning to work while breastfeeding requires time and commitment of the mother, and a supportive employee lactation program may ease that transition of return to work.

  12. Martin Marietta Paducah Gaseous Diffusion Plant comprehensive earthquake emergency management program

    International Nuclear Information System (INIS)

    1990-01-01

    Recognizing the value of a proactive, integrated approach to earthquake preparedness planning, Martin Marietta Energy Systems, Inc. initiated a contract in June 1989 with Murray State University, Murray, Kentucky, to develop a comprehensive earthquake management program for their Gaseous Diffusion Plant in Paducah, Kentucky (PGDP -- Subcontract No. 19P-JV649V). The overall purpose of the program is to mitigate the loss of life and property in the event of a major destructive earthquake. The program includes four distinct (yet integrated) components: an emergency management plan, with emphasis on the catastrophic earthquake; an Emergency Operations Center Duty Roster Manual; an Integrated Automated Emergency Management Information System (IAEMIS); and a series of five training program modules. The PLAN itself is comprised of four separate volumes: Volume I -- Chapters 1--3; Volume II -- Chapters 4--6, Volume III -- Chapter 7, and Volume IV -- 23 Appendices. The EOC Manual (which includes 15 mutual aid agreements) is designated as Chapter 7 in the PLAN and is a ''stand alone'' document numbered as Volume III. This document, Volume II, discusses methodology, engineering and environmental analyses, and operational procedures

  13. Martin Marietta Paducah Gaseous Diffusion Plant comprehensive earthquake emergency management program

    International Nuclear Information System (INIS)

    1990-01-01

    Recognizing the value of a proactive, integrated approach to earthquake preparedness planning, Martin Marietta Energy Systems, Inc, initiated a contract in June 1989 with Murray State University, Murray, Kentucky, to develop a comprehensive earthquake management program for their Gaseous Diffusion Plant in Paducah, Kentucky (PGDP--Subcontract No. 19P-JV649V). The overall purpose of the program is to mitigate the loss of life and property in the event of a major destructive earthquake. The program includes four distinct (yet integrated) components: (1) an emergency management plan, with emphasis on the catas trophic earthquake, (2) an Emergency Operations Center Duty Roster Manual, (3) an Integrated Automated Emergency Management Information System (IAEMIS), and (4) a series of five training program modules. The PLAN itself is comprised of four separate volumes: Volume I--Chapters 1--3; Volume II--Chapters 4--6, Volume III--Chapter 7, and Volume IV--23 Appendices. The EOC Manual (which includes 15 mutual aid agreements) is designated as Chapter 7 in the PLAN and is a ''stand alone'' document numbered as Volume III. This document, Volume IV contains the appendices to this report

  14. Martin Marietta Paducah Gaseous Diffusion Plant comprehensive earthquake emergency management program

    International Nuclear Information System (INIS)

    1990-01-01

    Recognizing the value of a proactive, integrated approach to earthquake preparedness planning, Martin Marietta Energy Systems, Inc. initiated a contract in June 1989 with Murray State University, Murray, Kentucky, to develop a comprehensive earthquake management program for their Gaseous Diffusion Plant in Paducah, Kentucky (PGDP -- Subcontract No. 19P-JV649V). The overall purpose of the program is to mitigate the loss of life and property in the event of a major destructive earthquake. The program includes four distinct (yet integrated) components: (1) an emergency management plan with emphasis on the catas trophic earthquake; (2) an Emergency Operations Center Duty Roster Manual; (3) an Integrated Automated Emergency Management Information System (IAEMIS); and (4) a series of five training program modules. The PLAN itself is comprised of four separate volumes: Volume I -- Chapters 1--3; Volume II -- Chapters 4--6; Volume III -- Chapter 7; and Volume IV -- 23 Appendices. The EOC Manual (which includes 15 mutual aid agreements) is designated as Chapter 7 in the PLAN and is this document numbered as Volume III

  15. Intensity modulated radiotherapy (IMRT) in bilateral retinoblastoma

    International Nuclear Information System (INIS)

    Atalar, Banu; Ozyar, Enis; Gunduz, Kaan; Gungor, Gorkem

    2010-01-01

    External beam radiotherapy (EBRT) for retinoblastoma has traditionally been done with conventional radiotherapy techniques which resulted high doses to the surrounding normal tissues. A 20 month-old girl with group D bilateral retinoblastoma underwent intensity modulated radiotherapy (IMRT) to both eyes after failing chemoreduction and focal therapies including cryotherapy and transpupillary thermotherapy. In this report, we discuss the use of IMRT as a method for reducing doses to adjacent normal tissues while delivering therapeutic doses to the tumour tissues compared with 3-dimensional conformal radiotherapy (3DCRT). At one year follow-up, the patient remained free of any obvious radiation complications. Image guided IMRT provides better dose distribution than 3DCRT in retinoblastoma eyes, delivering the therapeutic dose to the tumours and minimizing adjacent tissue damage

  16. Intensity modulated radiation therapy (IMRT: differences in target volumes and improvement in clinically relevant doses to small bowel in rectal carcinoma

    Directory of Open Access Journals (Sweden)

    Delclos Marc E

    2011-06-01

    Full Text Available Abstract Background A strong dose-volume relationship exists between the amount of small bowel receiving low- to intermediate-doses of radiation and the rates of acute, severe gastrointestinal toxicity, principally diarrhea. There is considerable interest in the application of highly conformal treatment approaches, such as intensity-modulated radiation therapy (IMRT, to reduce dose to adjacent organs-at-risk in the treatment of carcinoma of the rectum. Therefore, we performed a comprehensive dosimetric evaluation of IMRT compared to 3-dimensional conformal radiation therapy (3DCRT in standard, preoperative treatment for rectal cancer. Methods Using RTOG consensus anorectal contouring guidelines, treatment volumes were generated for ten patients treated preoperatively at our institution for rectal carcinoma, with IMRT plans compared to plans derived from classic anatomic landmarks, as well as 3DCRT plans treating the RTOG consensus volume. The patients were all T3, were node-negative (N = 1 or node-positive (N = 9, and were planned to a total dose of 45-Gy. Pairwise comparisons were made between IMRT and 3DCRT plans with respect to dose-volume histogram parameters. Results IMRT plans had superior PTV coverage, dose homogeneity, and conformality in treatment of the gross disease and at-risk nodal volume, in comparison to 3DCRT. Additionally, in comparison to the 3DCRT plans, IMRT achieved a concomitant reduction in doses to the bowel (small bowel mean dose: 18.6-Gy IMRT versus 25.2-Gy 3DCRT; p = 0.005, bladder (V40Gy: 56.8% IMRT versus 75.4% 3DCRT; p = 0.005, pelvic bones (V40Gy: 47.0% IMRT versus 56.9% 3DCRT; p = 0.005, and femoral heads (V40Gy: 3.4% IMRT versus 9.1% 3DCRT; p = 0.005, with an improvement in absolute volumes of small bowel receiving dose levels known to induce clinically-relevant acute toxicity (small bowel V15Gy: 138-cc IMRT versus 157-cc 3DCRT; p = 0.005. We found that the IMRT treatment volumes were typically larger than that

  17. Development of a Comprehensive Radioactive Waste Management Program in the Kingdom of Morocco

    International Nuclear Information System (INIS)

    Abderrahim, Bouhi; Bouchta, Moussaif; El Maati, Mouldoura; Touria, Lambarki; Touria, El Ghailassai; Fischer, R.

    2009-01-01

    methods were developed. The paper will also discuss the various challenges that class C countries encounter when designing and implementing a waste management program including lack of waste management infrastructure, little or no regulatory framework to guide activities, no waste disposal facilities. The waste management program then needs to be flexible and creative when dealing with these challenges. Morocco has done an exceptional job in cooperating with the international community on the development of their program. In particular Lawrence Livermore National Laboratory (LLNL) in the United States had partnered with Morocco through a sister laboratory agreement on the development of a waste management program. The paper will discuss how this agreement has helped in the establishment of the current waste management program. The resulting outcome demonstrates that a class C country can implement the terms of the joint convention and develop a comprehensive waste management program that meets or exceeds international standards. With the commissioning of the 2 MW TRIGA Mark-II research reactor expected shortly Morocco will enter a new phase in the operation of it radioactive waste management program. Because of substantial planning and foresight Morocco has designed and built a modern waste management program that will allow for its scientific community to fully exploit the benefits of this new research tool. The key to developing a waste management program has been strong support from the leadership of CNESTEN to ensure that modern facilities were incorporated into the design of the CENM and that adequate resources were made available to the CENM waste management team. Another key component has been the extensive use of international cooperation that has allowed Morocco to build a program that takes the best from other programs around the world and customizes it into a program that is unique to Morocco. The Moroccan experience demonstrates that a country with limited

  18. The Effect of the Cherry Hill Study Skills Program on Eighth Grade Students' Reading Comprehension and Study Skills.

    Science.gov (United States)

    La Marca, Marilyn Tierney

    A study was conducted to determine the effects of the "Cherry Hill Study Skills Program" on eighth grade students' reading comprehension and study skills. The "Cherry Hill Study Skills Program" is a process oriented course dealing with the sequential development of nine specific skills deemed essential to the retrieval and retention of information…

  19. Assessment of a pharmacist-led comprehensive medication management and wellness program

    Directory of Open Access Journals (Sweden)

    Daniel L. Janovick

    2015-01-01

    Full Text Available Background: Pharmacists are currently providing comprehensive medication management in the outpatient setting. However, there is little documented evidence demonstrating pharmacists are generating further improved health outcomes utilizing non-pharmacologic support, such as fitness and nutrition counseling. The objective of this study is to determine if a pharmacist-led wellness program with medication management and lifestyle modifications through fitness and nutrition coaching can lead to improved biometric markers. Methods: The wellness program targeted corporate employees and was offered in a corporate headquarters' setting with an on-site workout facility. The program was expected to recruit approximately 15 patients into the wellness program consisting of two treatment arms. The standard group featured nutrition-based classes, medication therapy management and fitness education. The intervention group performed the standard group's activities plus direct, supervised fitness training once weekly. Measured biometric markers were assessed at baseline, 3.5 months, and 7 months and included body mass index (BMI, waist circumference (WC, fasting blood glucose (FBG, systolic and diastolic blood pressure (SBP and DBP, and full lipid panel (TC, TG, HDL, and LDL. Results: Seventeen patients were enrolled in the study. The standard group (n = 11 and intervention group (n = 6 had relatively similar biometric markers at baseline. Seven total patients completed the study (4 from standard group, 3 from intervention group. The majority of biometric markers improved in both groups, and BP and LDL control was maintained for all who completed the study. Conclusion: These data suggest that a licensed pharmacist with certified personal trainer credentials may be capable of maintaining biometric markers at healthy levels and improving where necessary in an employee wellness program through one-on-one medication, fitness and nutrition support. Additional, large

  20. Trends in intensity modulated radiation therapy use for locally advanced rectal cancer at National Comprehensive Cancer Network centers

    OpenAIRE

    Marsha Reyngold, MD, PhD; Joyce Niland, PhD; Anna ter Veer, MS; Tanios Bekaii-Saab, MD; Lily Lai, MD; Joshua E. Meyer, MD; Steven J. Nurkin, MD, MS; Deborah Schrag, MD, MPH; John M. Skibber, MD, FACS; Al B. Benson, MD; Martin R. Weiser, MD; Christopher H. Crane, MD; Karyn A. Goodman, MD, MS

    2018-01-01

    Purpose: Intensity modulated radiation therapy (IMRT) has been rapidly incorporated into clinical practice because of its technological advantages over 3-dimensional conformal radiation therapy (CRT). We characterized trends in IMRT utilization in trimodality treatment of locally advanced rectal cancer at National Comprehensive Cancer Network cancer centers between 2005 and 2011. Methods and materials: Using the prospective National Comprehensive Cancer Network Colorectal Cancer Database, ...

  1. A High Precision Comprehensive Evaluation Method for Flood Disaster Loss Based on Improved Genetic Programming

    Institute of Scientific and Technical Information of China (English)

    ZHOU Yuliang; LU Guihua; JIN Juliang; TONG Fang; ZHOU Ping

    2006-01-01

    Precise comprehensive evaluation of flood disaster loss is significant for the prevention and mitigation of flood disasters. Here, one of the difficulties involved is how to establish a model capable of describing the complex relation between the input and output data of the system of flood disaster loss. Genetic programming (GP) solves problems by using ideas from genetic algorithm and generates computer programs automatically. In this study a new method named the evaluation of the grade of flood disaster loss (EGFD) on the basis of improved genetic programming (IGP) is presented (IGPEGFD). The flood disaster area and the direct economic loss are taken as the evaluation indexes of flood disaster loss. Obviously that the larger the evaluation index value, the larger the corresponding value of the grade of flood disaster loss is. Consequently the IGP code is designed to make the value of the grade of flood disaster be an increasing function of the index value. The result of the application of the IGP-EGFD model to Henan Province shows that a good function expression can be obtained within a bigger searched function space; and the model is of high precision and considerable practical significance.Thus, IGP-EGFD can be widely used in automatic modeling and other evaluation systems.

  2. Communication and quality of life outcomes from an interprofessional intensive, comprehensive, aphasia program (ICAP).

    Science.gov (United States)

    Hoover, Elizabeth L; Caplan, David N; Waters, Gloria S; Carney, Anne

    2017-03-01

    Intensive Comprehensive Aphasia Programs (ICAPs) have developed in response to a growing need for treatments which produce changes in language function in people with aphasia, especially in the chronic phase of recovery. ICAPs are growing in number and several papers have presented preliminary results of their use, but little data exist about their efficacy or effectiveness. This paper explores the communication effects of an ICAP program that incorporated evidenced-based individual and group treatment in an interprofessional program. Twenty-seven individuals with chronic aphasia were provided with 30 h of interprofessional treatment a week for a four-week period in both individual and group formats. A delayed treatment, within-participant research protocol was used. Language measures were taken at two intervals pre- and two intervals post treatment. Functional, narrative, and quality of life measures were taken once pre and once post treatment. Significant change was observed on targeted language functions post treatment. Significant treatment effects were also observed on functional and quality of life measures as well as on all impairment-based language measures for the group. The results provide evidence of linguistic and quality of life change in individuals with chronic aphasia who were treated in an interprofessional ICAP.

  3. Community energy auditing: experience with the comprehensive community energy management program

    Energy Technology Data Exchange (ETDEWEB)

    Moore, J.L.; Berger, D.A.; Rubin, C.B.; Hutchinson, P.A. Sr.; Griggs, H.M.

    1980-09-01

    The report provides local officials and staff with information on lessons from the audit, projection, and general planning experiences of the Comprehensive Community Energy Management Program (CCEMP) communities and provides ANL and US DOE with information useful to the further development of local energy management planning methods. In keeping with the objectives, the report is organized into the following sections: Section II presents the evaluation issues and key findings based on the communities' experiences from Spring of 1979 to approximately March of 1980; Section III gives an organized review of experience of communities in applying the detailed audit methodology for estimating current community energy consumption and projecting future consumption and supply; Section IV provides a preliminary assessment of how audit information is being used in other CCEMP tasks; Section V presents an organized review of preliminary lessons from development of the community planning processes; and Section VI provides preliminary conclusions on the audit and planning methodology. (MCW)

  4. Core components of a comprehensive quality assurance program in anatomic pathology.

    Science.gov (United States)

    Nakhleh, Raouf E

    2009-11-01

    In this article the core components of a comprehensive quality assurance and improvement plan are outlined. Quality anatomic pathology work comes with focus on accurate, timely, and complete reports. A commitment to continuous quality improvement and a systems approach with a persistent effort helps to achieve this end. Departments should have a quality assurance and improvement plan that includes a risk assessment of real and potential problems facing the laboratory. The plan should also list the individuals responsible for carrying out the program with adequate resources, a defined timetable, and annual assessment for progress and future directions. Quality assurance monitors should address regulatory requirements and be organized by laboratory division (surgical pathology, cytology, etc) as well as 5 segments (preanalytic, analytic, postanalytic phases of the test cycle, turn-around-time, and customer satisfaction). Quality assurance data can also be used to evaluate individual pathologists using multiple parameters with peer group comparison.

  5. Comprehensive human resources development program for nuclear power at NuTEC/JAEA

    International Nuclear Information System (INIS)

    Ishimura, T.

    2010-03-01

    Nuclear Technology and Education Center (NuTEC) of the Japan Atomic Energy Agency (JAEA) aims at comprehensive nuclear education and training activities, which cover 1) education and training for national nuclear engineers, 2) cooperation with universities and 3) international contribution and cooperation. The main feature of NuTEC's training programs is that the curricula place emphasis on the laboratory exercises with well-equipped training facilities, including research reacotrs, and expertise of lecturers mostly from JAEA. The wide spectrum of cooperative activities have been pursued with universities and also with international organizations, such as IAEA, ENEN, CEA/INSTN and FNCA countries. The present paper descrives the overall HRD activities of NuTEC, especially in nuclear power field. (author)

  6. Investigating Employee-Reported Benefits of Participation in a Comprehensive Australian Workplace Health Promotion Program.

    Science.gov (United States)

    Kilpatrick, Michelle; Blizzard, Leigh; Sanderson, Kristy; Teale, Brook; Nelson, Mark; Chappell, Kate; Venn, Alison

    2016-05-01

    To investigate employee-reported benefits of participation, employee organizational commitment, and health-related behaviors and body mass index (BMI) following implementation of a comprehensive workplace health promotion (WHP) program. State government employees from Tasmania, Australia, completed surveys in 2010 (n = 3408) and 2013 (n = 3228). Repeated cross-sectional data were collected on sociodemographic, health, and work characteristics. Participation in WHP activities, employee-reported organizational commitment, and benefits of participation were collected in 2013. Respondents who participated in multiple activities were more likely to agree that participation had motivated them, or helped them to address a range of health and work factors (trends: P employee organizational commitment. No differences were observed in health-related behaviors and BMI between 2010 and 2013. Healthy@Work (pH@W) was either ineffective, or insufficient time had elapsed to detect a population-level change in employee lifestyle factors.

  7. Comprehensive Human Resources Development Program for Nuclear Power at NuTEC/JAEA

    International Nuclear Information System (INIS)

    Ishimura, T.

    2012-01-01

    Nuclear Technology and Education Center (NuTEC) of the Japan Atomic Energy Agency (JAEA) aims at comprehensive nuclear education and training activities, which cover 1) education and training for national nuclear engineers, 2) cooperation with universities and 3) international contribution and cooperation. The main feature of NuTEC's training programs is that the curricula place emphasis on the laboratory exercises with well-equipped training facilities, including research reacotrs, and expertise of lecturers mostly from JAEA. The wide spectrum of cooperative activities have been pursued with universities and also with international organizations, such as IAEA, ENEN, CEA/INSTN and FNCA countries. The present paper descrives the overall HRD activities of NuTEC, especially in nuclear power field. (author)

  8. Comprehensive long-term management program for asthma: effect on outcomes in adult African-Americans.

    Science.gov (United States)

    Kelso, T M; Abou-Shala, N; Heilker, G M; Arheart, K L; Portner, T S; Self, T H

    1996-06-01

    To determine if a comprehensive long-term management program, emphasizing inhaled corticosteroids and patient education, would improve outcomes in adult African-American asthmatics a nonrandomized control trial with a 2-year intervention was performed in a university-based clinic. Inclusion criteria consisted of (> or = 5) emergency department (ED) visits or hospitalizations (> or = 2) during the previous 2 years. Intervention patients were volunteers; a comparable control group was identified via chart review at hospitals within the same area and time period as the intervention patients. Individualized doses of beclomethasone with a spacer, inhaled albuterol "as needed," and crisis prednisone were the primary therapies. Environmental control, peak flow monitoring, and a partnership with the patient were emphasized. Detailed patient education was an integral part of management. Control patients received usual care from local physicians. ED visits and hospitalizations for 2 years before and 2 years during the intervention period were compared. Quality of life (QOL) measurements were made at baseline and every 6 months in the intervention group. Study group (n = 21) had a significant reduction in ED visits (2.3 +/- 0.2 pre-intervention versus 0.6 +/- 0.2 post-intervention; P = 0.0001). Control group (n = 18) did not have a significant change in ED visits during the 2-year post-intervention period (2.6 +/- 0.2 pre-intervention versus 2.0 +/- 0.2 post-intervention; P = 0.11). Both groups had significant reductions in hospitalizations, but the study group had a greater reduction. Sixty-two percent of study patients had complete elimination of ED visits and hospitalizations, whereas no control patients had total elimination of the need for institutional acute care. QOL in the study patients revealed significant improvements for most parameters. A comprehensive long-term management program emphasizing inhaled corticosteroids combined with other state-of-the-art management

  9. On the role of modeling parameters in IMRT plan optimization

    International Nuclear Information System (INIS)

    Krause, Michael; Scherrer, Alexander; Thieke, Christian

    2008-01-01

    The formulation of optimization problems in intensity-modulated radiotherapy (IMRT) planning comprises the choice of various values such as function-specific parameters or constraint bounds. In current inverse planning programs that yield a single treatment plan for each optimization, it is often unclear how strongly these modeling parameters affect the resulting plan. This work investigates the mathematical concepts of elasticity and sensitivity to deal with this problem. An artificial planning case with a horse-shoe formed target with different opening angles surrounding a circular risk structure is studied. As evaluation functions the generalized equivalent uniform dose (EUD) and the average underdosage below and average overdosage beyond certain dose thresholds are used. A single IMRT plan is calculated for an exemplary parameter configuration. The elasticity and sensitivity of each parameter are then calculated without re-optimization, and the results are numerically verified. The results show the following. (1) elasticity can quantify the influence of a modeling parameter on the optimization result in terms of how strongly the objective function value varies under modifications of the parameter value. It also can describe how strongly the geometry of the involved planning structures affects the optimization result. (2) Based on the current parameter settings and corresponding treatment plan, sensitivity analysis can predict the optimization result for modified parameter values without re-optimization, and it can estimate the value intervals in which such predictions are valid. In conclusion, elasticity and sensitivity can provide helpful tools in inverse IMRT planning to identify the most critical parameters of an individual planning problem and to modify their values in an appropriate way

  10. Implementation of a free software for quality control of IMRT

    International Nuclear Information System (INIS)

    Chinillace, N.; Alonso, S.; Cortina, T.; Reinado, D.; Ricos, B.; Diaz, S.; Campayo, J. M.

    2011-01-01

    In this paper we focus on implementation and launch of software that allows us to compare quantitatively the two-dimensional dose distributions calculated and measured experimentally in IMRT treatment. The tool we are using to make this comparison is the free software DoseLab. This is a program written in MatLab and open source, thereby allowing in some cases adapt the program to the needs of each user. This program will be able to calculate the gamma function of these distributions, a parameter that simultaneously evaluates the difference in dose between two pixels of the image and the distance between them, giving us an objective and quantitative, allowing us to decide if both distributions are compatible or not.

  11. DEVELOPMENT PERSONALITY/SOCIAL COMPETENCY OF SECONDARY HIGH SCHOOL STUDENTS TROUGH A COMPREHENSIVE GUIDANCE AND COUNSELING PROGRAM

    Directory of Open Access Journals (Sweden)

    Anwar Sutoyo

    2015-10-01

    Full Text Available Abstract The goal this research is to find the effectiveness of model guidance and counseling comprehensive program to develop the personality/ social competency of secondary high school students.This research uses method one group pretest and posttest design. In data collecting technique, this research was directly done through interview, documentation and assessment scale.The conclusions of the research are, The model of guidance and counseling comprehensive program that developed is effective to evolving the personality/ social competency of secondary high school students. Therefore it, counselor need to have leadership ability, create an collaboration atmospherebetweenstakeholders, and tecnology information mastered. Keywords: Comprehensive Program; Personality/ Social Competency 

  12. Intensity modulated radiotherapy (IMRT) with compensators

    International Nuclear Information System (INIS)

    Salz, H.; Wiezorek, T.; Scheithauer, M.; Kleen, W.; Schwedas, M.; Wendt, T.G.

    2002-01-01

    The irradiation with intensity-modulated fields is possible with static as well as dynamic methods. In our university hospital, the intensity-modulated radiotherapy (IMRT) with compensators was prepared and used for the first time for patient irradiation in July 2001. The compensators consist of a mixture of tin granulate and wax, which is filled in a milled negative mould. The treatment planning is performed with Helax-TMS (MDS Nordion). An additional software is used for editing the modulation matrix ('Modifix'). Before irradiation of the first patient, extensive measurements have been carried out in terms of quality assurance of treatment planning and production of compensators. The results of the verification measurements have shown that IMRT with compensators possesses high spatial and dosimetric exactness. The calculated dose distributions are applied correctly. The accuracy of the calculated monitor units is normally better than 3%; in small volumes, further dosimetric inaccuracies between calculated and measured dose distributions are mostly less than 3%. Therefore, the compensators contribute to the achievement of high-level IMRT even when apparatuses without MLC are used. This paper describes the use of the IMRT with compensators, presents the limits of this technology, and discusses the first practical experiences. (orig.) [de

  13. Overview of a comprehensive environmental monitoring and surveillance program: The role of fish and wildlife

    International Nuclear Information System (INIS)

    Gray, R.H.

    1988-05-01

    Concern about the effects of potential releases from nuclear and non-nuclear activities on the US Department of Energy's Hanford Site in southeastern Washington has evolved over four decades into a comprehensive environmental monitoring and surveillance program. The program includes field sampling, and chemical and physical analyses of air, surface and ground water, fish and wildlife, soil, foodstuffs, and natural vegetation. In addition to monitoring radioactivity in fish and wildlife, population numbers of key species are determined, usually during the breeding season. Data from monitoring efforts are used to assess the environmental impacts of Hanford operations and calculate the overall radiological dose to humans onsite, at the Site perimeter, or residing in nearby communities. Chinook salmon spawning in the Columbia River at Hanford has increased in recent years with a concomitant increase in winter nesting activity of bald eagles (Haliaeetus leucocephalus). An elk (Cervus elaphus) herd, established by immigration in 1972, is also increasing. Nesting Canada goose (Branta canadensis) and great blue heron (Ardea herodias), and various other animals, e.g., mule deer (Odocoileus hemionus) and coyotes (Canis latrans) are common. Measured exposure to penetrating radiation and calculated radiation doses to the public are well below applicable regulatory limits

  14. Rapid gene expression changes in peripheral blood lymphocytes upon practice of a comprehensive yoga program.

    Directory of Open Access Journals (Sweden)

    Su Qu

    Full Text Available One of the most common integrative medicine (IM modalities is yoga and related practices. Previous work has shown that yoga may improve wellness in healthy people and have benefits for patients. However, the mechanisms of how yoga may positively affect the mind-body system are largely unknown. Here we have assessed possible rapid changes in global gene expression profiles in the peripheral blood mononuclear cells (PBMCs in healthy people that practiced either a comprehensive yoga program or a control regimen. The experimental sessions included gentle yoga postures, breathing exercises, and meditation (Sudarshan Kriya and Related Practices--SK&P compared with a control regimen of a nature walk and listening to relaxing music. We show that the SK&P program has a rapid and significantly greater effect on gene expression in PBMCs compared with the control regimen. These data suggest that yoga and related practices result in rapid gene expression alterations which may be the basis for their longer term cell biological and higher level health effects.

  15. Dosimetry of parotid glands in IMRT plan of nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Lian Jiancheng; Yu Xinsheng; Jiang Guoliang

    2007-01-01

    Objective: To evaluate the effect of different intensity-modulated radiation therapy (IMRT) plan on the dosimetry of parotid in patients with nasopharyngeal carcinoma. Methods: Under the same constraints and objections, the IMRT plan of nasopharyngeal carcinoma with sparing unilateral parotid and the IMRT plan added plan tumor volume (PTV) margin for parotid gland was investigated. Results: Between conventional IMRT plan and the IMRT plan spared unilateral parotid, their target coverage, homogeneity index and conformal index of PTV 70 is similar. On PTV 60 , D min in the plan of sparing one parotid gland was more than that in normal IMRT plan (P 95 in the plan of sparing one parotid gland have improved (P 50%VOL and D mean of parotid gland were similar between the two plans. Between conventional IMRT plan and the IMRT plan added 2 or 3 mm margin for parotid gland, their target coverage, homogeneity index and conformal index of PTV 70 is similar. D min , D mean and D 95 of PTV 60 have decreased tendency from normal IMRT plan to 2 mm margin plan to 3 mm margin plan. D max of brainstem and spine cord have increased tendency from normal IMRT plan to 2 mm margin plan to 3 mm margin plan. Conclusions: The IMRT plan of nasopharyngeal carcinoma with sparing unilateral parotid may be adopted not to protect both two parotids, while PTV margin for parotid added as parotid move. (authors)

  16. Selective prevention programs for children from substance-affected families: a comprehensive systematic review

    Directory of Open Access Journals (Sweden)

    Bröning Sonja

    2012-06-01

    Full Text Available Abstract Children from substance-affected families show an elevated risk for developing own substance-related or other mental disorders. Therefore, they are an important target group for preventive efforts. So far, such programs for children of substance-involved parents have not been reviewed together. We conducted a comprehensive systematic review to identify and summarize evaluations of selective preventive interventions in childhood and adolescence targeted at this specific group. From the overall search result of 375 articles, 339 were excluded, 36 full texts were reviewed. From these, nine eligible programs documented in 13 studies were identified comprising four school-based interventions (study 1–6, one community-based intervention (study 7–8, and four family-based interventions (study 9–13. Studies’ levels of evidence were rated in accordance with the Scottish Intercollegiate Guidelines Network (SIGN methodology, and their quality was ranked according to a score adapted from the area of meta-analytic family therapy research and consisting of 15 study design quality criteria. Studies varied in program format, structure, content, and participants. They also varied in outcome measures, results, and study design quality. We found seven RCT’s, two well designed controlled or quasi-experimental studies, three well-designed descriptive studies, and one qualitative study. There was preliminary evidence for the effectiveness of the programs, especially when their duration was longer than ten weeks and when they involved children’s, parenting, and family skills training components. Outcomes proximal to the intervention, such as program-related knowledge, coping-skills, and family relations, showed better results than more distal outcomes such as self-worth and substance use initiation, the latter due to the comparably young age of participants and sparse longitudinal data. However, because of the small overall number of studies found

  17. Louisiana Barrier Island Comprehensive Monitoring (BICM) Program Summary Report: Data and Analyses 2006 through 2010

    Science.gov (United States)

    Kindinger, Jack G.; Buster, Noreen A.; Flocks, James G.; Bernier, Julie C.; Kulp, Mark A.

    2013-01-01

    The Barrier Island Comprehensive Monitoring (BICM) program was implemented under the Louisiana Coastal Area Science and Technology (LCA S&T) office as a component of the System Wide Assessment and Monitoring (SWAMP) program. The BICM project was developed by the State of Louisiana (Coastal Protection Restoration Authority [CPRA], formerly Department of Natural Resources [DNR]) to complement other Louisiana coastal monitoring programs such as the Coastwide Reference Monitoring System-Wetlands (CRMS-Wetlands) and was a collaborative research effort by CPRA, University of New Orleans (UNO), and the U.S. Geological Survey (USGS). The goal of the BICM program was to provide long-term data on the barrier islands of Louisiana that could be used to plan, design, evaluate, and maintain current and future barrier-island restoration projects. The BICM program used both historical and newly acquired (2006 to 2010) data to assess and monitor changes in the aerial and subaqueous extent of islands, habitat types, sediment texture and geotechnical properties, environmental processes, and vegetation composition. BICM datasets included aerial still and video photography (multiple time series) for shoreline positions, habitat mapping, and land loss; light detection and ranging (lidar) surveys for topographic elevations; single-beam and swath bathymetry; and sediment grab samples. Products produced using BICM data and analyses included (but were not limited to) storm-impact assessments, rate of shoreline and bathymetric change, shoreline-erosion and accretion maps, high-resolution elevation maps, coastal-shoreline and barrier-island habitat-classification maps, and coastal surficial-sediment characterization maps. Discussions in this report summarize the extensive data-collection efforts and present brief interpretive analyses for four coastal Louisiana geographic regions. In addition, several coastal-wide and topical themes were selected that integrate the data and analyses within a

  18. Inverse IMRT workflow process at Austin health

    International Nuclear Information System (INIS)

    Rykers, K.; Fernando, W.; Grace, M.; Liu, G.; Rolfo, A.; Viotto, A.; Mantle, C.; Lawlor, M.; Au-Yeung, D.; Quong, G.; Feigen, M.; Lim-Joon, D.; Wada, M.

    2004-01-01

    Full text: The work presented here will review the strategies adopted at Austin Health to bring IMRT into clinical use. IMRT is delivered using step and shoot mode on an Elekta Precise machine with 40 pairs of 1cm wide MLC leaves. Planning is done using CMS Focus/XiO. A collaborative approach for RO's, Physicists and RTs from concept to implementation was adopted. An overview will be given of the workflow for the clinic, the equipment used, tolerance levels and the lessons learned. 1. Strategic Planning for IMRT 2. Training a. MSKCC (New York) b.ESTRO (Amsterdam) c.Elekta (US and UK) 3. Linac testing and data acquisition a. Equipment and software review and selection b. Linac reliability/geometric and mechanical checks c. Draft Patient QA procedure d. EPI Image matching checks and procedures 4. Planning system checks a. export of dose matrix (options) b. dose calculation choices 5. IMRT Research Initiatives a. IMRT Planning Studies, Stabilisation, On-line Imaging 6. Equipment Procurement and testing a. Physics and Linac Equipment, Hardware, Software/Licences, Stabilisation 7. Establishing a DICOM Environment a. Prescription sending, Image transfer for EPI checks b. QA Files 8. Physics QA (Pre-Treatment) a.Clinical plan review; DVH checks b. geometry; dosimetry checks; DICOM checks c. 2D Distance to agreement; mm difference reports; Gamma function index 9. Documentation a.Protocol Development i. ICRU 50/62 reporting and prescribing b. QA for Physics c. QA for RT's d. Generation of a report for RO/patient history. Copyright (2004) Australasian College of Physical Scientists and Engineers in Medicine

  19. A randomised clinical trial of a comprehensive exercise program for chronic whiplash: trial protocol

    Directory of Open Access Journals (Sweden)

    Latimer Jane

    2009-12-01

    Full Text Available Abstract Background Whiplash is the most common injury following a motor vehicle accident. Approximately 60% of people suffer persistent pain and disability six months post injury. Two forms of exercise; specific motor relearning exercises and graded activity, have been found to be effective treatments for this condition. Although the effect sizes for these exercise programs, individually, are modest, pilot data suggest much larger effects on pain and disability are achieved when these two treatments are combined. The aim of this study is to investigate the effectiveness and cost-effectiveness of this comprehensive exercise approach for chronic whiplash. Methods/Design A multicentre randomised controlled trial will be conducted. One hundred and seventy-six participants with chronic grade I to II whiplash will be recruited in Sydney and Brisbane, Australia. All participants will receive an educational booklet on whiplash and in addition, those randomised to the comprehensive exercise group (specific motor relearning and graded activity exercises will receive 20 progressive and individually-tailored, 1 hour exercise sessions over a 12 week period (specific motor relearning exercises: 8 sessions over 4 weeks; graded activity: 12 sessions over 8 weeks. The primary outcome to be assessed is pain intensity. Other outcomes of interest include disability, health-related quality of life and health service utilisation. Outcomes will be measured at baseline, 14 weeks, 6 months and 12 months by an assessor who is blinded to the group allocation of the subjects. Recruitment is due to commence in late 2009. Discussion The successful completion of this trial will provide evidence on the effectiveness and cost-effectiveness of a simple treatment for the management of chronic whiplash. Trial registration ACTRN12609000825257

  20. The Cost of Providing Comprehensive HIV Treatment in PEPFAR-Supported Programs

    Science.gov (United States)

    Menzies, Nicolas A; Berruti, Andres A; Berzon, Richard; Filler, Scott; Ferris, Robert; Ellerbrock, Tedd V; Blandford, John M

    2011-01-01

    PEPFAR, national governments, and other stakeholders are investing unprecedented resources to provide HIV treatment in developing countries. This study reports empirical data on costs and cost trends in a large sample of HIV treatment sites. In 2006–2007, we conducted cost analyses at 43 PEPFAR-supported outpatient clinics providing free comprehensive HIV treatment in Botswana, Ethiopia, Nigeria, Uganda, and Vietnam. We collected data on HIV treatment costs over consecutive 6-month periods from scale-up of dedicated HIV treatment services at each site. The study included all patients receiving HIV treatment and care at study sites (62,512 ART and 44,394 pre-ART patients). Outcomes were costs per-patient and total program costs, subdivided by major cost categories. Median annual economic costs were $202 (2009 USD) for pre-ART patients and $880 for ART patients. Excluding ARVs, per-patient ART costs were $298. Care for newly initiated ART patients cost 15–20% more than for established patients. Per-patient costs dropped rapidly as sites matured, with per-patient ART costs dropping 46.8% between first and second 6-month periods after the beginning of scale-up, and an additional 29.5% the following year. PEPFAR provided 79.4% of funding for service delivery, and national governments provided 15.2%. Treatment costs vary widely between sites, and high early costs drop rapidly as sites mature. Treatment costs vary between countries and respond to changes in ARV regimen costs and the package of services. While cost reductions may allow near-term program growth, programs need to weigh the trade-off between improving services for current patients and expanding coverage to new patients. PMID:21412127

  1. Television Literacy: Comprehension of Program Content Using Closed Captions for the Deaf.

    Science.gov (United States)

    Lewis, Margaret S. Jelinek; Jackson, Dorothy W.

    2001-01-01

    This study assessed deaf and hearing students' comprehension of captions with and without visuals/video. Results indicate that reading grade level is highly correlated with caption comprehension test scores. Comprehension of the deaf students was consistently below that of hearing students. The captioned video produced significantly better…

  2. Computational model to simulate the interplay effect in dynamic IMRT delivery

    International Nuclear Information System (INIS)

    Yoganathan, S A; Maria Das, K J; Kumar, Shaleen

    2014-01-01

    The purpose of this study was to develop and experimentally verify a patient specific model for simulating the interplay effect in a DMLC based IMRT delivery. A computational model was developed using MATLAB program to incorporate the interplay effect in a 2D beams eye view fluence of dynamic IMRT fields. To simulate interplay effect, the model requires two inputs: IMRT field (DMLC file with dose rate and MU) and the patient specific respiratory motion. The interplay between the DMLC leaf motion and target was simulated for three lung patients. The target trajectory data was acquired using RPM system during the treatment simulation. The model was verified experimentally for the same patients using Imatrix 2D array device placed over QUASAR motion platform in CL2100 linac. The simulated fluences and measured fluences were compared with the TPS generated static fluence (no motion) using an in-house developed gamma evaluation program (2%/2mm). The simulated results were well within agreement with the measured. Comparison of the simulated and measured fluences with the TPS static fluence resulted 55.3% and 58.5% pixels passed the gamma criteria. A patient specific model was developed and validated for simulating the interplay effect in the dynamic IMRT delivery. This model can be clinically used to quantify the dosimetric uncertainty due to the interplay effect prior to the treatment delivery.

  3. An Approach for Practical Multiobjective IMRT Treatment Planning

    International Nuclear Information System (INIS)

    Craft, David; Halabi, Tarek; Shih, Helen A.; Bortfeld, Thomas

    2007-01-01

    Purpose: To introduce and demonstrate a practical multiobjective treatment planning procedure for intensity-modulated radiation therapy (IMRT) planning. Methods and Materials: The creation of a database of Pareto optimal treatment plans proceeds in two steps. The first step solves an optimization problem that finds a single treatment plan which is close to a set of clinical aspirations. This plan provides an example of what is feasible, and is then used to determine mutually satisfiable hard constraints for the subsequent generation of the plan database. All optimizations are done using linear programming. Results: The two-step procedure is applied to a brain, a prostate, and a lung case. The plan databases created allow for the selection of a final treatment plan based on the observed tradeoffs between the various organs involved. Conclusions: The proposed method reduces the human iteration time common in IMRT treatment planning. Additionally, the database of plans, when properly viewed, allows the decision maker to make an informed final plan selection

  4. Findings of the first comprehensive radiological monitoring program of the Republic of the Marshall Islands

    International Nuclear Information System (INIS)

    Simon, S.L.; Graham, J.C.

    1997-01-01

    The Marshall Islands was the primary site of the United States atomic weapons testing program in the Pacific. From 1946 through 1958, 66 atomic weapons were detonated in the island country. For several decades, monitoring was conducted by the U.S. Department of Energy (or its predecessor agencies) on the test site atolls and neighboring atolls. However, 70% of the land area of the over 1,200 islands in the Marshall Islands was never systematically monitored prior to 1990. For the 5-y period from 1990 through 1994, the Government of the Republic of the Marshall Islands undertook an independent program to assess the radiological conditions throughout its 29 atolls. The scientific work was performed under the auspices of the Section 177 Agreement of the Compact of Free Association, U.S. public law 99-239, signed in 1986 by President Ronald Reagan. Although the total land area of the nations is a scant 180 km 2 , the islands are distributed over 6 X 10 5 km 2 of ocean. Consequently, logistics and instrumentation were main considerations, in addition to cultural and language issues. The objective of this paper is to report findings for all atolls of the Marshall Islands on the 137 Cs areal inventory (Bq m -2 ) and the external effective dose-rate (mSv y -1 ), the projected internal effective dose-rate (mSv y -1 ) from an assumed diet model, and surface soil concentrations of 239,240 Pu (Bq kg -1 ) for selected northern atolls. Interpretation is also provided on the degree of contamination above global fallout levels. This report provides the first comprehensive summary of the radiological conditions throughout the Marshall Islands. 37 refs., 25 figs., 1 tab

  5. Letter to the Editor on 'Single-Arc IMRT?'.

    Science.gov (United States)

    Otto, Karl

    2009-04-21

    In the note 'Single Arc IMRT?' (Bortfeld and Webb 2009 Phys. Med. Biol. 54 N9-20), Bortfeld and Webb present a theoretical investigation of static gantry IMRT (S-IMRT), single-arc IMRT and tomotherapy. Based on their assumptions they conclude that single-arc IMRT is inherently limited in treating complex cases without compromising delivery efficiency. Here we present an expansion of their work based on the capabilities of the Varian RapidArc single-arc IMRT system. Using the same theoretical framework we derive clinically deliverable single-arc IMRT plans based on these specific capabilities. In particular, we consider the range of leaf motion, the ability to rapidly and continuously vary the dose rate and the choice of collimator angle used for delivery. In contrast to the results of Bortfeld and Webb, our results show that single-arc IMRT plans can be generated that closely match the theoretical optimum. The disparity in the results of each investigation emphasizes that the capabilities of the delivery system, along with the ability of the optimization algorithm to exploit those capabilities, are of particular importance in single-arc IMRT. We conclude that, given the capabilities available with the RapidArc system, single-arc IMRT can produce complex treatment plans that are delivered efficiently (in approximately 2 min).

  6. Comprehensive vibration assessment program for Yonggwang nuclear power plant unit 4

    International Nuclear Information System (INIS)

    Rhee, Hui Nam; Hwang, Jong Keun; Kim, Tae Hyung; Kim, Jung Kyu; Song, Heuy Gap; Kim, Beom Shig

    1995-01-01

    A Comprehensive Vibration Assessment Program (CVAP) has been performed for Yonggwang Nuclear Power Plant Unit 4 (YGN 4) in order to verify the structural integrity of the reactor internals for flow induced vibrations prior to commercial operation. The theoretical evidence for the structural integrity of the reactor internals and the basis for measurement and inspection are provided by the analysis. Flow induced hydraulic loads and reactor internals vibration response data were measured during pre-core hot functional testing in YGN 4 site. Also, the critical areas in the reactor internals were inspected visually to check any existence of structural abnormality before and after the pre-core hot functional testing. Then, the measured data have been analyzed and compared with the predicted data by analysis. The measured stresses are less than the predicted values and the allowable limits. It is concluded that the vibration response of the reactor internals due to the flow induced vibration under normal operation is acceptable for long term operation

  7. Structure, Processes, and Retrospective Outcomes From an Intensive Comprehensive Aphasia Program.

    Science.gov (United States)

    Babbitt, Edna M; Worrall, Linda; Cherney, Leora R

    2015-11-01

    This study describes the structure, processes, and outcomes of an intensive comprehensive aphasia program (ICAP). The aim was to identify treatment gains and determine if outcomes were significantly different between participants grouped according to severity and type of aphasia, and time postonset. Data from 74 first-time ICAP participants were analyzed. Pre- and posttreatment scores on the Western Aphasia Battery-Revised and other impairment and participation measures were compared using paired t tests. Analyses of variance were used to compare outcomes related to aphasia severity (severe, moderate, and mild aphasia), aphasia type (fluent, nonfluent), and chronicity (0-6 months postonset, 7-12 months postonset, and 12+ months postonset). Participants made significant changes on all impairment and participation measures. Large effect sizes were noted for one participation and three impairment measures. Medium effect sizes were noted for one impairment and three participation measures. There was no significant difference among groups on any factor. ICAPs can have a significant effect on the language impairment and participation of people with aphasia, but further research is required to determine if the effect is comparable to other types of service delivery.

  8. Guidelines for a Comprehensive Care Program to Ostomized Patients and Families: a Nursing proposal

    Directory of Open Access Journals (Sweden)

    Paula Alvarenga de Figueiredo

    2016-01-01

    Full Text Available Objectives: describe care needs and demands that mark the discursive practices of ostomized clients and family members and discuss guidelines for a comprehensive care program to ostomized clients and their families, organized by macrosociological categories. Method: Creative and Sensitive, involving 17 ostomized subjects and family members at a municipal outpatient clinic. The ethical aspects were complied with. A characterization form was used, as well as Creativity and Sensitivity Dynamics: "speaking map", "body-knowledge" and "calendar". Critical Discourse Analysis was applied. Results: the health needs and care demands of the ostomized patients and their family members, in their multiple dimensions, were constituted in the home and community, outpatient and social context, implying new orientations for nursing care. The unveiling of the data brought elements that constituted guidelines, in a macrosociological approach, to achieve the expanded integrality of nursing care. Conclusion: the ostomized clients are unique in their genre/peculiar from Latin sui generis, calling for strategies that respond to and distinguish their specificities. Elaborating a Public Health Policy that improves and reorganizes the care demands, taking into account these individual biopsychosocial and spiritual aspects, is a possible and irrevocable target in the attempt to achieve better conditions of health and wellbeing.

  9. A web-based tool for the Comprehensive Unit-based Safety Program (CUSP).

    Science.gov (United States)

    Pronovost, Peter J; King, Jay; Holzmueller, Christine G; Sawyer, Melinda; Bivens, Shauna; Michael, Michelle; Haig, Kathy; Paine, Lori; Moore, Dana; Miller, Marlene

    2006-03-01

    An organization's ability to change is driven by its culture, which in turn has a significant impact on safety. The six-step Comprehensive Unit-Based Safety Program (CUSP) is intended to improve local culture and safety. A Web-based project management tool for CUSP was developed and then pilot tested at two hospitals. HOW ECUSP WORKS: Once a patient safety concern is identified (step 3), a unit-level interdisciplinary safety committee determines issue criticality and starts up the projects (step 4), which are managed using project management tools within eCUSP (step 5). On a project's completion, the results are disseminated through a shared story (step 6). OSF St. Joseph's Medical Center-The Medical Birthing Center (Bloomington, Illinois), identified 11 safety issues, implemented 11 projects, and created 9 shared stories--including one for its Armband Project. The Johns Hopkins Hospital (Baltimore) Medical Progressive Care (MPC4) Unit identified 5 safety issues and implemented 4 ongoing projects, including the intravenous (IV) Tubing Compliance Project. The eCUSP tool's success depends on an organizational commitment to creating a culture of safety.

  10. Effectiveness and Cost-benefit Evaluation of a Comprehensive Workers' Health Surveillance Program for Sustainable Employability of Meat Processing Workers

    NARCIS (Netherlands)

    Holland, van Berry J.; Reneman, Michiel F; Soer, Remko; Brouwer, Sandra; de Boer, Michiel R

    Objective To evaluate the effectiveness of a comprehensive workers' health surveillance (WHS) program on aspects of sustainable employability and cost-benefit. Methods A cluster randomized stepped wedge trial was performed in a Dutch meat processing company from february 2012 until march 2015. In

  11. Effectiveness and Cost-benefit Evaluation of a Comprehensive Workers' Health Surveillance Program for Sustainable Employability of Meat Processing Workers

    NARCIS (Netherlands)

    van Holland, Berry J; Reneman, Michiel F; Soer, Remko; Brouwer, Sandra; de Boer, Michiel R

    2017-01-01

    Objective To evaluate the effectiveness of a comprehensive workers' health surveillance (WHS) program on aspects of sustainable employability and cost-benefit. Methods A cluster randomized stepped wedge trial was performed in a Dutch meat processing company from february 2012 until march 2015. In

  12. A comprehensive linear programming tool to optimize formulations of ready-to-use therapeutic foods: An application to Ethiopia

    Science.gov (United States)

    Ready-to-use therapeutic food (RUTF) is the standard of care for children suffering from noncomplicated severe acute malnutrition (SAM). The objective was to develop a comprehensive linear programming (LP) tool to create novel RUTF formulations for Ethiopia. A systematic approach that surveyed inter...

  13. Comprehensive Community Mental Health Services for Children and Their Families Program, Evaluation Findings: Annual Report to Congress 2010

    Science.gov (United States)

    Substance Abuse and Mental Health Services Administration, 2010

    2010-01-01

    This report to Congress provides critical information about the Comprehensive Community Mental Health Services for Children and their Families Program (CMHI), including the characteristics of children, youth, and families as they enter the CMHI; the outcomes attained for children and youth, and their caregivers and families after entry into the…

  14. Gynecologic Cancer Prevention and Control in the National Comprehensive Cancer Control Program: Progress, Current Activities, and Future Directions

    OpenAIRE

    Stewart, Sherri L.; Lakhani, Naheed; Brown, Phaeydra M.; Larkin, O. Ann; Moore, Angela R.; Hayes, Nikki S.

    2013-01-01

    Gynecologic cancer confers a large burden among women in the United States. Several evidence-based interventions are available to reduce the incidence, morbidity, and mortality from these cancers. The National Comprehensive Cancer Control Program (NCCCP) is uniquely positioned to implement these interventions in the US population. This review discusses progress and future directions for the NCCCP in preventing and controlling gynecologic cancer.

  15. Gynecologic cancer prevention and control in the National Comprehensive Cancer Control Program: progress, current activities, and future directions.

    Science.gov (United States)

    Stewart, Sherri L; Lakhani, Naheed; Brown, Phaeydra M; Larkin, O Ann; Moore, Angela R; Hayes, Nikki S

    2013-08-01

    Gynecologic cancer confers a large burden among women in the United States. Several evidence-based interventions are available to reduce the incidence, morbidity, and mortality from these cancers. The National Comprehensive Cancer Control Program (NCCCP) is uniquely positioned to implement these interventions in the US population. This review discusses progress and future directions for the NCCCP in preventing and controlling gynecologic cancer.

  16. Effects of Comprehensive Risk Management Program on the Preparedness of Rofeide Rehabilitation Hospital in Disasters and Incidents

    Directory of Open Access Journals (Sweden)

    Samira Rajabi

    2017-07-01

    Conclusion: Considering the positive impact of the implementation of the risk management program on the preparedness of Rofeide Rehabilitation Hospital and promotion of its preparedness level from poor to moderate, as well as relatively high vulnerability of hospitals against internal and external risks, national hospitals are recommended to use the comprehensive hospital risk management model to be more prepared for disasters.

  17. The Effect of Neuro-Linguistic Programming (NLP) on Reading Comprehension in English for Specific Purposes Courses

    Science.gov (United States)

    Farahani, Fahimeh

    2018-01-01

    Neuro-Linguistic Programming (NLP) has potential to help language learners; however, it has received scant attention. The present study was an attempt to investigate the effect of NLP techniques on reading comprehension of English as a Foreign Language (EFL) learners at an English for Specific Purposes (ESP) course. To achieve this goal, two…

  18. Simultaneous optimization of sequential IMRT plans

    International Nuclear Information System (INIS)

    Popple, Richard A.; Prellop, Perri B.; Spencer, Sharon A.; Santos, Jennifer F. de los; Duan, Jun; Fiveash, John B.; Brezovich, Ivan A.

    2005-01-01

    Radiotherapy often comprises two phases, in which irradiation of a volume at risk for microscopic disease is followed by a sequential dose escalation to a smaller volume either at a higher risk for microscopic disease or containing only gross disease. This technique is difficult to implement with intensity modulated radiotherapy, as the tolerance doses of critical structures must be respected over the sum of the two plans. Techniques that include an integrated boost have been proposed to address this problem. However, clinical experience with such techniques is limited, and many clinicians are uncomfortable prescribing nonconventional fractionation schemes. To solve this problem, we developed an optimization technique that simultaneously generates sequential initial and boost IMRT plans. We have developed an optimization tool that uses a commercial treatment planning system (TPS) and a high level programming language for technical computing. The tool uses the TPS to calculate the dose deposition coefficients (DDCs) for optimization. The DDCs were imported into external software and the treatment ports duplicated to create the boost plan. The initial, boost, and tolerance doses were specified and used to construct cost functions. The initial and boost plans were optimized simultaneously using a gradient search technique. Following optimization, the fluence maps were exported to the TPS for dose calculation. Seven patients treated using sequential techniques were selected from our clinical database. The initial and boost plans used to treat these patients were developed independently of each other by dividing the tolerance doses proportionally between the initial and boost plans and then iteratively optimizing the plans until a summation that met the treatment goals was obtained. We used the simultaneous optimization technique to generate plans that met the original planning goals. The coverage of the initial and boost target volumes in the simultaneously optimized

  19. EPID-based verification of the MLC performance for dynamic IMRT and VMAT

    International Nuclear Information System (INIS)

    Rowshanfarzad, Pejman; Sabet, Mahsheed; Barnes, Michael P.; O’Connor, Daryl J.; Greer, Peter B.

    2012-01-01

    Purpose: In advanced radiotherapy treatments such as intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT), verification of the performance of the multileaf collimator (MLC) is an essential part of the linac QA program. The purpose of this study is to use the existing measurement methods for geometric QA of the MLCs and extend them to more comprehensive evaluation techniques, and to develop dedicated robust algorithms to quantitatively investigate the MLC performance in a fast, accurate, and efficient manner. Methods: The behavior of leaves was investigated in the step-and-shoot mode by the analysis of integrated electronic portal imaging device (EPID) images acquired during picket fence tests at fixed gantry angles and arc delivery. The MLC was also studied in dynamic mode by the analysis of cine EPID images of a sliding gap pattern delivered in a variety of conditions including different leaf speeds, deliveries at fixed gantry angles or in arc mode, and changing the direction of leaf motion. The accuracy of the method was tested by detection of the intentionally inserted errors in the delivery patterns. Results: The algorithm developed for the picket fence analysis was able to find each individual leaf position, gap width, and leaf bank skewness in addition to the deviations from expected leaf positions with respect to the beam central axis with sub-pixel accuracy. For the three tested linacs over a period of 5 months, the maximum change in the gap width was 0.5 mm, the maximum deviation from the expected leaf positions was 0.1 mm and the MLC skewness was up to 0.2°. The algorithm developed for the sliding gap analysis could determine the velocity and acceleration/deceleration of each individual leaf as well as the gap width. There was a slight decrease in the accuracy of leaf performance with increasing leaf speeds. The analysis results were presented through several graphs. The accuracy of the method was assessed as 0.01 mm

  20. An inter-centre quality assurance network for IMRT verification: Results of the ESTRO QUASIMODO project

    International Nuclear Information System (INIS)

    Gillis, Sofie; Wagter, Carlos de; Bohsung, Joerg; Perrin, Bruce; Williams, Peter; Mijnheer, Ben J.

    2005-01-01

    Background and purpose: IMRT necessitates extension of existing inter-centre quality assurance programs due to its increased complexity. We assessed the feasibility of an inter-centre verification method for different IMRT techniques. Materials and methods: Eight European radiotherapy institutions of the QUASIMODO network, have designed an IMRT plan for a horseshoe-shaped PTV surrounding a cylindrical OAR in a simplified pelvic phantom. All centres applied common plan objectives but used their own equipment for planning and delivery. They verified the delivery of this plan according to a common protocol with radiographic film and ionisation chamber measurements. The irradiated films, the results of the ionisation chamber measurements and the computed dose distributions were sent to one analysis centre that compared the measured and computed dose distributions with the gamma method and composite dose-area histograms. Results: 4% (relative to the prescribed dose) and 3 mm (distance-to-agreement) were decided feasible gamma criteria. The composite dose-area histograms showed a maximum local deviation of 3.5% in the mean dose of the PTV and 5% in the OAR. Systematic differences could be identified, and in some cases explained. Conclusions: This multi-centre dosimetric verification study demonstrated both the feasibility of a multi-centre quality assurance network to evaluate any IMRT planning and delivery system combination, as well as the validity of the methodology involved

  1. An absorbed dose calorimeter for IMRT dosimetry

    International Nuclear Information System (INIS)

    Duane, S.; Aldehaybes, M.; Bailey, M.; Lee, N.D.; Thomas, C.G.; Palmans, H.

    2012-01-01

    A new calorimeter for dosimetry in small and complex fields has been built. The device is intended for the direct determination of absorbed dose to water in moderately small fields and in composite fields such as IMRT treatments, and as a transfer instrument calibrated against existing absorbed dose standards in conventional reference conditions. The geometry, materials and mode of operation have been chosen to minimize detector perturbations when used in a water phantom, to give a reasonably isotropic response and to minimize the effects of heat transfer when the calorimeter is used in non-reference conditions in a water phantom. The size of the core is meant to meet the needs of measurement in IMRT treatments and is comparable to the size of the air cavity in a type NE2611 ionization chamber. The calorimeter may also be used for small field dosimetry. Initial measurements in reference conditions and in an IMRT head and neck plan, collapsed to gantry angle zero, have been made to estimate the thermal characteristics of the device, and to assess its performance in use. The standard deviation (estimated repeatability) of the reference absorbed dose measurements was 0.02 Gy (0.6%). (authors)

  2. SU-E-T-163: Evaluation of Dose Distributions Recalculated with Per-Field Measurement Data Under the Condition of Respiratory Motion During IMRT for Liver Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Song, J; Yoon, M; Nam, T; Ahn, S; Chung, W [Chonnam National University Hwasun Hospital, Hwasun-kun, Chonnam (Korea, Republic of)

    2014-06-01

    Purpose: The dose distributions within the real volumes of tumor targets and critical organs during internal target volume-based intensity-modulated radiation therapy (ITV-IMRT) for liver cancer were recalculated by applying the effects of actual respiratory organ motion, and the dosimetric features were analyzed through comparison with gating IMRT (Gate-IMRT) plan results. Methods: The 4DCT data for 10 patients who had been treated with Gate-IMRT for liver cancer were selected to create ITV-IMRT plans. The ITV was created using MIM software, and a moving phantom was used to simulate respiratory motion. The period and range of respiratory motion were recorded in all patients from 4DCT-generated movie data, and the same period and range were applied when operating the dynamic phantom to realize coincident respiratory conditions in each patient. The doses were recalculated with a 3 dose-volume histogram (3DVH) program based on the per-field data measured with a MapCHECK2 2-dimensional diode detector array and compared with the DVHs calculated for the Gate-IMRT plan. Results: Although a sufficient prescription dose covered the PTV during ITV-IMRT delivery, the dose homogeneity in the PTV was inferior to that with the Gate-IMRT plan. We confirmed that there were higher doses to the organs-at-risk (OARs) with ITV-IMRT, as expected when using an enlarged field, but the increased dose to the spinal cord was not significant and the increased doses to the liver and kidney could be considered as minor when the reinforced constraints were applied during IMRT plan optimization. Conclusion: Because Gate-IMRT cannot always be considered an ideal method with which to correct the respiratory motional effect, given the dosimetric variations in the gating system application and the increased treatment time, a prior analysis for optimal IMRT method selection should be performed while considering the patient's respiratory condition and IMRT plan results.

  3. [Comprehensive care program for the mentally ill in Spanish prisons (PAIEM): assessment after four years operation].

    Science.gov (United States)

    Sanz, J; Gómez-Pintado, P; Ruiz, A; Pozuelo, F; Arroyo, J M

    2014-01-01

    To assess the comprehensive care program for the mentally ill in prison (PAIEM), which has been implemented for 3 years in Spanish prisons with the aim of improving processes and results. Descriptive study of the data gathered from an anonymous questionnaire completed by members of the PAIEM team in prisons. Frequency distributions were obtained of all the variables relating to facts, attitudes, opinions, experiences, situations and processes of the PAIEM. 91.2% of the PAIEM teams responded. Psychologists, educators, doctors and social workers were the professionals that collaborated most actively in the PAIEM (73%-84%) and were the ones to act most frequently as tutors. The mentally ill are usually located in ordinary modules (80%). The most commonly used activities for their psycho-social rehabilitation are self care (73%), education for health, preparation for daily life and social skills (more than 60%). Interventions with families are basically by telephone (79%). Bivariate analysis showed that the PAIEMs that operate most effectively are those that coordinate well with other technical teams, that prepare referral more than six months prior to release and ones where the NGOs process the referrals. Over 71% of the professionals observed improvements of disabilities and needs in over half the patients more than half of the professionals involved are satisfied (3.4/5) with their participation, although they acknowledge that there is a greater work load. The activities of the PAIEM are adequate, especially in the phases of early detection, stabilisation and rehabilitation and less so in the social incorporation phase, which improves when the third sector intervenes in referrals of patients to the social health care network outside prison.

  4. Comprehensive evaluation of cervical cancer screening programs: the case of Colombia

    Directory of Open Access Journals (Sweden)

    Raúl Murillo

    2011-12-01

    Full Text Available OBJECTIVE: To identify critical screening program factors for reducing cervical cancer mortality in Colombia. MATERIAL AND METHODS: Coverage, quality, and screening follow-up were evaluated in four Colombian states with different mortality rates. A case-control study (invasive cancer and healthy controls evaluating screening history was performed. RESULTS: 3-year cytology coverage was 72.7%, false negative rate 49%, positive cytology follow-up 64.2%. There was no association between screening history and invasive cancer in two states having high cytology coverage but high false negative rates. Two states revealed association between deficient screening history and invasive cancer as well as lower positive-cytology follow-up. CONCLUSIONS: Reduced number of visits between screening and treatment is more relevant when low access to health care is present. Improved quality is a priority if access to screening is available. Suitable interventions for specific scenarios and proper appraisal of new technologies are compulsory to improve cervical cancer screening. Comprehensive process-failure audits among invasive cancer cases could improve program evaluation since mortality is a late outcome.OBJETIVO: Identificar factores críticos para reducir la mortalidad por cáncer cervical en Colombia. MATERIAL Y MÉTODOS: Se evaluó cobertura, calidad y seguimiento del tamizaje en cuatro departamentos con tasas de mortalidad diferenciales. Un estudio de casos (cáncer invasor y controles (sanos evaluó historia de tamizaje. RESULTADOS: Cobertura 72,7%; falsos negativos 49%; acceso a diagnóstico-tratamiento de HSIL 64,2%. La historia de tamizaje no se asoció con cáncer invasor en dos departamentos con elevada cobertura pero elevada proporción de falsos negativos. Dos departamentos con asociación entre historia de tamizaje deficiente y cáncer invasor tuvieron cobertura aceptable pero bajo acceso a diagnóstico-tratamiento. No hubo relación entre mortalidad

  5. A cross-cultural, long-term outcome evaluation of the ISTAR Comprehensive Stuttering Program across Dutch and Canadian adults who stutter.

    NARCIS (Netherlands)

    Langevin, M.; Huinck, W.J.; Kully, D.; Peters, H.F.M.; Lomheim, H.; Tellers, M.

    2006-01-01

    There is a need to evaluate the effectiveness of stuttering treatment programs delivered in domestic and international contexts and to determine if treatment delivered internationally is culturally sensitive. Evaluation of the effectiveness of the ISTAR Comprehensive Stuttering Program (CSP) within

  6. Stereotactic intensity-modulated radiation therapy (IMRT) and inverse treatment planning for advanced pleural mesothelioma. Feasibility and initial results

    Energy Technology Data Exchange (ETDEWEB)

    Muenter, M.W.; Thilmann, C.; Hof, H.; Debus, J. [Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (dkfz), Heidelberg (Germany); Nill, S.; Hoess, A.; Partridge, M. [Dept. of Medical Physics, German Cancer Research Center (dkfz), Heidelberg (Germany); Haering, P. [Dept. of Central Dosimetry, German Cancer Research Center (dkfz), Heidelberg (Germany); Manegold, C. [Dept. of Medical Oncology/Internal Medicine, Thoraxklinik Heidelberg gGmbH, Heidelberg (Germany); Wannenmacher, M. [Dept. of Clinical Radiology, Univ. of Heidelberg, Heidelberg (Germany)

    2003-08-01

    Background and Purpose: Complex-shaped malignant pleural mesotheliomas (MPMs) with challenging volumes are extremely difficult to treat by conventional radiotherapy due to tolerance doses of the surrounding normal tissue. In a feasibility study, we evaluated if inversely planned stereotactic intensity-modulated radiation therapy (IMRT) could be applied in the treatment of MPM. Patients and Methods: Eight patients with unresectable lesions were treated after failure of chemotherapy. All patients were positioned using noninvasive patient fixation techniques which can be attached to the applied extracranial stereotactic system. Due to craniocaudal extension of the tumor, it was necessary to develop a special software attached to the inverse planning program KonRad, which can connect two inverse treatment plans and consider the applied dose of the first treatment plan in the area of the matchline of the second treatment plan. Results: Except for one patient, in whom radiotherapy was canceled due to abdominal metastasis, treatment could be completed in all patients and was well tolerated. Median survival after diagnosis was 20 months and after IMRT 6.5 months. Therefore, both the 1-year actuarial overall survival from the start of radiotherapy and the 2-year actuarial overall survival since diagnosis were 28%. IMRT did not result in clinically significant acute side effects. By using the described inverse planning software, over- or underdosage in the region of the field matchline could be prevented. Pure treatment time ranged between 10 and 21 min. Conclusion: This study showed that IMRT is feasible in advanced unresectable MPM. The presented possibilities of stereotactic IMRT in the treatment of MPM will justify the evaluation of IMRT in early-stage pleural mesothelioma combined with chemotherapy in a study protocol, in order to improve the outcome of these patients. Furthermore, dose escalation should be possible by using IMRT. (orig.)

  7. New Mexico’s comprehensive impaired-driving program : crash data analysis.

    Science.gov (United States)

    2014-03-01

    In late 2004, the National Highway Traffic Safety Administration provided funds through a Cooperative Agreement to the New Mexico Department of Transportation to demonstrate a process for implementing a comprehensive State impaired-driving system. NH...

  8. Reading for Understanding: Towards an R&D Program in Reading Comprehension

    National Research Council Canada - National Science Library

    Snow, Catherine

    2001-01-01

    .... We encourage readers of this draft version to respond with feedback about our summary of the issues, the coherence of our model of reading comprehension, and our sketch of the research enterprise...

  9. The application of parameters for comprehensive smile esthetics by digital smile design programs: A review of literature

    Directory of Open Access Journals (Sweden)

    Doya Omar

    2018-01-01

    Full Text Available Cosmetic dentistry is increasingly becoming an issue of concern to patients who hope to improve their smile. A systematic and comprehensive dentofacial analysis must be performed before commencing esthetic treatment. Several computer software programs have been developed for digital smile design (DSD to assist clinicians in this process. This article compares DSD programs commonly used in cosmetic dentistry and their ability to assess esthetic parameters. A literature review was performed of current dentofacial aesthetic parameters and clinical applications of computer technology to assess facial, dentogingival and dental esthetics. Eight DSD programs (Photoshop CS6, Keynote, Planmeca Romexis Smile Design, Cerec SW 4.2, Aesthetic Digital Smile Design, Smile Designer Pro, DSD App and VisagiSMile were compared. Photoshop, Keynote and Aesthetic Digital Smile Design included the largest number of esthetic analysis parameters. Other studied DSD programs presented deficiencies in their ability to analyze facial esthetic parameters but included comprehensive dentogingival and dental esthetic functions. The DSD App, Planmeca Romexis Smile Design, and Cerec SW 4.2 were able to perform 3D analysis; furthermore, Cerec SW 4.2 and PRSD could be used jointly with CAD/CAM. The DSD App and Smile Designer Pro are available as mobile phone applications. It can be concluded that despite the fact that they were not specifically designed for dental diagnosis, Photoshop CS6 and Keynote provide a more comprehensive smile analysis than most specialized DSD programs. However, other program functions should also be considered when deciding which DSD program is applicable to individual clinical setups.

  10. Comprehensive pelvic floor physical therapy program for men with idiopathic chronic pelvic pain syndrome: a prospective study

    OpenAIRE

    Masterson, Thomas A.; Masterson, John M.; Azzinaro, Jessica; Manderson, Lattoya; Swain, Sanjaya; Ramasamy, Ranjith

    2017-01-01

    Background Male chronic pelvic pain syndrome (CPPS) is a heterogeneous constellation of symptoms that causes significant impairment and is often challenging to treat. In this prospective study, we evaluated men with CPPS who underwent comprehensive pelvic floor physical therapy (PFPT) program. We used the previously validated Genitourinary Pain Index (GUPI) to measure outcomes. Methods We included 14 men who underwent physical therapy for idiopathic CPPS from October 2015 to October 2016. Men...

  11. The development of intensity modulated radiotherapy (IMRT) for prostate cancer at Austin and Repatriation Medical Centre (ARMC)

    International Nuclear Information System (INIS)

    Joon, D.L.; Mantle, C.; Viotto, A.; Rolfo, A.; Rykers, K.; Fernando, W.; Grace, M.; Liu, G.; Quong, G.; Feigen, M.; Wada, M.; Joon, M.L.; Fogarty, G.; Chao, M.W.; Khoo, V.

    2003-01-01

    To describe the protocol development of the IMRT program for prostate cancer at the ARMC. A series of protocols were defined and developed to facilitate the delivery of intensity modulated radiotherapy for prostate cancer. These included the following: 1. Physical Simulation including bowel and bladder preparation and immobilization 2. Image Acquisition including CT and MRI simulation scans with image co-registration 3. Contouring Definitions including target and organ at risk volumes as well as IMRT optimization and evaluation volumes 4. Radiotherapy Planning including constraint definition, inverse planning and CMS Focus specific parameters 5. DICOM RT interface including data transfer between CMS Focus and the Elekta Linac Desktop record and verify system 6. Verification including action limits and pre-treatment online EPID verification 7. Radiotherapy Delivery being that of step and shoot 8. Quality Assurance including physics testing and documentation The protocol development and testing has lead to the precise clinical delivery of IMRT for prostate cancer at ARMC that exceeds most of the parameters that were previously measured with our conventional and 3D conformal radiotherapy. Further development is now underway to allow it to be implemented as the routine treatment of prostate cancer at ARMC. The clinical implementation of IMRT for prostate cancer involves a collaborative team approach including radiation oncologists, radiation therapists, and radiation physics. This is necessary to develop the appropriate protocols and quality assurance for precision radiotherapy that is required for IMRT

  12. Analysis of Local Control in Patients Receiving IMRT for Resected Pancreatic Cancers

    International Nuclear Information System (INIS)

    Yovino, Susannah; Maidment, Bert W.; Herman, Joseph M.; Pandya, Naimish; Goloubeva, Olga; Wolfgang, Chris; Schulick, Richard; Laheru, Daniel; Hanna, Nader; Alexander, Richard; Regine, William F.

    2012-01-01

    Purpose: Intensity-modulated radiotherapy (IMRT) is increasingly incorporated into therapy for pancreatic cancer. A concern regarding this technique is the potential for geographic miss and decreased local control. We analyzed patterns of first failure among patients treated with IMRT for resected pancreatic cancer. Methods and Materials: Seventy-one patients who underwent resection and adjuvant chemoradiation for pancreas cancer are included in this report. IMRT was used for all to a median dose of 50.4 Gy. Concurrent chemotherapy was 5-FU–based in 72% of patients and gemcitabine-based in 28%. Results: At median follow-up of 24 months, 49/71 patients (69%) had failed. The predominant failure pattern was distant metastases in 35/71 patients (49%). The most common site of metastases was the liver. Fourteen patients (19%) developed locoregional failure in the tumor bed alone in 5 patients, regional nodes in 4 patients, and concurrently with metastases in 5 patients. Median overall survival (OS) was 25 months. On univariate analysis, nodal status, margin status, postoperative CA 19-9 level, and weight loss during treatment were predictive for OS. On multivariate analysis, higher postoperative CA19-9 levels predicted for worse OS on a continuous basis (p < 0.01). A trend to worse OS was seen among patients with more weight loss during therapy (p = 0.06). Patients with positive nodes and positive margins also had significantly worse OS (HR for death 2.8, 95% CI 1.1–7.5; HR for death 2.6, 95% CI 1.1–6.2, respectively). Grade 3-4 nausea and vomiting was seen in 8% of patients. Late complication of small bowel obstruction occurred in 4 (6%) patients. Conclusions: This is the first comprehensive report of patterns of failure among patients treated with adjuvant IMRT for pancreas cancer. IMRT was not associated with an increase in local recurrences in our cohort. These data support the use of IMRT in the recently activated EORTC/US Intergroup/RTOG 0848 adjuvant

  13. Effectiveness of a Comprehensive Stress Management Program to Reduce Work-Related Stress in a Medium-Sized Enterprise

    Science.gov (United States)

    2014-01-01

    Objectives To assess the effectiveness of a comprehensive workplace stress management program consisting of participatory action-oriented training (PAOT) and individual management. Methods A comprehensive workplace stress management program was conducted in a medium-sized enterprise. The baseline survey was conducted in September 2011, using the Korean Occupational Stress Scale (KOSS) and Worker’s Stress Response Inventory (WSRI). After implementing both organizational and individual level interventions, the follow up evaluation was conducted in November 2011. Results Most of the workers participated in the organizational level PAOT and made Team-based improvement plans. Based on the stress survey, 24 workers were interviewed by a researcher. After the organizational and individual level interventions, there was a reduction of several adverse psychosocial factors and stress responses. In the case of blue-collar workers, psychosocial factors such as the physical environment, job demands, organizational system, lack of rewards, and occupational climate were significantly improved; in the case of white-collar workers, the occupational climate was improved. Conclusions In light of these results, we concluded that the comprehensive stress management program was effective in reducing work-related stress in a short-term period. A persistent long-term follow up is necessary to determine whether the observed effects are maintained over time. Both team-based improvement activities and individual interviews have to be sustainable and complementary to each other under the long-term plan. PMID:24524591

  14. Effectiveness of a comprehensive stress management program to reduce work-related stress in a medium-sized enterprise.

    Science.gov (United States)

    Kim, Shin-Ae; Suh, Chunhui; Park, Mi-Hee; Kim, Kunhyung; Lee, Chae-Kwan; Son, Byung-Chul; Kim, Jeong-Ho; Lee, Jong-Tae; Woo, Kuck-Hyun; Kang, Kabsoon; Jung, Hyunjin

    2014-01-01

    To assess the effectiveness of a comprehensive workplace stress management program consisting of participatory action-oriented training (PAOT) and individual management. A comprehensive workplace stress management program was conducted in a medium-sized enterprise. The baseline survey was conducted in September 2011, using the Korean Occupational Stress Scale (KOSS) and Worker's Stress Response Inventory (WSRI). After implementing both organizational and individual level interventions, the follow up evaluation was conducted in November 2011. Most of the workers participated in the organizational level PAOT and made Team-based improvement plans. Based on the stress survey, 24 workers were interviewed by a researcher. After the organizational and individual level interventions, there was a reduction of several adverse psychosocial factors and stress responses. In the case of blue-collar workers, psychosocial factors such as the physical environment, job demands, organizational system, lack of rewards, and occupational climate were significantly improved; in the case of white-collar workers, the occupational climate was improved. In light of these results, we concluded that the comprehensive stress management program was effective in reducing work-related stress in a short-term period. A persistent long-term follow up is necessary to determine whether the observed effects are maintained over time. Both team-based improvement activities and individual interviews have to be sustainable and complementary to each other under the long-term plan.

  15. The Effectiveness of the Barton’s Intervention Program on Reading Comprehension and Reading Attitude of Students with Dyslexia

    Science.gov (United States)

    Mihandoost, Zeinab; Elias, Habibah

    2011-01-01

    Objective: The current research tested the differences in reading attitude and reading comprehension in the dyslexic students between the control group and the experimental group following the Barton intervention program. Methods: Dyslexia screening instrument and reading text were employed in order to identify dyslexic students. The population of the study included 138 dyslexic students studying in schools in Ilam, Iran. From this population, 64 students were randomly selected and assigned to an experimental group as well as a control group. The experimental group was taught for 36 sessions, using the Barton’s method at two levels, and ten lessons were provided to improve the reading skill. The reading comprehension and reading attitude instruments were employed for the measurement of the attitude and comprehension before and after the intervention program. Results: The analysis of covariance showed a significant difference between the control group and the experimental group following the Barton intervention program. Conclusion: This study showed that dyslexic students learned to read, and a more direct instruction related to decoding could influence their progress more than the general exposure to education. PMID:24644446

  16. Chemical Technology Division Comprehensive Self-Assessment and Upgrade Program (CSAUP). Performance Objectives and Criteria

    International Nuclear Information System (INIS)

    1990-05-01

    The U.S. Department of Energy (DOE) has placed strong emphasis on a new way of doing business patterned on the lessons learned in the nuclear power industry after the accident at Three Mile Island Unit 2. The new way relies on strict adherence to policies and procedures, a greatly expanded training program, and much more rigor and formality in operations. Another key element is more visible oversight by upper management and auditability by DOR Although the Chemical Technology Division (Chem Tech) has functioned in a safe manner since its beginning, the policies and methods of the past are no longer appropriate. Therefore, in accordance with these directives, Chem Tech is improving its operational performance by making a transition to greater formality in the observance of policies and procedures and a more deliberate consideration of the interrelationships between organizations at ORNL. This transition to formality is vitally important because both our staff and our facilities are changing with time. For example, some of the inventors and developers of the processes and facilities in use are now ''passing the torch'' to the next generation of Chem Tech staff. Our faculties have also served us well for many years, but the newest of these are now over 20 years old. All have increasing needs of refurbishment and repair, and some of the older ones need to be replaced. The Comprehensive Self-Assessment and Upgrade Program (CSAUP) has been patterned on a similar activity performed at the High Flux Isotope Reactor. Using the Draft DOE Performance Objectives and Criteria for Technical Safety Appraisals (May 1987) as a starting point, it was determined that 14 functional areas for evaluation listed in the report were suitable for Chem Tech use. An additional 5 functional areas were added for completeness since Chem Tech has a broader set of missions than a reactor facility. The Performance Objectives and Criteria (POC) for each functional area in the DOE report were

  17. Assessment of training needs and preferences for geographic information systems (GIS) mapping in state comprehensive cancer-control programs.

    Science.gov (United States)

    Hopfer, Suellen; Chadwick, Amy E; Parrott, Roxanne L; Ghetian, Christie B; Lengerich, Eugene J

    2009-10-01

    Geographic information systems (GIS) mapping technologies have potential to advance public health promotion by mapping regional differences in attributes (e.g., disease burden, environmental exposures, access to health care services) to suggest priorities for public health interventions. Training in GIS for comprehensive cancer control (CCC) has been overlooked. State CCC programs' GIS training needs were assessed by interviewing 49 state CCC directors. A majority perceived a need for GIS training, slightly more than half of state CCC programs had access to geocoded data, and the majority of programs did not require continuing education credits of their staff. CCC directors perceived judging maps and realizing their limitations as important skills and identified epidemiologists, CCC staff, public health officials, policy makers, and cancer coalition members as training audiences. They preferred in-class training sessions that last a few hours to a day. Lessons learned are shared to develop training programs with translatable GIS skills for CCC.

  18. Development of a quality control system in intensity modulated radiotherapy (IMRT)

    International Nuclear Information System (INIS)

    Souza, Roberto Salomon de; Braz, Delson

    2013-01-01

    The more complex the technique of radiotherapy is, the more refined the quality control must be. The technique of Intensity Modulated Radiotherapy (IMRT) is one of the technological innovations that gained space in the whole worlds in the last decade whose parameters of quality control are not fully established yet. The present work developed a phantom for quality control in IMRT to be implemented in the routine of the Radiotherapy Quality Control Program (PQRT) of the Brazilian National Cancer Institute (INCa). The device consists of a block formed by several polystyrene slice with TDLs and radiochromic film inserted. It should be sent (or taken) to the Program participating institutions to be irradiated under certain conditions and then be returned to the PQRT., where the discrepancy degree between the planned treatment and those effectively delivered will be evaluated. The system was validated through the test cases and the pilot program preformed in nine radiotherapy centers that perform IMRT in the southeast region of Brazil. (author)

  19. Lhermitte's Sign Developing after IMRT for Head and Neck Cancer

    Directory of Open Access Journals (Sweden)

    Dong C. Lim

    2010-01-01

    Full Text Available Background. Lhermitte's sign (LS is a benign form of myelopathy with neck flexion producing an unpleasant electric-shock sensation radiating down the extremities. Although rare, it can occur after head and neck radiotherapy. Results. We report a case of Lhermitte's developing after curative intensity-modulated radiotherapy (IMRT for a patient with locoregionally advanced oropharyngeal cancer. IMRT delivers a conformal dose of radiation in head and neck cancer resulting in a gradient of radiation dose throughout the spinal cord. Using IMRT, more dose is delivered to the anterior spinal cord than the posterior cord. Conclusions. Lhermitte's sign can develop after IMRT for head and neck cancer. We propose an anterior spinal cord structure, the spinothalamic tract to be the target of IMRT-caused LS.

  20. A Comprehensive Review of Selected Business Programs in Community Colleges and Area Vocational-Technical Centers. Program Review Report.

    Science.gov (United States)

    Florida State Dept. of Education, Tallahassee. Div. of Vocational, Adult, and Community Education.

    In 1988, a review was conducted of the business component of associate in arts and associate in science (AS) degree programs, and of the certificate programs in business in Florida community colleges and area vocational-technical centers. Focusing primarily on business programs in marketing, general business management, and small business…

  1. SU-F-T-295: MLCs Performance and Patient-Specific IMRT QA Using Log File Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Osman, A [King Fahd University of Petroleum and Minerals, Dhahran (Saudi Arabia); American University of Biuret Medical Center, Biuret (Lebanon); Maalej, N [King Fahd University of Petroleum and Minerals, Dhahran (Saudi Arabia); Jayesh, K; Abdel-Rahman, W [King Fahad Specialist Hospital-Dammam, Eastern Province (Saudi Arabia)

    2016-06-15

    Purpose: To analyze the performance of the multi-leaf collimators (MLCs) from the log files recorded during the intensity modulated radiotherapy (IMRT) treatment and to construct the relative fluence maps and do the gamma analysis to compare the planned and executed MLCs movement. Methods: We developed a program to extract and analyze the data from dynamic log files (dynalog files) generated from sliding window IMRT delivery treatments. The program extracts the planned and executed (actual or delivered) MLCs movement, calculates and compares the relative planned and executed fluences. The fluence maps were used to perform the gamma analysis (with 3% dose difference and 3 mm distance to agreement) for 3 IMR patients. We compared our gamma analysis results with those obtained from portal dose image prediction (PDIP) algorithm performed using the EPID. Results: For 3 different IMRT patient treatments, the maximum difference between the planned and the executed MCLs positions was 1.2 mm. The gamma analysis results of the planned and delivered fluences were in good agreement with the gamma analysis from portal dosimetry. The maximum difference for number of pixels passing the gamma criteria (3%/3mm) was 0.19% with respect to portal dosimetry results. Conclusion: MLC log files can be used to verify the performance of the MLCs. Patientspecific IMRT QA based on MLC movement log files gives similar results to EPID dosimetry results. This promising method for patient-specific IMRT QA is fast, does not require dose measurements in a phantom, can be done before the treatment and for every fraction, and significantly reduces the IMRT workload. The author would like to thank King Fahd University of petroleum and Minerals for the support.

  2. Investigating the feasibility of 3D dosimetry in the RPC IMRT H and N phantom

    Energy Technology Data Exchange (ETDEWEB)

    Sakhalkar, H S; Sterling, D [Department of Radiation Oncology Physics, Duke University Medical Center, Durham, NC (United States); Adamovics, J [Department of Chemistry and Biology, Rider University, Lawrenceville, NJ (United States); Ibbott, G [Department of Radiation Physics, M. D. Anderson Cancer Center, Houston, Tx (United States); Oldham, M, E-mail: mark.oldham@duke.edu

    2009-05-01

    An urgent requirement for 3D dosimetry has been recognized because of high failure rate ({approx}25%) in RPC credentialing, which relies on point and 2D dose measurements. Comprehensive 3D dosimetry is likely to resolve more errors and improve IMRT quality assurance. This work presents an investigation of the feasibility of PRESAGE/optical-CT 3D dosimetry in the Radiologic Physics Center (RPC) IMRT H and N phantom. The RPC H and N phantom (with standard and PRESAGE dosimetry inserts alternately) was irradiated with the same IMRT plan. The TLD and EBT film measurement data from standard insert irradiation was provided by RPC. The 3D dose measurement data from PRESAGE insert irradiation was readout using the OCTOPUS{sup TM} 5X optical-CT scanner at Duke. TLD, EBT and PRESAGE dose measurements were inter-compared with Eclipse calculations to evaluate consistency of planning and delivery. Results showed that the TLD point dose measurements agreed with Eclipse calculations to within 5% dose-difference. Relative dose comparison between Eclipse dose, EBT dose and PRESAGE dose was conducted using profiles and gamma comparisons (4% dose-difference and 4 mm distance-to-agreement). Profiles showed good agreement between measurement and calculation except along steep dose gradient regions where Eclipse modelling might be inaccurate. Gamma comparisons showed that the measurement and calculation showed good agreement (>96%) if edge artefacts in measurements are ignored. In conclusion, the PRESAGE/optical-CT dosimetry system was found to be feasible as an independent dosimetry tool in the RPC IMRT H and N phantom.

  3. Investigating the feasibility of 3D dosimetry in the RPC IMRT H and N phantom

    International Nuclear Information System (INIS)

    Sakhalkar, H S; Sterling, D; Adamovics, J; Ibbott, G; Oldham, M

    2009-01-01

    An urgent requirement for 3D dosimetry has been recognized because of high failure rate (∼25%) in RPC credentialing, which relies on point and 2D dose measurements. Comprehensive 3D dosimetry is likely to resolve more errors and improve IMRT quality assurance. This work presents an investigation of the feasibility of PRESAGE/optical-CT 3D dosimetry in the Radiologic Physics Center (RPC) IMRT H and N phantom. The RPC H and N phantom (with standard and PRESAGE dosimetry inserts alternately) was irradiated with the same IMRT plan. The TLD and EBT film measurement data from standard insert irradiation was provided by RPC. The 3D dose measurement data from PRESAGE insert irradiation was readout using the OCTOPUS TM 5X optical-CT scanner at Duke. TLD, EBT and PRESAGE dose measurements were inter-compared with Eclipse calculations to evaluate consistency of planning and delivery. Results showed that the TLD point dose measurements agreed with Eclipse calculations to within 5% dose-difference. Relative dose comparison between Eclipse dose, EBT dose and PRESAGE dose was conducted using profiles and gamma comparisons (4% dose-difference and 4 mm distance-to-agreement). Profiles showed good agreement between measurement and calculation except along steep dose gradient regions where Eclipse modelling might be inaccurate. Gamma comparisons showed that the measurement and calculation showed good agreement (>96%) if edge artefacts in measurements are ignored. In conclusion, the PRESAGE/optical-CT dosimetry system was found to be feasible as an independent dosimetry tool in the RPC IMRT H and N phantom.

  4. A system for EPID-based real-time treatment delivery verification during dynamic IMRT treatment.

    Science.gov (United States)

    Fuangrod, Todsaporn; Woodruff, Henry C; van Uytven, Eric; McCurdy, Boyd M C; Kuncic, Zdenka; O'Connor, Daryl J; Greer, Peter B

    2013-09-01

    To design and develop a real-time electronic portal imaging device (EPID)-based delivery verification system for dynamic intensity modulated radiation therapy (IMRT) which enables detection of gross treatment delivery errors before delivery of substantial radiation to the patient. The system utilizes a comprehensive physics-based model to generate a series of predicted transit EPID image frames as a reference dataset and compares these to measured EPID frames acquired during treatment. The two datasets are using MLC aperture comparison and cumulative signal checking techniques. The system operation in real-time was simulated offline using previously acquired images for 19 IMRT patient deliveries with both frame-by-frame comparison and cumulative frame comparison. Simulated error case studies were used to demonstrate the system sensitivity and performance. The accuracy of the synchronization method was shown to agree within two control points which corresponds to approximately ∼1% of the total MU to be delivered for dynamic IMRT. The system achieved mean real-time gamma results for frame-by-frame analysis of 86.6% and 89.0% for 3%, 3 mm and 4%, 4 mm criteria, respectively, and 97.9% and 98.6% for cumulative gamma analysis. The system can detect a 10% MU error using 3%, 3 mm criteria within approximately 10 s. The EPID-based real-time delivery verification system successfully detected simulated gross errors introduced into patient plan deliveries in near real-time (within 0.1 s). A real-time radiation delivery verification system for dynamic IMRT has been demonstrated that is designed to prevent major mistreatments in modern radiation therapy.

  5. A system for EPID-based real-time treatment delivery verification during dynamic IMRT treatment

    Energy Technology Data Exchange (ETDEWEB)

    Fuangrod, Todsaporn [Faculty of Engineering and Built Environment, School of Electrical Engineering and Computer Science, the University of Newcastle, NSW 2308 (Australia); Woodruff, Henry C.; O’Connor, Daryl J. [Faculty of Science and IT, School of Mathematical and Physical Sciences, the University of Newcastle, NSW 2308 (Australia); Uytven, Eric van; McCurdy, Boyd M. C. [Division of Medical Physics, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, Manitoba R3E 0V9 (Canada); Department of Physics and Astronomy, University of Manitoba, Winnipeg, Manitoba R3T 2N2 (Canada); Department of Radiology, University of Manitoba, Winnipeg, Manitoba R3T 2N2 (Canada); Kuncic, Zdenka [School of Physics, University of Sydney, Sydney, NSW 2006 (Australia); Greer, Peter B. [Faculty of Science and IT, School of Mathematical and Physical Sciences, the University of Newcastle, NSW 2308, Australia and Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Locked Bag 7, Hunter region Mail Centre, Newcastle, NSW 2310 (Australia)

    2013-09-15

    Purpose: To design and develop a real-time electronic portal imaging device (EPID)-based delivery verification system for dynamic intensity modulated radiation therapy (IMRT) which enables detection of gross treatment delivery errors before delivery of substantial radiation to the patient.Methods: The system utilizes a comprehensive physics-based model to generate a series of predicted transit EPID image frames as a reference dataset and compares these to measured EPID frames acquired during treatment. The two datasets are using MLC aperture comparison and cumulative signal checking techniques. The system operation in real-time was simulated offline using previously acquired images for 19 IMRT patient deliveries with both frame-by-frame comparison and cumulative frame comparison. Simulated error case studies were used to demonstrate the system sensitivity and performance.Results: The accuracy of the synchronization method was shown to agree within two control points which corresponds to approximately ∼1% of the total MU to be delivered for dynamic IMRT. The system achieved mean real-time gamma results for frame-by-frame analysis of 86.6% and 89.0% for 3%, 3 mm and 4%, 4 mm criteria, respectively, and 97.9% and 98.6% for cumulative gamma analysis. The system can detect a 10% MU error using 3%, 3 mm criteria within approximately 10 s. The EPID-based real-time delivery verification system successfully detected simulated gross errors introduced into patient plan deliveries in near real-time (within 0.1 s).Conclusions: A real-time radiation delivery verification system for dynamic IMRT has been demonstrated that is designed to prevent major mistreatments in modern radiation therapy.

  6. A system for EPID-based real-time treatment delivery verification during dynamic IMRT treatment

    International Nuclear Information System (INIS)

    Fuangrod, Todsaporn; Woodruff, Henry C.; O’Connor, Daryl J.; Uytven, Eric van; McCurdy, Boyd M. C.; Kuncic, Zdenka; Greer, Peter B.

    2013-01-01

    Purpose: To design and develop a real-time electronic portal imaging device (EPID)-based delivery verification system for dynamic intensity modulated radiation therapy (IMRT) which enables detection of gross treatment delivery errors before delivery of substantial radiation to the patient.Methods: The system utilizes a comprehensive physics-based model to generate a series of predicted transit EPID image frames as a reference dataset and compares these to measured EPID frames acquired during treatment. The two datasets are using MLC aperture comparison and cumulative signal checking techniques. The system operation in real-time was simulated offline using previously acquired images for 19 IMRT patient deliveries with both frame-by-frame comparison and cumulative frame comparison. Simulated error case studies were used to demonstrate the system sensitivity and performance.Results: The accuracy of the synchronization method was shown to agree within two control points which corresponds to approximately ∼1% of the total MU to be delivered for dynamic IMRT. The system achieved mean real-time gamma results for frame-by-frame analysis of 86.6% and 89.0% for 3%, 3 mm and 4%, 4 mm criteria, respectively, and 97.9% and 98.6% for cumulative gamma analysis. The system can detect a 10% MU error using 3%, 3 mm criteria within approximately 10 s. The EPID-based real-time delivery verification system successfully detected simulated gross errors introduced into patient plan deliveries in near real-time (within 0.1 s).Conclusions: A real-time radiation delivery verification system for dynamic IMRT has been demonstrated that is designed to prevent major mistreatments in modern radiation therapy

  7. Implementing a Comprehensive Program for the Prevention of Conduct Problems in Rural Communities: The Fast Track Experience1

    Science.gov (United States)

    Bierman, Karen L.

    2012-01-01

    Childhood conduct problems are predictive of a number of serious long-term difficulties (e.g., school failure, delinquent behavior, and mental health problems), making the design of effective prevention programs a priority. The Fast Track Program is a demonstration project currently underway in four demographically diverse areas of the United States, testing the feasibility and effectiveness of a comprehensive, multicomponent prevention program targeting children at risk for conduct disorders. This paper describes some lessons learned about the implementation of this program in a rural area. Although there are many areas of commonality in terms of program needs, program design, and implementation issues in rural and urban sites, rural areas differ from urban areas along the dimensions of geographical dispersion and regionalism, and community stability and insularity. Rural programs must cover a broad geographical area and must be sensitive to the multiple, small and regional communities that constitute their service area. Small schools, homogeneous populations, traditional values, limited recreational, educational and mental health services, and politically conservative climates are all more likely to emerge as characteristics of rural rather than urban sites (Sherman, 1992). These characteristics may both pose particular challenges to the implementation of prevention programs in rural areas, as well as offer particular benefits. Three aspects of program implementation are described in detail: (a) community entry and program initiation in rural areas, (b) the adaptation of program components and service delivery to meet the needs of rural families and schools, and (c) issues in administrative organization of a broadly dispersed tricounty rural prevention program. PMID:9338956

  8. The Effects of Captions on EFL Learners' Comprehension of English-Language Television Programs

    Science.gov (United States)

    Rodgers, Michael P. H.; Webb, Stuart

    2017-01-01

    The Multimedia Principle (Fletcher & Tobias, 2005) states that people learn better and comprehend more when words and pictures are presented together. The potential for English language learners to increase their comprehension of video through the use of captions, which graphically display the same language as the spoken dialogue, has been…

  9. 75 FR 13110 - Proposed Waivers for the Comprehensive Centers Program and Funding of Continuation Grants

    Science.gov (United States)

    2010-03-18

    ... schools to close achievement gaps in core content areas and raise student achievement in schools... 1116 of the ESEA. Eligible applicants for Comprehensive Center grants are research organizations... grantees from the account-closing provisions in 31 U.S.C. 1552(a), nor would they extend the availability...

  10. A Comprehensive Study of the Incentive Award Program at General Leonard Wood Army Community Hospital

    National Research Council Canada - National Science Library

    Cox, Michael

    2001-01-01

    .... Therefore, they commissioned this study to evaluate the present incentive award program based on fairness and effectiveness and to explore methods of reshaping the program into one that both rewards...

  11. SU-E-T-49: A Multi-Institutional Study of Independent Dose Verification for IMRT

    International Nuclear Information System (INIS)

    Baba, H; Tachibana, H; Kamima, T; Takahashi, R; Kawai, D; Sugawara, Y; Yamamoto, T; Sato, A; Yamashita, M

    2015-01-01

    Purpose: AAPM TG114 does not cover the independent verification for IMRT. We conducted a study of independent dose verification for IMRT in seven institutes to show the feasibility. Methods: 384 IMRT plans in the sites of prostate and head and neck (HN) were collected from the institutes, where the planning was performed using Eclipse and Pinnacle3 with the two techniques of step and shoot (S&S) and sliding window (SW). All of the institutes used a same independent dose verification software program (Simple MU Analysis: SMU, Triangle Product, Ishikawa, JP), which is Clarkson-based and CT images were used to compute radiological path length. An ion-chamber measurement in a water-equivalent slab phantom was performed to compare the doses computed using the TPS and an independent dose verification program. Additionally, the agreement in dose computed in patient CT images between using the TPS and using the SMU was assessed. The dose of the composite beams in the plan was evaluated. Results: The agreement between the measurement and the SMU were −2.3±1.9 % and −5.6±3.6 % for prostate and HN sites, respectively. The agreement between the TPSs and the SMU were −2.1±1.9 % and −3.0±3.7 for prostate and HN sites, respectively. There was a negative systematic difference with similar standard deviation and the difference was larger in the HN site. The S&S technique showed a statistically significant difference between the SW. Because the Clarkson-based method in the independent program underestimated (cannot consider) the dose under the MLC. Conclusion: The accuracy would be improved when the Clarkson-based algorithm should be modified for IMRT and the tolerance level would be within 5%

  12. Hybrid IMRT plans-concurrently treating conventional and IMRT beams for improved breast irradiation and reduced planning time

    International Nuclear Information System (INIS)

    Mayo, Charles S.; Urie, Marcia M.; Fitzgerald, Thomas J.

    2005-01-01

    Purpose: To evaluate a hybrid intensity modulated radiation therapy (IMRT) technique as a class solution for treatment of the intact breast. Methods and materials: The following five plan techniques were compared for 10 breast patients using dose-volume histogram analysis: conventional wedged-field tangents (Tangents), forward-planned field-within-a-field tangents (FIF), IMRT-only tangents (IMRT tangents), conventional open plus IMRT tangents (4-field hybrid), and conventional open plus IMRT tangents with 2 anterior oblique IMRT beams (6-field hybrid). Results: The 4-field hybrid and FIF achieved dose distributions better than Tangents and IMRT tangents. The volume of tissue outside the planning target volume receiving ≥110% of prescribed dose was largest for IMRT tangents (average 158 cc) and least for 6-field hybrid (average 1 cc); the FIF and 4-field hybrid were comparable (average 15 cc). Heart volume ≥30 Gy averaged 13 cc for all techniques, except Tangents, for which it was 32 cc. Average total lung volume ≥20 Gy was 7% for all. Contralateral breast doses were < 3% for all. Planning time for hybrid techniques was significantly less than for conventional FIF technique. Conclusions: The 4-field hybrid technique is a viable class solution. The 6-field hybrid technique creates the most conformal dose distribution at the expense of more normal tissue receiving low dose

  13. Using Robotics to Improve Retention and Increase Comprehension in Introductory Programming Courses

    Science.gov (United States)

    Pullan, Marie

    2013-01-01

    Several college majors, outside of computer science, require students to learn computer programming. Many students have difficulty getting through the programming sequence and ultimately change majors or drop out of college. To deal with this problem, active learning techniques were developed and implemented in a freshman programming logic and…

  14. The effect of comprehensive sexual education program on sexual health knowledge and sexual attitude among college students in Southwest China.

    Science.gov (United States)

    Chi, Xinli; Hawk, Skyler T; Winter, Sam; Meeus, Wim

    2015-03-01

    The purpose of this study was to evaluate whether a comprehensive sexual education program for college students in Southwest China (a) improved sexual health knowledge in reproduction, contraception, condom use, sexually transmitted diseases, and HIV; (b) increased accepting attitudes toward lesbian, gay, bisexual, and transsexual individuals; and (c) altered participants' attitudes toward premarital sex and monogamy. The program used diverse teaching methods, providing 6 sessions over a period of 9 weeks about sexual health knowledge and sexual attitudes to college students (age 18-26 years) in Southwest China. Sexual health knowledge and sexual attitudes of 80 comprehensive sexual education class students (education group) and 92 general mental health education class students (control group) were measured at baseline, the end of course (posttest), and 3 weeks after the end of course (follow-up). There were significant effects of the program on (a) sexual health knowledge, including reproductive health, contraception, condom use, and HIV/AIDS and (b) positive attitudes toward sexual minorities, although these changes may require further reinforcement. In contrast, the program did not alter students' attitudes about premarital sex or monogamy. The results are discussed in terms of recommendations of sex education in China and future directions for research. © 2013 APJPH.

  15. School-Based Supported Employment: A Comprehensive Supported Employment Program for Mildly Mentally Retarded Youth.

    Science.gov (United States)

    Morgan, Valda B.; Karr-Kidwell, PJ

    Supported employment opportunities can help to meet the transition needs of individuals enrolled in special education programs. A review of related literature discusses characteristics of supported employment program participants, the need for individual transition planning, the school's role and responsibility, vocational planning, benefits,…

  16. IMRT for Image-Guided Single Vocal Cord Irradiation

    International Nuclear Information System (INIS)

    Osman, Sarah O.S.; Astreinidou, Eleftheria; Boer, Hans C.J. de; Keskin-Cambay, Fatma; Breedveld, Sebastiaan; Voet, Peter; Al-Mamgani, Abrahim; Heijmen, Ben J.M.; Levendag, Peter C.

    2012-01-01

    Purpose: We have been developing an image-guided single vocal cord irradiation technique to treat patients with stage T1a glottic carcinoma. In the present study, we compared the dose coverage to the affected vocal cord and the dose delivered to the organs at risk using conventional, intensity-modulated radiotherapy (IMRT) coplanar, and IMRT non-coplanar techniques. Methods and Materials: For 10 patients, conventional treatment plans using two laterally opposed wedged 6-MV photon beams were calculated in XiO (Elekta-CMS treatment planning system). An in-house IMRT/beam angle optimization algorithm was used to obtain the coplanar and non-coplanar optimized beam angles. Using these angles, the IMRT plans were generated in Monaco (IMRT treatment planning system, Elekta-CMS) with the implemented Monte Carlo dose calculation algorithm. The organs at risk included the contralateral vocal cord, arytenoids, swallowing muscles, carotid arteries, and spinal cord. The prescription dose was 66 Gy in 33 fractions. Results: For the conventional plans and coplanar and non-coplanar IMRT plans, the population-averaged mean dose ± standard deviation to the planning target volume was 67 ± 1 Gy. The contralateral vocal cord dose was reduced from 66 ± 1 Gy in the conventional plans to 39 ± 8 Gy and 36 ± 6 Gy in the coplanar and non-coplanar IMRT plans, respectively. IMRT consistently reduced the doses to the other organs at risk. Conclusions: Single vocal cord irradiation with IMRT resulted in good target coverage and provided significant sparing of the critical structures. This has the potential to improve the quality-of-life outcomes after RT and maintain the same local control rates.

  17. IMRT for Image-Guided Single Vocal Cord Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Osman, Sarah O.S., E-mail: s.osman@erasmusmc.nl [Department of Radiation Oncology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands); Astreinidou, Eleftheria; Boer, Hans C.J. de; Keskin-Cambay, Fatma; Breedveld, Sebastiaan; Voet, Peter; Al-Mamgani, Abrahim; Heijmen, Ben J.M.; Levendag, Peter C. [Department of Radiation Oncology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands)

    2012-02-01

    Purpose: We have been developing an image-guided single vocal cord irradiation technique to treat patients with stage T1a glottic carcinoma. In the present study, we compared the dose coverage to the affected vocal cord and the dose delivered to the organs at risk using conventional, intensity-modulated radiotherapy (IMRT) coplanar, and IMRT non-coplanar techniques. Methods and Materials: For 10 patients, conventional treatment plans using two laterally opposed wedged 6-MV photon beams were calculated in XiO (Elekta-CMS treatment planning system). An in-house IMRT/beam angle optimization algorithm was used to obtain the coplanar and non-coplanar optimized beam angles. Using these angles, the IMRT plans were generated in Monaco (IMRT treatment planning system, Elekta-CMS) with the implemented Monte Carlo dose calculation algorithm. The organs at risk included the contralateral vocal cord, arytenoids, swallowing muscles, carotid arteries, and spinal cord. The prescription dose was 66 Gy in 33 fractions. Results: For the conventional plans and coplanar and non-coplanar IMRT plans, the population-averaged mean dose {+-} standard deviation to the planning target volume was 67 {+-} 1 Gy. The contralateral vocal cord dose was reduced from 66 {+-} 1 Gy in the conventional plans to 39 {+-} 8 Gy and 36 {+-} 6 Gy in the coplanar and non-coplanar IMRT plans, respectively. IMRT consistently reduced the doses to the other organs at risk. Conclusions: Single vocal cord irradiation with IMRT resulted in good target coverage and provided significant sparing of the critical structures. This has the potential to improve the quality-of-life outcomes after RT and maintain the same local control rates.

  18. Dosimetric adaptive IMRT driven by fiducial points

    International Nuclear Information System (INIS)

    Crijns, Wouter; Van Herck, Hans; Defraene, Gilles; Van den Bergh, Laura; Haustermans, Karin; Slagmolen, Pieter; Maes, Frederik; Van den Heuvel, Frank

    2014-01-01

    Purpose: Intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy have become standard treatments but are more sensitive to anatomical variations than 3D conformal techniques. To correct for inter- and intrafraction anatomical variations, fast and easy to implement methods are needed. Here, the authors propose a full dosimetric IMRT correction that finds a compromise in-between basic repositioning (the current clinical practice) and full replanning. It simplifies replanning by avoiding a recontouring step and a full dose calculation. It surpasses repositioning by updating the preoptimized fluence and monitor units (MU) using a limited number of fiducial points and a pretreatment (CB)CT. To adapt the fluence the fiducial points were projected in the beam's eye view (BEV). To adapt the MUs, point dose calculation towards the same fiducial points were performed. The proposed method is intrinsically fast and robust, and simple to understand for operators, because of the use of only four fiducial points and the beam data based point dose calculations. Methods: To perform our dosimetric adaptation, two fluence corrections in the BEV are combined with two MU correction steps along the beam's path. (1) A transformation of the fluence map such that it is realigned with the current target geometry. (2) A correction for an unintended scaling of the penumbra margin when the treatment beams scale to the current target size. (3) A correction for the target depth relative to the body contour and (4) a correction for the target distance to the source. The impact of the correction strategy and its individual components was evaluated by simulations on a virtual prostate phantom. This heterogeneous reference phantom was systematically subjected to population based prostate transformations to simulate interfraction variations. Additionally, a patient example illustrated the clinical practice. The correction strategy was evaluated using both dosimetric

  19. Dosimetric adaptive IMRT driven by fiducial points

    Energy Technology Data Exchange (ETDEWEB)

    Crijns, Wouter, E-mail: wouter.crijns@uzleuven.be [Department of Oncology, Laboratory of Experimental Radiotherapy, KU Leuven, Herestraat 49, 3000 Leuven, Belgium and Medical Imaging Research Center, KU Leuven, Herestraat 49, 3000 Leuven (Belgium); Van Herck, Hans [Medical Imaging Research Center, KU Leuven, Herestraat 49, 3000 Leuven, Belgium and Department of Electrical Engineering (ESAT) – PSI, Center for the Processing of Speech and Images, KU Leuven, 3000 Leuven (Belgium); Defraene, Gilles; Van den Bergh, Laura; Haustermans, Karin [Department of Oncology, Laboratory of Experimental Radiotherapy, KU Leuven, Herestraat 49, 3000 Leuven (Belgium); Slagmolen, Pieter [Medical Imaging Research Center, KU Leuven, Herestraat 49, 3000 Leuven (Belgium); Department of Electrical Engineering (ESAT) – PSI, Center for the Processing of Speech and Images, KU Leuven, 3000 Leuven (Belgium); iMinds-KU Leuven Medical IT Department, KU Leuven, 3000 Leuven (Belgium); Maes, Frederik [Medical Imaging Research Center, KU Leuven, Herestraat 49, 3000 Leuven (Belgium); Department of Electrical Engineering (ESAT) – PSI, Center for the Processing of Speech and Images, KU Leuven and iMinds, 3000 Leuven (Belgium); Van den Heuvel, Frank [Department of Oncology, Laboratory of Experimental Radiotherapy, KU Leuven, Herestraat 49, 3000 Leuven, Belgium and Department of Oncology, MRC-CR-UK Gray Institute of Radiation Oncology and Biology, University of Oxford, Oxford OX1 2JD (United Kingdom)

    2014-06-15

    Purpose: Intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy have become standard treatments but are more sensitive to anatomical variations than 3D conformal techniques. To correct for inter- and intrafraction anatomical variations, fast and easy to implement methods are needed. Here, the authors propose a full dosimetric IMRT correction that finds a compromise in-between basic repositioning (the current clinical practice) and full replanning. It simplifies replanning by avoiding a recontouring step and a full dose calculation. It surpasses repositioning by updating the preoptimized fluence and monitor units (MU) using a limited number of fiducial points and a pretreatment (CB)CT. To adapt the fluence the fiducial points were projected in the beam's eye view (BEV). To adapt the MUs, point dose calculation towards the same fiducial points were performed. The proposed method is intrinsically fast and robust, and simple to understand for operators, because of the use of only four fiducial points and the beam data based point dose calculations. Methods: To perform our dosimetric adaptation, two fluence corrections in the BEV are combined with two MU correction steps along the beam's path. (1) A transformation of the fluence map such that it is realigned with the current target geometry. (2) A correction for an unintended scaling of the penumbra margin when the treatment beams scale to the current target size. (3) A correction for the target depth relative to the body contour and (4) a correction for the target distance to the source. The impact of the correction strategy and its individual components was evaluated by simulations on a virtual prostate phantom. This heterogeneous reference phantom was systematically subjected to population based prostate transformations to simulate interfraction variations. Additionally, a patient example illustrated the clinical practice. The correction strategy was evaluated using both dosimetric

  20. Comprehensive Technical Report, General Electric Direct-Air-Cycle Aircraft Nuclear Propulsion Program, Program Summary and References

    Energy Technology Data Exchange (ETDEWEB)

    Thornton, G.; Rothstein, A.J.

    1962-06-28

    This is one of twenty-one volumes sumarizing the Aircraft Nuclear Propulsion Program of the General Electric Company. This volume discusses the background to the General Electric program, and summarizes the various direct-air-cycle nuclear test assemblies and power plants that were developed. Because of the requirements of high performance, low weight, and small size, vast improvements in existing technology were required to meet the flight objectives. The technological progress achieved during the program is also summarized. The last appendix contains a compilation of the abstracts, tables of contents, and reference lists of the other twenty volumes.

  1. Lessons from sexual and reproductive health voucher program design and function: a comprehensive review

    Science.gov (United States)

    2014-01-01

    Background Developing countries face challenges in financing healthcare; often the poor do not receive the most basic services. The past decade has seen a sharp increase in the number of voucher programs, which target output-based subsidies for specific services to poor and underserved groups. The dearth of literature that examines lessons learned risks the wheel being endlessly reinvented. This paper examines commonalities and differences in voucher design and implementation, highlighting lessons learned for the design of new voucher programmes. Methodology The methodology comprised: discussion among key experts to develop inclusion/exclusion criteria; up-dating the literature database used by the DFID systematic review of voucher programs; and networking with key contacts to identify new programs and obtain additional program documents. We identified 40 programs for review and extracted a dataset of more than 120 program characteristics for detailed analysis. Results All programs aimed to increase utilisation of healthcare, particularly maternal health services, overwhelmingly among low-income populations. The majority contract(ed) private providers, or public and private providers, and all facilitate(d) access to services that are well defined, time-limited and reflect the country’s stated health priorities. All voucher programs incorporate a governing body, management agency, contracted providers and target population, and all share the same incentive structure: the transfer of subsidies from consumers to service providers, resulting in a strong effect on both consumer and provider behaviour. Vouchers deliver subsidies to individuals, who in the absence of the subsidy would likely not have sought care, and in all programs a positive behavioural response is observed, with providers investing voucher revenue to attract more clients. A large majority of programs studied used targeting mechanisms. Conclusions While many programs remain too small to address

  2. Lessons from sexual and reproductive health voucher program design and function: a comprehensive review.

    Science.gov (United States)

    Grainger, Corinne; Gorter, Anna; Okal, Jerry; Bellows, Ben

    2014-04-29

    Developing countries face challenges in financing healthcare; often the poor do not receive the most basic services. The past decade has seen a sharp increase in the number of voucher programs, which target output-based subsidies for specific services to poor and underserved groups. The dearth of literature that examines lessons learned risks the wheel being endlessly reinvented. This paper examines commonalities and differences in voucher design and implementation, highlighting lessons learned for the design of new voucher programmes. The methodology comprised: discussion among key experts to develop inclusion/exclusion criteria; up-dating the literature database used by the DFID systematic review of voucher programs; and networking with key contacts to identify new programs and obtain additional program documents. We identified 40 programs for review and extracted a dataset of more than 120 program characteristics for detailed analysis. All programs aimed to increase utilisation of healthcare, particularly maternal health services, overwhelmingly among low-income populations. The majority contract(ed) private providers, or public and private providers, and all facilitate(d) access to services that are well defined, time-limited and reflect the country's stated health priorities. All voucher programs incorporate a governing body, management agency, contracted providers and target population, and all share the same incentive structure: the transfer of subsidies from consumers to service providers, resulting in a strong effect on both consumer and provider behaviour. Vouchers deliver subsidies to individuals, who in the absence of the subsidy would likely not have sought care, and in all programs a positive behavioural response is observed, with providers investing voucher revenue to attract more clients. A large majority of programs studied used targeting mechanisms. While many programs remain too small to address national-level need among the poor, large programs

  3. Conformal intensity-modulated radiotherapy (IMRT) delivered by robotic linac - testing IMRT to the limit?

    International Nuclear Information System (INIS)

    Webb, S.

    1999-01-01

    In this paper it is proposed that intensity-modulated radiotherapy (IMRT) could be delivered optimally by a short-length linac mounted on a robotic arm. The robot would allow the linac to 'plant' narrow pencils of photon radiation with any orientation (excluding zones within which the linac and couch might collide) relative to the planning target volume (PTV). The treatment is specified by the trajectory of the robot and by the number of monitor units (MUs) delivered at each robotic orientation. An inverse-planning method to determine the optimum robotic trajectory is presented. It is shown that for complex PTVs, specifically those with concavities in their outline, the conformality of the treatment is improved by the use of a complex trajectory in comparison with a less complex constrained trajectory and this improvement is quantified. It is concluded that robotic linac delivery would lead to a great flexibility in those IMRT treatments requiring very complicated dose distributions with complex 3D shapes. However, even using very fast computers, the goal of determining whether robotic linac delivery is the ultimate IMRT cannot be conclusively reached at present. (author)

  4. A framework for developing an evidence-based, comprehensive tobacco control program

    Directory of Open Access Journals (Sweden)

    Shacham Galia

    2010-05-01

    Full Text Available Abstract Background Tobacco control is an area where the translation of evidence into policy would seem to be straightforward, given the wealth of epidemiological, behavioural and other types of research available. Yet, even here challenges exist. These include information overload, concealment of key (industry-funded evidence, contextualization, assessment of population impact, and the changing nature of the threat. Methods In the context of Israel's health targeting initiative, Healthy Israel 2020, we describe the steps taken to develop a comprehensive tobacco control strategy. We elaborate on the following: a scientific issues influencing the choice of tobacco control strategies; b organization of existing evidence of effectiveness of interventions into a manageable form, and c consideration of relevant philosophical and political issues. We propose a framework for developing a plan and illustrate this process with a case study in Israel. Results Broad consensus exists regarding the effectiveness of most interventions, but current recommendations differ in the emphasis they place on different strategies. Scientific challenges include integration of complex and sometimes conflicting information from authoritative sources, and lack of estimates of population impact of interventions. Philosophical and political challenges include the use of evidence-based versus innovative policymaking, the importance of individual versus governmental responsibility, and whether and how interventions should be prioritized. The proposed framework includes: 1 compilation of a list of potential interventions 2 modification of that list based on local needs and political constraints; 3 streamlining the list by categorizing interventions into broad groupings of related interventions; together these groupings form the basis of a comprehensive plan; and 4 refinement of the plan by comparing it to existing comprehensive plans. Conclusions Development of a comprehensive

  5. A framework for developing an evidence-based, comprehensive tobacco control program.

    Science.gov (United States)

    Rosen, Laura; Rosenberg, Elliot; McKee, Martin; Gan-Noy, Shosh; Levin, Diane; Mayshar, Elana; Shacham, Galia; Borowski, John; Nun, Gabi Bin; Lev, Boaz

    2010-05-27

    Tobacco control is an area where the translation of evidence into policy would seem to be straightforward, given the wealth of epidemiological, behavioural and other types of research available. Yet, even here challenges exist. These include information overload, concealment of key (industry-funded) evidence, contextualization, assessment of population impact, and the changing nature of the threat. In the context of Israel's health targeting initiative, Healthy Israel 2020, we describe the steps taken to develop a comprehensive tobacco control strategy. We elaborate on the following: a) scientific issues influencing the choice of tobacco control strategies; b) organization of existing evidence of effectiveness of interventions into a manageable form, and c) consideration of relevant philosophical and political issues. We propose a framework for developing a plan and illustrate this process with a case study in Israel. Broad consensus exists regarding the effectiveness of most interventions, but current recommendations differ in the emphasis they place on different strategies. Scientific challenges include integration of complex and sometimes conflicting information from authoritative sources, and lack of estimates of population impact of interventions. Philosophical and political challenges include the use of evidence-based versus innovative policymaking, the importance of individual versus governmental responsibility, and whether and how interventions should be prioritized.The proposed framework includes: 1) compilation of a list of potential interventions 2) modification of that list based on local needs and political constraints; 3) streamlining the list by categorizing interventions into broad groupings of related interventions; together these groupings form the basis of a comprehensive plan; and 4) refinement of the plan by comparing it to existing comprehensive plans. Development of a comprehensive tobacco control plan is a complex endeavour, involving

  6. Environmental Guidance Program Reference Book: Comprehensive Environmentally Response, Compensation, and Liability Act

    Energy Technology Data Exchange (ETDEWEB)

    1991-12-31

    This Reference Book contains a current copy of the Comprehensive Environmental Response Compensation, and Liability Act and those regulations that implement the statute and appear to be most relevant to Department of Energy (DOE) activities. The document is provided to DOE and contractor staff for informational purposes only and should not be interpreted as legal guidance. Updates that include important new requirements will be provided periodically. Questions concerning this Reference Book may be directed to Mark Petts, EH-231 (FTS 896-2609 or Commercial 202/586-2609).

  7. A comprehensive approach to RCM-based preventive maintenance program development

    International Nuclear Information System (INIS)

    Hall, B.E.; Davis, T.; Pennington, A.J.

    1988-01-01

    In late 1986, Public Service Electric and Gas Company (PSE ampersand G) concluded that to support its vision and strategic planning it would be necessary to develop a consistent approach to maintenance for all nuclear units at the artificial island. General Physics Corporation was selected to lead a consultant team to support full-scale development of a preventive maintenance (PM) program for Salem and Hope Creek generating stations based on a reliability-centered maintenance (RCM) approach. RCM was selected because it represents a systematic approach to developing a PM program that provides a logical, consistent, and traceable methodology and produces a well-documented engineering basis for the program. Early in 1987, primary objectives for the PM program were defined. The Phase I tasks addressed key programmatic areas such as maintenance philosophy, procedures, condition monitoring, performance trending, equipment failure data base, ogranization, PM program effectiveness evaluation, RCM process, reliability/availability modeling, information management, training, spare parts, software/hardware, and commitments. Phase I of the PM program development project was completed in January 1988. Highlights of the Phase I work and the PM program manual are described

  8. Cost-benefit analysis of comprehensive mental health prevention programs in Japanese workplaces: a pilot study.

    Science.gov (United States)

    Iijima, Sachiko; Yokoyama, Kazuhito; Kitamura, Fumihiko; Fukuda, Takashi; Inaba, Ryoichi

    2013-01-01

    We examined the implementation of mental health prevention programs in Japanese workplaces and the costs and benefits. A cross-sectional survey targeting mental health program staff at 11 major companies was conducted. Questionnaires explored program implementation based on the guidelines of the Japanese Ministry of Health, Labor and Welfare. Labor, materials, outsourcing costs, overheads, employee mental discomfort, and absentee numbers, and work attendance were examined. Cost-benefit analyses were conducted from company perspectives assessing net benefits per employee and returns on investment. The surveyed companies employ an average of 1,169 workers. The implementation rate of the mental health prevention programs was 66% for primary, 51% for secondary, and 60% for tertiary programs. The program's average cost was 12,608 yen per employee and the total benefit was 19,530 yen per employee. The net benefit per employee was 6,921 yen and the return on investment was in the range of 0.27-16.85. Seven of the 11 companies gained a net benefit from the mental health programs.

  9. Toward development of a comprehensive external quality assurance program for polyfunctional intracellular cytokine staining assays.

    Science.gov (United States)

    Staats, Janet S; Enzor, Jennifer H; Sanchez, Ana M; Rountree, Wes; Chan, Cliburn; Jaimes, Maria; Chan, Ray Chun-Fai; Gaur, Amitabh; Denny, Thomas N; Weinhold, Kent J

    2014-07-01

    The External Quality Assurance Program Oversight Laboratory (EQAPOL) Flow Cytometry Program assesses the proficiency of NIH/NIAID/DAIDS-supported and potentially other interested research laboratories in performing Intracellular Cytokine Staining (ICS) assays. The goal of the EQAPOL Flow Cytometry External Quality Assurance Program (EQAP) is to provide proficiency testing and remediation for participating sites. The program is not punitive; rather, EQAPOL aims to help sites identify areas for improvement. EQAPOL utilizes a highly standardized ICS assay to minimize variability and readily identify those sites experiencing technical difficulties with their assays. Here, we report the results of External Proficiency 3 (EP3) where participating sites performed a 7-color ICS assay. On average, sites perform well in the Flow Cytometry EQAP (median score is "Good"). The most common technical issues identified by the program involve protocol adherence and data analysis; these areas have been the focus of site remediation. The EQAPOL Flow Cytometry team is now in the process of expanding the program to 8-color ICS assays. Evaluating polyfunctional ICS responses would align the program with assays currently being performed in support of HIV immune monitoring assays. Copyright © 2014 Elsevier B.V. All rights reserved.

  10. Implementation of a comprehensive pharmaceutical care program for an underserved population.

    Science.gov (United States)

    Mascardo, Lisa A; Spading, Kimberly A; Abramowitz, Paul W

    2012-07-15

    The implementation of a prescription benefit program for low-income patients emphasizing clinical pharmacist services and strict formulary control is described, with a review of program expenditures and cost avoidance. In 2006, University of Iowa Hospitals and Clinics (UIHC) launched a program to provide a limited prescription benefit to indigent patients under the IowaCare Medicaid demonstration waiver. Sudden dramatic growth in IowaCare enrollment, combined with sharp budget cuts, forced UIHC pharmacy leaders to implement creative cost-control strategies: (1) the establishment of an ambulatory care clinic staffed by a clinical pharmacy specialist, (2) increased reliance on an almost exclusively generic formulary, (3) collaboration with social services staff to help secure medication assistance for patients requiring brand-name drugs, (4) optimized purchasing through the federal 340B Drug Pricing Program, and (5) the imposition of medication copayments and mailing fees for prescription refills. Now in its seventh year, the UIHC pharmacy program has expanded indigent patients' access to pharmaceutical care services while reducing their use of hospital and emergency room services and lowering program medication costs by an estimated 50% (from $2.6 million in fiscal year 2009 to $1.3 million in fiscal year 2010). The UIHC ambulatory care pharmacy implemented a prescription program in collaboration with social service workers to address the medication needs of the state's low-income and uninsured patients in a fiscally responsible manner by managing purchasing contracts, revising a generic formulary, implementing copayments and mailing fees, and reviewing medication profiles.

  11. Budget Impact of a Comprehensive Nutrition-Focused Quality Improvement Program for Malnourished Hospitalized Patients.

    Science.gov (United States)

    Sulo, Suela; Feldstein, Josh; Partridge, Jamie; Schwander, Bjoern; Sriram, Krishnan; Summerfelt, Wm Thomas

    2017-07-01

    Nutrition interventions can alleviate the burden of malnutrition by improving patient outcomes; however, evidence on the economic impact of medical nutrition intervention remains limited. A previously published nutrition-focused quality improvement program targeting malnourished hospitalized patients showed that screening patients with a validated screening tool at admission, rapidly administering oral nutritional supplements, and educating patients on supplement adherence result in significant reductions in 30-day unplanned readmissions and hospital length of stay. To assess the potential cost-savings associated with decreased 30-day readmissions and hospital length of stay in malnourished inpatients through a nutrition-focused quality improvement program using a web-based budget impact model, and to demonstrate the clinical and fiscal value of the intervention. The reduction in readmission rate and length of stay for 1269 patients enrolled in the quality improvement program (between October 13, 2014, and April 2, 2015) were compared with the pre-quality improvement program baseline and validation cohorts (4611 patients vs 1319 patients, respectively) to calculate potential cost-savings as well as to inform the design of the budget impact model. Readmission rate and length-of-stay reductions were calculated by determining the change from baseline to post-quality improvement program as well as the difference between the validation cohort and the post-quality improvement program, respectively. As a result of improved health outcomes for the treated patients, the nutrition-focused quality improvement program led to a reduction in 30-day hospital readmissions and length of stay. The avoided hospital readmissions and reduced number of days in the hospital for the patients in the quality improvement program resulted in cost-savings of $1,902,933 versus the pre-quality improvement program baseline cohort, and $4,896,758 versus the pre-quality improvement program in the

  12. Limited parameter set IMRT for carcinoma breast

    International Nuclear Information System (INIS)

    Gopinath, M.; Sharma, Sanjiv; Vivek, T.R.; Suparna; Deka, Preeti; Manikandan; Giriraj

    2008-01-01

    Post operative radiotherapy after breast conservation surgery is an effective and widely accepted treatment modality in early stage breast cancer. The treatment is usually performed using two wedged tangential photon beams. The disadvantage of this technique is significant dose inhomogeneity as large as 15-20% in the superior and inferior regions of the breast due to lesser transmission thickness and in the medial and lateral aspect of the breast due to lower attenuation of lung tissue in the field. The aim of the study is to modify the conventional wedged tangential pair to achieve a more homogeneous dose distribution and a reduction in acute toxicity and improved cosmetic result. A comparative study is done between the conventional wedged technique and limited parameter set IMRT

  13. TETRA-COM: a comprehensive SPSS program for estimating the tetrachoric correlation.

    Science.gov (United States)

    Lorenzo-Seva, Urbano; Ferrando, Pere J

    2012-12-01

    We provide an SPSS program that implements descriptive and inferential procedures for estimating tetrachoric correlations. These procedures have two main purposes: (1) bivariate estimation in contingency tables and (2) constructing a correlation matrix to be used as input for factor analysis (in particular, the SPSS FACTOR procedure). In both cases, the program computes accurate point estimates, as well as standard errors and confidence intervals that are correct for any population value. For purpose (1), the program computes the contingency table together with five other measures of association. For purpose (2), the program checks the positive definiteness of the matrix, and if it is found not to be Gramian, performs a nonlinear smoothing procedure at the user's request. The SPSS syntax, a short manual, and data files related to this article are available as supplemental materials from brm.psychonomic-journals.org/content/supplemental.

  14. A Comprehensive Study of the Incentive Award Program at General Leonard Wood Army Community Hospital

    National Research Council Canada - National Science Library

    Cox, Michael

    2001-01-01

    ... appropriate behavior and motivates employees. The study is broken into three phases. In Phase I, a retrospective study looked at the current incentive award program to determine if awards distribution is equitable...

  15. Film dosimetry for IMRT: sensitivity corrections

    International Nuclear Information System (INIS)

    Suchowerska, N.; Hoban, P.; Davison, A.; Metcalfe, P.

    2000-01-01

    Full text: The trend towards conformal, dynamic and intensity modulated radiotherapy treatments has furthered the need for true integrating dosimetry. In traditional radiotherapy, film dosimetry is commonly used. The accuracy and reproducibility of film optical density as an indicator of dose, has been associated with several variables. These include the effects of film specific sensitivity, direction of exposure, chemical processing and film scanner sensitivity. In this study, a procedure is developed to account for these variables, with a particular view to film being used as a dosimeter for conformal treatments. An effective sensitometric curve was established by exposing part of a single sheet of film to known doses. All films were processed together and scanned using a DuoscanT1200 transmission scanner, resulting in 12 bit image files. The images were analysed using Osiris software and the results fitted to the modified Williamson equation: P P s (l - 10 αD ) This yields values of α [film sensitivity], and P s [saturation pixel value], allowing individual dosimetry films to be normalised to this sensitometric calibration curve. For validation, a piece of Kodak X Omat-V film was sealed in a head phantom and exposed to a total of 51 IMRT fields, delivered from 6 gantry angles. The rest of the sheet of film was resealed and exposed to four known doses, providing sensitometric data, specific to this exposure. All films were then processed, scanned and analysed as described above. Observed variations in serial films exposed to 50cGy is in the order of 9% [mean 25.0,standard deviation = 3.2]. The automatic gain of the scanner system typically contributed 4% variation and needs to be carefully monitored. Results indicate that by using the sensitometric data from each exposure, the collective errors can be minimised. The IMRT exposure results confirm that the above process is viable for use in dosimetry for conformal radiation therapy. Copyright (2000) Australasian

  16. Inverse vs. forward breast IMRT planning

    International Nuclear Information System (INIS)

    Mihai, Alina; Rakovitch, Eileen; Sixel, Katharina; Woo, Tony; Cardoso, Marlene; Bell, Chris; Ruschin, Mark; Pignol, Jean-Philippe

    2005-01-01

    Breast intensity-modulated radiation therapy (IMRT) improves dose distribution homogeneity within the whole breast. Previous publications report the use of inverse or forward dose optimization algorithms. Because the inverse technique is not widely available in commercial treatment planning systems, it is important to compare the 2 algorithms. The goal of this work is to compare them on a prospective cohort of 30 patients. Dose distributions were evaluated on differential dose-volume histograms using the volumes receiving more than 105% (V 105 ) and 110% (V 110 ) of the prescribed dose, and on the maximum dose (D max ) or hot spot and the sagittal dose gradient (SDG) being the gradient between the dose on inframammary crease and the dose prescribed. The data were analyzed using Wilcoxon signed rank test. The inverse planning significantly improves the V 105 (mean value 9.7% vs. 14.5%, p = 0.002), and the V 110 (mean value 1.4% vs. 3.2%, p = 0.006). However, the SDG is not statistically significantly different for either algorithm. Looking at the potential impact on skin acute reaction, although there is a significant reduction of V 110 using an inverse algorithm, it is unlikely this 1.6% volume reduction will present a significant clinical advantage over a forward algorithm. Both algorithms are equivalent in removing the hot spots on the inframammary fold, where acute skin reactions occur more frequently using a conventional wedge technique. Based on these results, we recommend that both forward and inverse algorithms should be considered for breast IMRT planning

  17. Coverage-based constraints for IMRT optimization

    Science.gov (United States)

    Mescher, H.; Ulrich, S.; Bangert, M.

    2017-09-01

    Radiation therapy treatment planning requires an incorporation of uncertainties in order to guarantee an adequate irradiation of the tumor volumes. In current clinical practice, uncertainties are accounted for implicitly with an expansion of the target volume according to generic margin recipes. Alternatively, it is possible to account for uncertainties by explicit minimization of objectives that describe worst-case treatment scenarios, the expectation value of the treatment or the coverage probability of the target volumes during treatment planning. In this note we show that approaches relying on objectives to induce a specific coverage of the clinical target volumes are inevitably sensitive to variation of the relative weighting of the objectives. To address this issue, we introduce coverage-based constraints for intensity-modulated radiation therapy (IMRT) treatment planning. Our implementation follows the concept of coverage-optimized planning that considers explicit error scenarios to calculate and optimize patient-specific probabilities q(\\hat{d}, \\hat{v}) of covering a specific target volume fraction \\hat{v} with a certain dose \\hat{d} . Using a constraint-based reformulation of coverage-based objectives we eliminate the trade-off between coverage and competing objectives during treatment planning. In-depth convergence tests including 324 treatment plan optimizations demonstrate the reliability of coverage-based constraints for varying levels of probability, dose and volume. General clinical applicability of coverage-based constraints is demonstrated for two cases. A sensitivity analysis regarding penalty variations within this planing study based on IMRT treatment planning using (1) coverage-based constraints, (2) coverage-based objectives, (3) probabilistic optimization, (4) robust optimization and (5) conventional margins illustrates the potential benefit of coverage-based constraints that do not require tedious adjustment of target volume objectives.

  18. Costs of implementing and maintaining comprehensive school health: the case of the Annapolis Valley Health Promoting Schools program.

    Science.gov (United States)

    Ohinmaa, Arto; Langille, Jessie-Lee; Jamieson, Stuart; Whitby, Caroline; Veugelers, Paul J

    2011-01-01

    Comprehensive school health (CSH) is increasingly receiving renewed interest as a strategy to improve health and learning. The present study estimates the costs associated with implementing and maintaining CSH. We reviewed the accounting information of all schools in the Annapolis Valley Health Promoting Schools (AVHPS) program in 2008/2009. We considered support for nutrition and physical activity programs by the public system, grants, donations, fundraising and volunteers. The annual public funding to AVHPS to implement and maintain CSH totaled $344,514, which translates, on average, to $7,830 per school and $22.67 per student. Of the public funding, $140,500 was for CSH, $86,250 for breakfast programs, $28,750 for school food policy programs, and the remainder for other subsidized programs. Grants, donations and fundraising were mostly locally acquired. They totaled $127,235, which translates, on average, to $2,892 per school or $8.37 per student. The value of volunteer support was estimated to be equivalent to the value of grants, donations and fundraising combined. Of all grants, donations, fundraising and volunteers, 20% was directed to physical activity programs and 80% to nutrition programs. The public costs to implement and maintain CSH are modest. They leveraged substantial local funding and in-kind contributions, underlining community support for healthy eating and active living. Where CSH is effective in preventing childhood overweight, it is most likely cost-effective too, as costs for future chronic diseases are mounting. CSH programs that are proven effective and cost-effective have enormous potential for broad implementation and for reducing the public health burden associated with obesity.

  19. Gerundium: A Comprehensive Public Educational Program on Organ Donation and Transplantation and Civil Law in Hungary.

    Science.gov (United States)

    Kovács, D Á; Mihály, S; Rajczy, K; Zsom, L; Zádori, G; Fedor, R; Eszter, K; Enikő, B; Asztalos, L; Nemes, B

    2015-09-01

    Organ transplantation has become an organized, routine, widely used method in the treatment of several end-stage diseases. Kidney transplantation means the best life-quality and longest life expectancy for patients with end-stage renal diseases. Transplantation is the only available long-term medical treatment for patients with end-stage liver, heart, and lung diseases. Despite the number of transplantations increasing worldwide, the needs of the waiting lists remain below expectations. One of the few methods to increase the number of transplantations is public education. In cooperation with the University of Debrecen Institute for Surgery Department of Transplantation, the Hungarian National Blood Transfusion Service Organ Coordination Office, and the Local Committee Debrecen of Hungarian Medical Students' International Relations Committee (HuMSIRC), the Gerundium, a new educational program, has been established to serve this target. Gerundium is a special program designed especially for youth education. Peer education means that age-related medical student volunteers educate their peers during interactive unofficial sessions. Volunteers were trained during specially designed training. Medical students were honored by HuMSIRC, depending on their activity on the basis of their own regulations. Uniform slides and brochures to share were designed. Every Hungarian secondary school was informed. The Local Committee Budapest of HuMSIRC also joined the program, which helps to expand our activity throughout Hungary. The aim of the program is public education to help disperse disapproval, if presented. As a multiple effect, our program promotes medical students to have better skills in the field of transplantation, presentation, and communication skills. Our program is a voluntary program with strong professional support and is free of charge for the community. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Impact of a Comprehensive Early Clinical Exposure Program for Preclinical Year Medical Students

    Directory of Open Access Journals (Sweden)

    Sumitra Govindarajan

    2018-06-01

    Full Text Available Purpose: To study the impact of an early clinical exposure program designed to provide a wide variety (cognitive, affective and psychomotor of learning experiences for the preclinical year students. Method: One hundred and fifty preclinical students were posted in small groups to selected departments – Transfusion medicine, Catheterization lab, Simulation lab, Radiology, Neurology, Nephrology, Respiratory medicine and General surgery. Each student had atleast ten hours  of clinical exposure under this program. The program was evaluated through a series of pre and post-test questionnaires, which were designed based on the learning objectives of each session. Students who wished to participate in the program evaluation gave informed consent, took up the pre / post test and were also asked to give their written open comments about the program. Results: There was a significant increase in the post-test scores (ranging from 9.14±2.67 to 36.65±6.62 when compared to the pre-test scores (ranging from 7.94±2.31 to 28.69±6.11 for all the sessions (p value <0.001, n=144. Analysis of the open feedback showed that the program had significant impact on the cognitive, psychomotor and affective domains. “Application of basic sciences in clinical practice”, “motivation to learn”, “got familiar with various specialties”, “insight about what the patient undergoes” were the themes identified from the open comments. Conclusion: The innovative use of early clinical exposure program to teach/learn clinical skills like phlebotomy and Basic Life Support had been well appreciated by the students. The present design involving a variety of learning experiences has been successful in introducing the various dimensions of medical profession like scientific, ethical, interpersonal, professional and social to the new entrants in addition to enhancing their motivation to learn. Keywords: Attitude, Learning, Simulation lab, Medical education, Curriculum

  1. Independent dose calculation in IMRT for the Tps Iplan using the Clarkson modified integral

    International Nuclear Information System (INIS)

    Adrada, A.; Tello, Z.; Garrigo, E.; Venencia, D.

    2014-08-01

    Intensity-Modulated Radiation Therapy (IMRT) treatments require a quality assurance (Q A) specific patient before delivery. These controls include the experimental verification in dose phantom of the total plan as well as dose distributions. The use of independent dose calculation (IDC) is used in 3D-Crt treatments; however its application in IMRT requires the implementation of an algorithm that allows considering a non-uniform intensity beam. The purpose of this work was to develop IDC software in IMRT with MLC using the algorithm proposed by Kung (Kung et al. 2000). The software was done using Matlab programming. The Clarkson modified integral was implemented on each flowing, applying concentric rings for the dose determination. From the integral of each field was calculated the dose anywhere. One time finished a planning; all data are exported to a phantom where a Q A plan is generated. On this is calculated the half dose in a representative volume of the ionization chamber and the dose at the center of it. Until now 230 IMRT planning were analyzed carried out ??in the treatment planning system (Tps) Iplan. For each one of them Q A plan was generated, were calculated and compared calculated dose with the Tps, IDC system and measurement with ionization chamber. The average difference between measured and calculated dose with the IDC system was 0.4% ± 2.2% [-6.8%, 6.4%]. The difference between the measured and the calculated doses by the pencil-beam algorithm (Pb) of Tps was 2.6% ± 1.41% [-2.0%, 5.6%] and with the Monte Carlo algorithm was 0.4% ± 1.5% [-4.9%, 3.7%]. The differences of the carried out software are comparable to the obtained with the ionization chamber and Tps in Monte Carlo mode. (author)

  2. Clinical Evaluation of Direct Aperture Optimization When Applied to Head-And-Neck IMRT

    International Nuclear Information System (INIS)

    Jones, Stephen; Williams, Matthew

    2008-01-01

    Direct Machine Parameter Optimization (DMPO) is a leaf segmentation program released as an optional item of the Pinnacle planning system (Philips Radiation Oncology Systems, Milpitas, CA); it is based on the principles of direct aperture optimization where the size, shape, and weight of individual segments are optimized to produce an intensity modulated radiation treatment (IMRT) plan. In this study, we compare DMPO to the traditional method of IMRT planning, in which intensity maps are optimized prior to conversion into deliverable multileaf collimator (MLC) apertures, and we determine if there was any dosimetric improvement, treatment efficiency gain, or planning advantage provided by the use of DMPO. Eleven head-and-neck patients treated with IMRT had treatment plans generated using each optimization method. For each patient, the same planning parameters were used for each optimization method. All calculations were performed using Pinnacle version 7.6c software and treatments were delivered using a step-and-shoot IMRT method on a Varian 2100EX linear accelerator equipped with a 120-leaf Millennium MLC (Varian Medical Systems, Palo Alto, CA). Each plan was assessed based on the calculation time, a conformity index, the composite objective value used in the optimization, the number of segments, monitor units (MUs), and treatment time. The results showed DMPO to be superior to the traditional optimization method in all areas. Considerable advantages were observed in the dosimetric quality of DMPO plans, which also required 32% less time to calculate, 42% fewer MUs, and 35% fewer segments than the conventional optimization method. These reductions translated directly into a 29% decrease in treatment times. While considerable gains were observed in planning and treatment efficiency, they were specific to our institution, and the impact of direct aperture optimization on plan quality and workflow will be dependent on the planning parameters, planning system, and

  3. A situational analysis methodology to inform comprehensive HIV prevention and treatment programming, applied in rural South Africa.

    Science.gov (United States)

    Treves-Kagan, Sarah; Naidoo, Evasen; Gilvydis, Jennifer M; Raphela, Elsie; Barnhart, Scott; Lippman, Sheri A

    2017-09-01

    Successful HIV prevention programming requires engaging communities in the planning process and responding to the social environmental factors that shape health and behaviour in a specific local context. We conducted two community-based situational analyses to inform a large, comprehensive HIV prevention programme in two rural districts of North West Province South Africa in 2012. The methodology includes: initial partnership building, goal setting and background research; 1 week of field work; in-field and subsequent data analysis; and community dissemination and programmatic incorporation of results. We describe the methodology and a case study of the approach in rural South Africa; assess if the methodology generated data with sufficient saturation, breadth and utility for programming purposes; and evaluate if this process successfully engaged the community. Between the two sites, 87 men and 105 women consented to in-depth interviews; 17 focus groups were conducted; and 13 health facilities and 7 NGOs were assessed. The methodology succeeded in quickly collecting high-quality data relevant to tailoring a comprehensive HIV programme and created a strong foundation for community engagement and integration with local health services. This methodology can be an accessible tool in guiding community engagement and tailoring future combination HIV prevention and care programmes.

  4. Implementation and Outcomes of a Comprehensive Type 2 Diabetes Program in Rural Guatemala.

    Science.gov (United States)

    Flood, David; Mux, Sandy; Martinez, Boris; García, Pablo; Douglas, Kate; Goldberg, Vera; Lopez, Waleska; Rohloff, Peter

    2016-01-01

    The burden of chronic, non-communicable diseases such as diabetes is growing rapidly in low- and middle-income countries. Implementing management programs for diabetes and other chronic diseases for underserved populations is thus a critical global health priority. However, there is a notable dearth of shared programmatic and outcomes data from diabetes treatment programs in these settings. We describe our experiences as a non-governmental organization designing and implementing a type 2 diabetes program serving Maya indigenous people in rural Guatemala. We detail the practical challenges and solutions we have developed to build and sustain diabetes programming in this setting. We conduct a retrospective chart review from our electronic medical record to evaluate our program's performance. We generate a cohort profile, assess cross-sectional indicators using a framework adapted from the literature, and report on clinical longitudinal outcomes. A total of 142 patients were identified for the chart review. The cohort showed a decrease in hemoglobin A1C from a mean of 9.2% to 8.1% over an average of 2.1 years of follow-up (p Guatemala.

  5. IMRT and radiation protection in the prostate cancer therapy

    International Nuclear Information System (INIS)

    Santos, Helena C.; Silva, Andre R.M.; Oliveira, Claudia F.M.

    2015-01-01

    This study aims to specify the technological advances that IMRT presents relative to other traditional radiotherapy, particularly to conformal radiotherapy three dimensional (3D-TCR) and benefits compared to the side effects caused by from treatment of radiotherapy

  6. IMRT fluence map editing to control hot and cold spots

    International Nuclear Information System (INIS)

    Taylor Cook, J.; Tobler, Matt; Leavitt, Dennis D.; Watson, Gordon

    2005-01-01

    Manually editing intensity-modulated radiation therapy (IMRT) fluence maps effectively controls hot and cold spots that the IMRT optimization cannot control. Many times, re-optimizing does not reduce the hot spots or increase the cold spots. In fact, re-optimizing only places the hot and cold spots in different locations. Fluence-map editing provides manual control of dose delivery and provides the best treatment plan possible. Several IMRT treatments were planned using the Varian Eclipse planning system. We compare the effects on dose distributions between fluence-map editing and re-optimization, discuss techniques for fluence-map editing, and analyze differences between fluence editing on one beam vs. multiple beams. When editing a beam's fluence map, it is essential to choose a beam that least affects dose to the tumor and critical structures. Editing fluence maps gives an advantage in treatment planning and provides controlled delivery of IMRT dose

  7. Prostate Dose Escalation by Innovative Inverse Planning-Driven IMRT

    National Research Council Canada - National Science Library

    Xing, Lei

    2005-01-01

    .... Because of the tacit ignorance of intra-structural tradeoff, the IMRT plans generated by these systems for prostate treatment are, at best, sub-optimal and our endeavor of providing the best possible...

  8. Development and implementation of a comprehensive groundwater protection program at the Savannah River Plant

    International Nuclear Information System (INIS)

    Gordon, D.E.

    1984-01-01

    The major goals of the groundwater protection program are to evaluate the impact on groundwater quality as a result of Savannah River Plant operations, to take corrective measures as required to restore or protect groundwater quality, and to ensure that future operations do not adversely affect the quality or availability of the groundwater resources at the site. The specific elements of this program include (1) continuation of an extensive groundwater monitoring program, (2) assessment of waste disposal sites for impacts on groundwater quality, (3) implementation of mitigative actions, as required, to restore or protect groundwater quality, (4) incorporation of groundwater protection concepts in the design of new production and waste management facilities, and (5) review of site utilization of groundwater resources to ensure compatibility with regional needs. The major focal points of the groundwater protection program are the assessment of waste disposal sites for impacts on groundwater quality and the implementation of remedial action projects. Many locations at SRP have been used as waste disposal sites for a variety of liquid and solid wastes. Field investigations are ongoing to determine the nature and extent of any contamination in the sediments and groundwater at these waste sites on a priority basis. Remedial action has been initiated. Certain aspects of the groundwater protection program have been identified as key to the success in achieving the desired objectives. Key elements of the program have included early identification of all the potential sources for groundwater contamination, development of an overall strategy for waste site assessment and mitigation, use of a flexible computerized system for data base management, and establishing good relationships with regulatory agencies. 10 references, 6 figures, 4 tables

  9. A comprehensive survey on selective breeding programs and seed market in the European aquaculture fish industry

    DEFF Research Database (Denmark)

    Chavanne, Hervé; Janssen, Kasper; Hofherr, Johann

    2016-01-01

    –50 % market share. Only part of the European fish aquaculture industry today fully exploits selective breeding to the best advantage. A larger impact assessment still needs to be made by the remainder, particularly on the market share of fish seed (eggs, larvae or juveniles) and its consequences for hatchery...... of molecular tools is now common in all programs, mainly for pedigree traceability. An increasing number of programs use either genomic or marker-assisted selection. Results related to the seed production market confirmed that for Atlantic salmon there are a few dominant players at the European level, with 30...

  10. Automated IMRT planning with regional optimization using planning scripts.

    Science.gov (United States)

    Xhaferllari, Ilma; Wong, Eugene; Bzdusek, Karl; Lock, Michael; Chen, Jeff

    2013-01-07

    Intensity-modulated radiation therapy (IMRT) has become a standard technique in radiation therapy for treating different types of cancers. Various class solutions have been developed for simple cases (e.g., localized prostate, whole breast) to generate IMRT plans efficiently. However, for more complex cases (e.g., head and neck, pelvic nodes), it can be time-consuming for a planner to generate optimized IMRT plans. To generate optimal plans in these more complex cases which generally have multiple target volumes and organs at risk, it is often required to have additional IMRT optimization structures such as dose limiting ring structures, adjust beam geometry, select inverse planning objectives and associated weights, and additional IMRT objectives to reduce cold and hot spots in the dose distribution. These parameters are generally manually adjusted with a repeated trial and error approach during the optimization process. To improve IMRT planning efficiency in these more complex cases, an iterative method that incorporates some of these adjustment processes automatically in a planning script is designed, implemented, and validated. In particular, regional optimization has been implemented in an iterative way to reduce various hot or cold spots during the optimization process that begins with defining and automatic segmentation of hot and cold spots, introducing new objectives and their relative weights into inverse planning, and turn this into an iterative process with termination criteria. The method has been applied to three clinical sites: prostate with pelvic nodes, head and neck, and anal canal cancers, and has shown to reduce IMRT planning time significantly for clinical applications with improved plan quality. The IMRT planning scripts have been used for more than 500 clinical cases.

  11. Connected Vehicle Pilot Deployment Program, Comprehensive Installation Plan - WYDOT CV Pilot

    Science.gov (United States)

    2018-02-16

    The Wyoming Department of Transportation's (WYDOT) Connected Vehicle (CV) Pilot Deployment Program is intended to develop a suite of applications that utilize vehicle-to-infrastructure (V2I) and vehicle-to-vehicle (V2V) communication technology to re...

  12. POLYMAT-C: a comprehensive SPSS program for computing the polychoric correlation matrix.

    Science.gov (United States)

    Lorenzo-Seva, Urbano; Ferrando, Pere J

    2015-09-01

    We provide a free noncommercial SPSS program that implements procedures for (a) obtaining the polychoric correlation matrix between a set of ordered categorical measures, so that it can be used as input for the SPSS factor analysis (FA) program; (b) testing the null hypothesis of zero population correlation for each element of the matrix by using appropriate simulation procedures; (c) obtaining valid and accurate confidence intervals via bootstrap resampling for those correlations found to be significant; and (d) performing, if necessary, a smoothing procedure that makes the matrix amenable to any FA estimation procedure. For the main purpose (a), the program uses a robust unified procedure that allows four different types of estimates to be obtained at the user's choice. Overall, we hope the program will be a very useful tool for the applied researcher, not only because it provides an appropriate input matrix for FA, but also because it allows the researcher to carefully check the appropriateness of the matrix for this purpose. The SPSS syntax, a short manual, and data files related to this article are available as Supplemental materials that are available for download with this article.

  13. Understanding implementation of comprehensive geriatric care programs: a multiple perspective approach is preferred

    NARCIS (Netherlands)

    J.B.M. Vos; J.M. Cramm (Jane); J.D.H. van Wijngaarden (Jeroen); T.J.E.M. Bakker (Ton); J.P. Mackenbach (Johan); A.P. Nieboer (Anna)

    2017-01-01

    textabstractBackground: The Prevention and Reactivation Care Program (PReCaP) provides a novel approach targeting hospital-related functional decline among elderly patients. Despite the high expectations, the PReCaP was not effective in preventing functional decline (ADL and iADL) among older

  14. Standards & Criteria for the Development and Evaluation of a Comprehensive Employee Assistance Program.

    Science.gov (United States)

    Health Resources and Services Administration, Rockville, MD. Bureau of Health Care Delivery and Assistance.

    This document was designed for use by persons or agencies interested in both establishing and evaluating employee assistance programs (EAP) for federal employees. It contains essential elements, standards, and assessment criteria which have been developed to assist in the planning and implementation of services, and to provide a framework for…

  15. Implementation and Outcomes of a Comprehensive Type 2 Diabetes Program in Rural Guatemala.

    Directory of Open Access Journals (Sweden)

    David Flood

    Full Text Available The burden of chronic, non-communicable diseases such as diabetes is growing rapidly in low- and middle-income countries. Implementing management programs for diabetes and other chronic diseases for underserved populations is thus a critical global health priority. However, there is a notable dearth of shared programmatic and outcomes data from diabetes treatment programs in these settings.We describe our experiences as a non-governmental organization designing and implementing a type 2 diabetes program serving Maya indigenous people in rural Guatemala. We detail the practical challenges and solutions we have developed to build and sustain diabetes programming in this setting.We conduct a retrospective chart review from our electronic medical record to evaluate our program's performance. We generate a cohort profile, assess cross-sectional indicators using a framework adapted from the literature, and report on clinical longitudinal outcomes.A total of 142 patients were identified for the chart review. The cohort showed a decrease in hemoglobin A1C from a mean of 9.2% to 8.1% over an average of 2.1 years of follow-up (p <0.001. The proportions of patients meeting glycemic targets were 53% for hemoglobin A1C < 8% and 32% for the stricter target of hemoglobin A1C < 7%.We first offer programmatic experiences to address a gap in resources relating to the practical issues of designing and implementing global diabetes management interventions. We then present clinical data suggesting that favorable diabetes outcomes can be attained in poor areas of rural Guatemala.

  16. Short-term Evaluation of a Comprehensive Education Program Including Inhaler Training and Disease Management on Chronic Obstructive Pulmonary Disease.

    Science.gov (United States)

    Yoo, Kwang Ha; Chung, Wou Young; Park, Joo Hun; Hwang, Sung Chul; Kim, Tae Eun; Oh, Min Jung; Kang, Dae Ryong; Rhee, Chin Kook; Yoon, Hyoung Kyu; Kim, Tae Hyung; Kim, Deog Kyeom; Park, Yong Bum; Kim, Sang Ha; Yum, Ho Kee

    2017-10-01

    Proper education regarding inhaler usage and optimal management of chronic obstructive pulmonary disease (COPD) is essential for effectively treating patients with COPD. This study was conducted to evaluate the effects of a comprehensive education program including inhaler training and COPD management. We enlisted 127 patients with COPD on an outpatient basis at 43 private clinics in Korea. The patients were educated on inhaler usage and disease management for three visits across 2 weeks. Physicians and patients were administered a COPD assessment test (CAT) and questionnaires about the correct usage of inhalers and management of COPD before commencement of this program and after their third visit. The outcomes of 127 COPD patients were analyzed. CAT scores (19.6±12.5 vs. 15.1±12.3) improved significantly after this program (pmanagement and the correct technique for using inhalers than those who did not have improved CAT scores (peducation program including inhaler training and COPD management at a primary care setting improved CAT scores and led to patients' better understanding of COPD management. Copyright©2017. The Korean Academy of Tuberculosis and Respiratory Diseases

  17. IMRT limits nephrotoxicity after chemoradiotherapy for gastric cancer

    International Nuclear Information System (INIS)

    Trip, Anouk Kirsten; Nijkamp, Jasper; Tinteren, Harm van; Cats, Annemieke; Boot, Henk; Jansen, Edwin Petrus Marianus; Verheij, Marcel

    2014-01-01

    Objective: This observational study compares the effect of different radiotherapy techniques on late nephrotoxicity after postoperative chemoradiotherapy for gastric cancer. Patients and methods: Dosimetric parameters were compared between AP–PA, 3D-conformal and IMRT techniques. Renal function was measured by 99m Tc-MAG-3 renography, glomerular filtration rate (GFR) and the development of hypertension. Mixed effects models were used to compare renal function over time. Results: Eighty-seven patients treated between 2002 and 2010 were included, AP–PA (n = 31), 3D-conformal (n = 25) and IMRT (n = 31), all 45 Gy in 25 fractions. Concurrent chemotherapy: 5FU/leucovorin (n = 4), capecitabine (n = 37), and capecitabine/cisplatin (n = 46). Median follow-up time was 4.7 years (range 0.2–8). With IMRT, the mean dose to the left kidney was significantly lower. Left kidney function decreased progressively in the total study population, however with IMRT this occurred at a lower rate. A dose–effect relationship was present between mean dose to the left kidney and the left kidney function. GFR decreased only moderately in time, which was not different between techniques. Six patients developed hypertension, of whom none in the IMRT group. Conclusions: This study confirms progressive late nephrotoxicity in patients treated with postoperative chemoradiotherapy by different techniques for gastric cancer. Nephrotoxicity was less severe with IMRT and should be considered the preferred technique

  18. Phantoms for IMRT dose distribution measurement and treatment verification

    International Nuclear Information System (INIS)

    Low, Daniel A.; Gerber, Russell L.; Mutic, Sasa; Purdy, James A.

    1998-01-01

    Background: The verification of intensity-modulated radiation therapy (IMRT) patient treatment dose distributions is currently based on custom-built or modified dose measurement phantoms. The only commercially available IMRT treatment planning and delivery system (Peacock, NOMOS Corp.) is supplied with a film phantom that allows accurate spatial localization of the dose distribution using radiographic film. However, measurements using other dosimeters are necessary for the thorough verification of IMRT. Methods: We have developed a phantom to enable dose measurements using a cylindrical ionization chamber and the localization of prescription isodose curves using a matrix of thermoluminescent dosimetry (TLD) chips. The external phantom cross-section is identical to that of the commercial phantom, to allow direct comparisons of measurements. A supplementary phantom has been fabricated to verify the IMRT dose distributions for pelvis treatments. Results: To date, this phantom has been used for the verification of IMRT dose distributions for head and neck and prostate cancer treatments. Designs are also presented for a phantom insert to be used with polymerizing gels (e.g., BANG-2) to obtain volumetric dose distribution measurements. Conclusion: The phantoms have proven useful in the quantitative evaluation of IMRT treatments

  19. IMRT limits nephrotoxicity after chemoradiotherapy for gastric cancer.

    Science.gov (United States)

    Trip, Anouk Kirsten; Nijkamp, Jasper; van Tinteren, Harm; Cats, Annemieke; Boot, Henk; Jansen, Edwin Petrus Marianus; Verheij, Marcel

    2014-08-01

    This observational study compares the effect of different radiotherapy techniques on late nephrotoxicity after postoperative chemoradiotherapy for gastric cancer. Dosimetric parameters were compared between AP-PA, 3D-conformal and IMRT techniques. Renal function was measured by (99m)Tc-MAG-3 renography, glomerular filtration rate (GFR) and the development of hypertension. Mixed effects models were used to compare renal function over time. Eighty-seven patients treated between 2002 and 2010 were included, AP-PA (n=31), 3D-conformal (n=25) and IMRT (n=31), all 45 Gy in 25 fractions. Concurrent chemotherapy: 5FU/leucovorin (n=4), capecitabine (n=37), and capecitabine/cisplatin (n=46). Median follow-up time was 4.7 years (range 0.2-8). With IMRT, the mean dose to the left kidney was significantly lower. Left kidney function decreased progressively in the total study population, however with IMRT this occurred at a lower rate. A dose-effect relationship was present between mean dose to the left kidney and the left kidney function. GFR decreased only moderately in time, which was not different between techniques. Six patients developed hypertension, of whom none in the IMRT group. This study confirms progressive late nephrotoxicity in patients treated with postoperative chemoradiotherapy by different techniques for gastric cancer. Nephrotoxicity was less severe with IMRT and should be considered the preferred technique. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  20. IMRT and radiation protection in the prostate cancer therapy; IMRT e a protecao radiologica no tratamento do cancer de prostata

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Helena C.; Silva, Andre R.M.; Oliveira, Claudia F.M., E-mail: andrerichard88@bol.com.br [Instituto Federal de Educacao, Ciencia e Tecnologia de Pernambuco (IFPE), Recife, PE (Brazil)

    2015-07-01

    This study aims to specify the technological advances that IMRT presents relative to other traditional radiotherapy, particularly to conformal radiotherapy three dimensional (3D-TCR) and benefits compared to the side effects caused by from treatment of radiotherapy.

  1. Effectiveness and Cost-benefit Evaluation of a Comprehensive Workers' Health Surveillance Program for Sustainable Employability of Meat Processing Workers.

    Science.gov (United States)

    van Holland, Berry J; Reneman, Michiel F; Soer, Remko; Brouwer, Sandra; de Boer, Michiel R

    2018-03-01

    Objective To evaluate the effectiveness of a comprehensive workers' health surveillance (WHS) program on aspects of sustainable employability and cost-benefit. Methods A cluster randomized stepped wedge trial was performed in a Dutch meat processing company from february 2012 until march 2015. In total 305 workers participated in the trial. Outcomes were retrieved during a WHS program, by multiple questionnaires, and from company registries. Primary outcomes were sickness absence, work ability, and productivity. Secondary outcomes were health, vitality, and psychosocial workload. Data were analyzed with linear and logistic multilevel models. Cost-benefit analyses from the employer's perspective were performed as well. Results Primary outcomes sickness absence (OR = 1.40), work ability (B = -0.63) and productivity (OR = 0.71) were better in the control condition. Secondary outcomes did not or minimally differ between conditions. Of the 12 secondary outcomes, the only outcome that scored better in the experimental condition was meaning of work (B = 0.18). Controlling for confounders did not or minimally change the results. However, our stepped wedge design did not enable adjustment for confounding in the last two periods of the trial. The WHS program resulted in higher costs for the employer on the short and middle term. Conclusions Primary outcomes did not improve after program implementation and secondary outcomes remained equal after implementation. The program was not cost-beneficial after 1-3 year follow-up. Main limitation that may have contributed to absence of positive effects may be program failure, because interventions were not deployed as intended.

  2. The FaceBase Consortium: A comprehensive program to facilitate craniofacial research

    Science.gov (United States)

    Hochheiser, Harry; Aronow, Bruce J.; Artinger, Kristin; Beaty, Terri H.; Brinkley, James F.; Chai, Yang; Clouthier, David; Cunningham, Michael L.; Dixon, Michael; Donahue, Leah Rae; Fraser, Scott E.; Hallgrimsson, Benedikt; Iwata, Junichi; Klein, Ophir; Marazita, Mary L.; Murray, Jeffrey C.; Murray, Stephen; de Villena, Fernando Pardo-Manuel; Postlethwait, John; Potter, Steven; Shapiro, Linda; Spritz, Richard; Visel, Axel; Weinberg, Seth M.; Trainor, Paul A.

    2012-01-01

    The FaceBase Consortium consists of ten interlinked research and technology projects whose goal is to generate craniofacial research data and technology for use by the research community through a central data management and integrated bioinformatics hub. Funded by the National Institute of Dental and Craniofacial Research (NIDCR) and currently focused on studying the development of the middle region of the face, the Consortium will produce comprehensive datasets of global gene expression patterns, regulatory elements and sequencing; will generate anatomical and molecular atlases; will provide human normative facial data and other phenotypes; conduct follow up studies of a completed genome-wide association study; generate independent data on the genetics of craniofacial development, build repositories of animal models and of human samples and data for community access and analysis; and will develop software tools and animal models for analyzing and functionally testing and integrating these data. The FaceBase website (http://www.facebase.org) will serve as a web home for these efforts, providing interactive tools for exploring these datasets, together with discussion forums and other services to support and foster collaboration within the craniofacial research community. PMID:21458441

  3. Comprehensive implementation plan for the DOE defense buried TRU- contaminated waste program

    International Nuclear Information System (INIS)

    Everette, S.E.; Detamore, J.A.; Raudenbush, M.H.; Thieme, R.E.

    1988-02-01

    In 1970, the US Atomic Energy Commission established a ''transuranic'' (TRU) waste classification. Waste disposed of prior to the decision to retrievably store the waste and which may contain TRU contamination is referred to as ''buried transuranic-contaminated waste'' (BTW). The DOE reference plan for BTW, stated in the Defense Waste Management Plan, is to monitor it, to take such remedial actions as may be necessary, and to re-evaluate its safety as necessary or in about 10-year periods. Responsibility for management of radioactive waste and byproducts generated by DOE belongs to the Secretary of Energy. Regulatory control for these sites containing mixed waste is exercised by both DOE (radionuclides) and EPA (hazardous constituents). Each DOE Operations Office is responsible for developing and implementing plans for long-term management of its radioactive and hazardous waste sites. This comprehensive plan includes site-by-site long-range plans, site characteristics, site costs, and schedules at each site. 13 figs., 15 tabs

  4. Comprehensive Assessment of Struggling Learners Referred to a Graduate Medical Education Remediation Program.

    Science.gov (United States)

    Warburton, Karen M; Goren, Eric; Dine, C Jessica

    2017-12-01

    Implementation of the Next Accreditation System has provided a standardized framework for identifying learners not meeting milestones, but there is as yet no corresponding framework for remediation. We developed a comprehensive assessment process that allows correct diagnosis of a struggling learner's deficit(s) to promote successful remediation. At the University of Pennsylvania, resident learners within the Department of Medicine who are not meeting milestones are referred to the Early Intervention Remediation Committee (EIRC). The EIRC, composed of 14 faculty members with expertise in remediation, uses a standardized process to assess learners' deficits. These faculty members categorize primary deficits as follows: medical knowledge, clinical reasoning, organization and efficiency, professionalism, and communication skills. The standardized process of assessment includes an analysis of the learner's file, direct communication with evaluators, an interview focused on learner perception of the problem, screening for underlying medical or psychosocial issues, and a review of systems for deficits in the 6 core competencies. Participants were surveyed after participating in this process. Over a 2-year period, the EIRC assessed and developed remediation plans for 4% of learners (14 of a total 342). Following remediation and reassessment, the identified problems were satisfactorily resolved in all cases with no disciplinary action. While the process was time intensive, an average of 45 hours per learner, the majority of faculty and residents rated it as positive and beneficial. This structured assessment process identifies targeted areas for remediation and adds to the tools available to Clinical Competency Committees.

  5. Comprehensive Report to Congress Clean Coal Technology Program: Clean power from integrated coal/ore reduction

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-10-01

    This report describes a clean coal program in which an iron making technology is paired with combined cycle power generation to produce 3300 tons per day of hot metal and 195 MWe of electricity. The COREX technology consists of a metal-pyrolyzer connected to a reduction shaft, in which the reducing gas comes directly from coal pyrolysis. The offgas is utilized to fuel a combined cycle power plant.

  6. A comprehensive program for children with gender variant behaviors and gender identity disorders.

    Science.gov (United States)

    Menvielle, Edgardo

    2012-01-01

    This article describes a clinical program designed to address broadly defined mental health needs of children who experience stress related to not fitting into normative gender types and argues for the need for integrated services that address the spectrum of gender variance. An array of services useful to children and their families is proposed. The article describes the clinical population served, common clinical and social problems, and a rationale for the interventions provided.

  7. Understanding implementation of comprehensive geriatric care programs: a multiple perspective approach is preferred

    OpenAIRE

    Vos, J.B.M.; Cramm, Jane; Wijngaarden, Jeroen; Bakker, Ton; Mackenbach, Johan; Nieboer, Anna

    2017-01-01

    Summary Background The Prevention and Reactivation Care Program (PReCaP) provides a novel approach targeting hospital‐related functional decline among elderly patients. Despite the high expectations, the PReCaP was not effective in preventing functional decline (ADL and iADL) among older patients. Although elderly PReCaP patients demonstrated slightly better cognitive functioning (Mini Mental State Examination; 0.4 [95% confidence interval (CI) 0.2–0.6]), lower depression (Geriatric Depressio...

  8. A Comprehensive Examination of the Influence of State Tobacco Control Programs and Policies on Youth Smoking

    Science.gov (United States)

    Loomis, Brett R.; Han, Beth; Gfroerer, Joe; Kuiper, Nicole; Couzens, G. Lance; Dube, Shanta; Caraballo, Ralph S.

    2013-01-01

    Objectives. We examined the influence of tobacco control policies (tobacco control program expenditures, smoke-free air laws, youth access law compliance, and cigarette prices) on youth smoking outcomes (smoking susceptibility, past-year initiation, current smoking, and established smoking). Methods. We combined data from the 2002 to 2008 National Surveys on Drug Use and Health with state and municipality population data from the US Census Bureau to assess the associations between state tobacco control policy variables and youth smoking outcomes, focusing on youths aged 12 to 17 years. We also examined the influence of policy variables on youth access when these variables were held at 2002 levels. Results. Per capita funding for state tobacco control programs was negatively associated with all 4 smoking outcomes. Smoke-free air laws were negatively associated with all outcomes except past-year initiation, and cigarette prices were associated only with current smoking. We found no association between these outcomes and retailer compliance with youth access laws. Conclusions. Smoke-free air laws and state tobacco control programs are effective strategies for curbing youth smoking. PMID:23327252

  9. A comprehensive medical student career development program improves medical student satisfaction with career planning.

    Science.gov (United States)

    Zink, Brian J; Hammoud, Maya M; Middleton, Eric; Moroney, Donney; Schigelone, Amy

    2007-01-01

    In 1999, the University of Michigan Medical School (UMMS) initiated a new career development program (CDP). The CDP incorporates the 4-phase career development model described by the Association of American Medical Colleges (AAMC) Careers in Medicine (CiM). The CDP offers self-assessment exercises with guidance from trained counselors for 1st- and 2nd-year medical students. Career exploration experiences include Career Seminar Series luncheons, shadow experiences with faculty, and a shadow program with second-year (M2) and fourth-year (M4) medical students. During the decision-making phase, students work with trained faculty career advisors (FCA). Mandatory sessions are held on career selection, preparing the residency application, interviewing, and program evaluation. During the implementation phase, students meet with deans or counselors to discuss residency application and matching. An "at-risk plan" assists students who may have difficulty matching. The CiM Web site is extensively used during the 4 stages. Data from the AAMC and UMMS Graduation Questionnaires (GQ) show significant improvements for UMMS students in overall satisfaction with career planning services and with faculty mentoring, career assessment activities, career information, and personnel availability. By 2003, UMMS students had significantly higher satisfaction in all measured areas of career planning services when compared with all other U.S. medical students.

  10. The benefits of a comprehensive rehabilitation program in patients diagnosed with spastic quadriplegia.

    Science.gov (United States)

    Rogoveanu, O C; Tuțescu, N C; Kamal, D; Alexandru, D O; Kamal, C; Streba, C T; Trăistaru, M R

    2016-01-01

    Spastic quadriplegia has as an etiopathogenic substrate, a non-progressive brain lesion; however, the clinical manifestations of the disease evolve over time. Children diagnosed with spastic quadriplegia show a variety of symptoms in different areas: sensorimotor, emotional, cognitive, and social. The purpose of this study was to assess the functional status in patients diagnosed with spastic quadriplegia, who followed a complex medical rehabilitation program, during a year, and highlight the importance of using physical and kinetic techniques in improving their status. A total of 10 children diagnosed with spastic quadriplegia were included in the study and the Gross Motor Function Classification System (GMFCS) and manual ability classification system (MACS) were used to evaluate the functionality status of each patient. Every patient was evaluated initially (T1), after six months of program (T2), and after they completed the study. All the children were originally monitored daily, for 5 days per week for a period of one month, then two times a week for a year. A statistically significant difference regarding the modification of the GMFCS and MACS stage was found, which occurred between the first and the third evaluation. The inverse correlation of the statistical significance between the ages of patients and the decrease in GMFCS or MACS stage was highlighted; the younger the patient, the more the scale decreased. A direct link between the gross motor function and the manual ability was noticed. Applying a complex rehabilitation program has proven efficient by improving both the gross motor functionality and the manual ability.

  11. IMRT treatment planning based on prioritizing prescription goals

    International Nuclear Information System (INIS)

    Wilkens, Jan J; Alaly, James R; Zakarian, Konstantin; Thorstad, Wade L; Deasy, Joseph O

    2007-01-01

    Determining the 'best' optimization parameters in IMRT planning is typically a time-consuming trial-and-error process with no unambiguous termination point. Recently we and others proposed a goal-programming approach which better captures the desired prioritization of dosimetric goals. Here, individual prescription goals are addressed stepwise in their order of priority. In the first step, only the highest order goals are considered (target coverage and dose-limiting normal structures). In subsequent steps, the achievements of the previous steps are turned into hard constraints and lower priority goals are optimized, in turn, subject to higher priority constraints. So-called 'slip' factors were introduced to allow for slight, clinically acceptable violations of the constraints. Focusing on head and neck cases, we present several examples for this planning technique. The main advantages of the new optimization method are (i) its ability to generate plans that meet the clinical goals, as well as possible, without tuning any weighting factors or dose-volume constraints, and (ii) the ability to conveniently include more terms such as fluence map smoothness. Lower level goals can be optimized to the achievable limit without compromising higher order goals. The prioritized prescription-goal planning method allows for a more intuitive and human-time-efficient way of dealing with conflicting goals compared to the conventional trial-and-error method of varying weighting factors and dose-volume constraints

  12. The number of beams in IMRT-theoretical investigations and implications for single-arc IMRT

    International Nuclear Information System (INIS)

    Bortfeld, Thomas

    2010-01-01

    The first purpose of this paper is to shed some new light on the old question of selecting the number of beams in intensity-modulated radiation therapy (IMRT). The second purpose is to illuminate the related issue of discrete static beam angles versus rotational techniques, which has recently re-surfaced due to the advancement of volumetric modulated arc therapy (VMAT). A specific objective is to find analytical expressions that allow one to address the points raised above. To make the problem mathematically tractable, it is assumed that the depth dose is flat and that the lateral dose profile can be approximated by polynomials, specifically Chebyshev polynomials of the first kind, of finite degree. The application of methods known from image reconstruction then allows one to answer the first question above as follows: the required number of beams is determined by the maximum degree of the polynomials used in the approximation of the beam profiles, which is a measure of the dose variability. There is nothing to be gained by using more beams. In realistic cases, in which the variability of the lateral dose profile is restricted in several ways, the required number of beams is of the order of 10-20. The consequence of delivering the beams with a 'leaf sweep' technique during continuous rotation of the gantry, as in VMAT, is also derived in an analytical form. The main effect is that the beams fan out, but the effect near the axis of rotation is small. This result can serve as a theoretical justification of VMAT. Overall the analytical derivations in this paper, albeit based on strong simplifications, provide new insights into, and a deeper understanding of, the beam angle problem in IMRT. The decomposition of the beam profiles into well-behaved and easily deliverable smooth functions, such as Chebyshev polynomials, could be of general interest in IMRT treatment planning.

  13. Intensity-modulated radiotherapy (IMRT) for carcinoma of the maxillary sinus: A comparison of IMRT planning systems

    International Nuclear Information System (INIS)

    Ahmed, Raef S.; Ove, Roger; Duan, Jun; Popple, Richard; Cobb, Glenn

    2006-01-01

    The treatment of maxillary sinus carcinoma with forward planning can be technically difficult when the neck also requires radiotherapy. This difficulty arises because of the need to spare the contralateral face while treating the bilateral neck. There is considerable potential for error in clinical setup and treatment delivery. We evaluated intensity-modulated radiotherapy (IMRT) as an improvement on forward planning, and compared several inverse planning IMRT platforms. A composite dose-volume histogram (DVH) was generated from a complex forward planned case. We compared the results with those generated by sliding window fixed field dynamic multileaf collimator (MLC) IMRT, using sets of coplanar beams. All setups included an anterior posterior (AP) beam, and 3-, 5-, 7-, and 9-field configurations were evaluated. The dose prescription and objective function priorities were invariant. We also evaluated 2 commercial tomotherapy IMRT delivery platforms. DVH results from all of the IMRT approaches compared favorably with the forward plan. Results for the various inverse planning approaches varied considerably across platforms, despite an attempt to prescribe the therapy similarly. The improvement seen with the addition of beams in the fixed beam sliding window case was modest. IMRT is an effective means of delivering radiotherapy reliably in the complex setting of maxillary sinus carcinoma with neck irradiation. Differences in objective function definition and optimization algorithms can lead to unexpected differences in the final dose distribution, and our evaluation suggests that these factors are more significant than the beam arrangement or number of beams

  14. Research Paper: Effect of Navayesh Parent-Based Comprehensive Rehabilitation Program on the Development of Early Language and Communication Skills in Deaf Children Aged 0-2 Years

    Directory of Open Access Journals (Sweden)

    Saeid Hassanzadeh

    2017-02-01

    Conclusion The results are indicative of the effect of the Navayesh parent-based comprehensive rehabilitation program on the development of early language and communication skills of deaf children. Therefore, it is recommended that this program should be used at rehabilitation centers for deaf children, aiming at training parents as the primary therapists of deaf children.

  15. Comprehensive Early Stimulation Program for Infants. Instruction Manual [and] Early Interventionist's Workbook [and] Parent/Caregiver Workbook. William Beaumont Hospital Speech and Language Pathology Series.

    Science.gov (United States)

    Santana, Altagracia A.; Bottino, Patti M.

    This early intervention kit includes a Comprehensive Early Stimulation Program for Infants (CESPI) instruction manual, an early interventionist workbook, and ten parent/caregiver workbooks. The CESPI early intervention program is designed to provide therapists, teachers, other health professionals, and parents with a common-sense, practical guide…

  16. A Comprehensive Review of School-Based Body Mass Index Screening Programs and Their Implications for School Health: Do the Controversies Accurately Reflect the Research?

    Science.gov (United States)

    Ruggieri, Dominique G.; Bass, Sarah B.

    2015-01-01

    Background: Whereas legislation for body mass index (BMI) surveillance and screening programs has passed in 25 states, the programs are often subject to ethical debates about confidentiality and privacy, school-to-parent communication, and safety and self-esteem issues for students. Despite this debate, no comprehensive analysis has been completed…

  17. Follow the Money: A Comprehensive Review of the Funding Mechanisms of Voucher Programs in Six Cases. Informing Policy & Improving Practice Research Brief

    Science.gov (United States)

    Stewart, Molly S.; Moon, Jodi S.

    2016-01-01

    This comprehensive review is part of a three-part report, Follow the "Money: A Detailed Analysis of the Funding Mechanisms of Voucher Programs in Six Cases"; this review contains the cross-case analysis and findings of the funding mechanisms of voucher programs across five states (Arizona, Indiana, Louisiana, Ohio, and Wisconsin) and the…

  18. A comprehensive program to develop correlations for physical properties of kraft black liquor. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Fricke, A.L.; Zaman, A.A.

    1998-05-01

    The overall objective of the program was to develop correlations to predict physical properties within requirements of engineering precision from a knowledge of pulping conditions and of kraft black liquor composition, if possible. These correlations were to include those relating thermodynamic properties to pulping conditions and liquor composition. The basic premise upon which the research was based is the premise that black liquor behaves as a polymer solution. This premise has proven to be true, and has been used successfully in developing data reduction methods and in interpreting results. A three phase effort involving pulping, analysis of liquor composition, and measurement of liquor properties was conducted.

  19. Exercise program for children and adolescents with leukemia and lymphoma during treatment: A comprehensive review.

    Science.gov (United States)

    Zucchetti, Giulia; Rossi, Francesca; Chamorro Vina, Carolina; Bertorello, Nicoletta; Fagioli, Franca

    2018-05-01

    An exercise program (EP) during cancer treatment seems to be a valid strategy against physiological and quality-of-life impairments, but scientific evidence of benefits among pediatric patients is still limited. This review summarizes the literature focused on randomized controlled trials of EP offered to patients during leukemia and lymphoma treatment. Studies published up to June 2017 were selected from multiple databases and assessed by three independent reviewers for methodological validity. The review identified eight studies, but several types of bias have to be avoided to provide evidence-based recommendations accessible to patients, families, and professionals. © 2018 Wiley Periodicals, Inc.

  20. IMRT for adjuvant radiation in gastric cancer: A preferred plan?

    International Nuclear Information System (INIS)

    Ringash, Jolie; Perkins, Greg; Brierley, James; Lockwood, Gina; Islam, Mohammad; Catton, Pamela; Cummings, Bernard; Kim, John; Wong, Rebecca; Dawson, Laura

    2005-01-01

    Purpose: To assess the potential advantage of intensity-modulated radiotherapy (IMRT) over conformal planning for postoperative adjuvant radiotherapy in patients with gastric carcinoma. Methods and Materials: Twenty patients who had undergone treatment planning with conformal beam arrangements for 4500 cGy adjuvant radiotherapy between 2000 and 2001 underwent repeat planning using IMRT techniques. Conformal five-field plans were compared with seven- to nine-field coplanar sliding-window IMRT plans. For each patient, the cumulative dose-volume histograms and organ-dose summaries (without distributions or digitally reconstructed radiographs) were provided to two independent, 'blinded' GI radiation oncologists. The oncologists indicated which plan provided better planning target volume coverage and critical organ sparing, any safety concerns with either plan, and which plan they would choose to treat the patient. Results: In 18 (90%) of 20 cases, both oncologists chose the same plan. Cases with disagreement were given to a third 'blinded' reviewer. A 'preferred plan' could be determined in 19 (95%) of 20 cases. IMRT was preferred in 17 (89%) of 19 cases. In 4 (20%) of 20 IMRT plans at least one radiation oncologist had safety concerns because of the spinal cord dose (3 cases) or small bowel dose (2 cases). Of 42 ratings, IMRT was thought to provide better planning target volume coverage in 36 (86%) and better sparing of the spinal cord in 31 (74%) of 42, kidneys in 29 (69%), liver in 30 (71%), and heart in 29 (69%) of 42 ratings. The median underdose volume (1.7 vs. 4.1 cm 3 ), maximal dose to the spinal cord (36.85 vs. 45.65 Gy), and dose to 50% of the liver (17.29 vs. 27.97), heart (12.89 vs. 15.50 Gy), and left kidney (15.50 vs. 16.06 Gy) were lower with IMRT than with the conformal plans. Conclusion: Compared with the conformal plans, oncologists frequently preferred IMRT plans when using dose-volume histogram data. The advantages of IMRT plans include both

  1. Documentation of COMRAD program (= Comprehensive System for Interactive Planning in Radiation Therapy)

    International Nuclear Information System (INIS)

    Pfister, G.; Friedlein, H.P.

    1984-05-01

    COMRAD is a radiotherapy planning program for calculating dose distribution in two- and three-dimensional patient geometries with coplanar or non-coplanar fields. The program was developed at the IBM Scientific Center Heidelberg and extended for applications in neutron therapy at the IKE by integration of the neutron dose formula and further specification options. These modifications were necessary for an accurate determination of inhomogeneities in neutron therapy and for neutron kerma calculations. Administrative data, e.g. patient name and number, date, doctor and physicist appear on all printed dose distributions. The treatment data comprise the therapy unit in use, specifications of the radiation field (radiation axis, source/skin distance, portal size, rotation parameters), dose specifications, and field specifications. The location and orientation of the planar cuts through the patient (windows) into which dose distributions shall be calculated can be set at will. The same applies to the density of the raster points at which dose values shall be computed. (orig./HP) [de

  2. A comprehensive program to develop correlations for physical properties of kraft black liquor. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Fricke, A.L.; Zaman, A.A.; Stoy, M.O.; Schmidl, G.W.; Dong, D.J.; Speck, B.

    1998-04-01

    A wide variety of experimental techniques have been used in this work, and many of these have been developed completely or improved significantly in the course of the research done during this program. Therefore, it is appropriate to describe these techniques in detail as a reference for future workers so that the techniques can be used in future work with little additional effort or so that the results reported from this program can be compared better with future results from other work. In many cases, the techniques described are for specific analytical instruments. It is recognized that these may be superseded by future developments and improvements in instrumentation if a complete description of techniques used successfully in the past on other instrumentation is available. The total pulping and liquor preparation research work performed included chip and white liquor preparation, digestion, pulp washing, liquor and wash recovery, liquor sampling, weak liquor concentration in two steps to about 45--50% solids with an intermediate soap skimming at about 140F and 27--30% solids, determination of pulp yield and Kappa number, determination of total liquor solids, and a check on the total material balance for pulping. All other research was performed either on a sample of the weak black liquor (the combined black liquor and washes from the digester) or on the skimmed liquor that had been concentrated.

  3. Analysis of a comprehensive dataset of diversity generating retroelements generated by the program DiGReF

    Directory of Open Access Journals (Sweden)

    Schillinger Thomas

    2012-08-01

    Full Text Available Abstract Background Diversity Generating Retroelements (DGRs are genetic cassettes that can introduce tremendous diversity into a short, defined region of the genome. They achieve hypermutation through replacement of the variable region with a strongly mutated cDNA copy generated by the element-encoded reverse transcriptase. In contrast to “selfish” retroelements such as group II introns and retrotransposons, DGRs impart an advantage to their host by increasing its adaptive potential. DGRs were discovered in a bacteriophage, but since then additional examples have been identified in some bacterial genomes. Results Here we present the program DiGReF that allowed us to comprehensively screen available databases for DGRs. We identified 155 DGRs which are found in all major classes of bacteria, though exhibiting sporadic distribution across species. Phylogenetic analysis and sequence comparison showed that DGRs move between genomes by associating with various mobile elements such as phages, transposons and plasmids. The DGR cassettes exhibit high flexibility in the arrangement of their components and easily acquire additional paralogous target genes. Surprisingly, the genomic data alone provide new insights into the molecular mechanism of DGRs. Most notably, our data suggest that the template RNA is transcribed separately from the rest of the element. Conclusions DiGReF is a valuable tool to detect DGRs in genome data. Its output allows comprehensive analysis of various aspects of DGR biology, thus deepening our understanding of the role DGRs play in prokaryotic genome plasticity, from the global down to the molecular level.

  4. Introducing the Comprehensive Unit-based Safety Program for mechanically ventilated patients in Saudi Arabian Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Raymond M Khan

    2017-01-01

    Full Text Available Over the past decade, there have been major improvements to the care of mechanically ventilated patients (MVPs. Earlier initiatives used the concept of ventilator care bundles (sets of interventions, with a primary focus on reducing ventilator-associated pneumonia. However, recent evidence has led to a more comprehensive approach: The ABCDE bundle (Awakening and Breathing trial Coordination, Delirium management and Early mobilization. The approach of the Comprehensive Unit-based Safety Program (CUSP was developed by patient safety researchers at the Johns Hopkins Hospital and is supported by the Agency for Healthcare Research and Quality to improve local safety cultures and to learn from defects by utilizing a validated structured framework. In August 2015, 17 Intensive Care Units (ICUs (a total of 271 beds in eight hospitals in the Kingdom of Saudi Arabia joined the CUSP for MVPs (CUSP 4 MVP that was conducted in 235 ICUs in 169 US hospitals and led by the Johns Hopkins Armstrong Institute for Patient Safety and Quality. The CUSP 4 MVP project will set the stage for cooperation between multiple hospitals and thus strives to create a countrywide plan for the management of all MVPs in Saudi Arabia.

  5. The Effect of Neuro-Linguistic Programming (NLP on Reading Comprehension in English for Specific Purposes Courses

    Directory of Open Access Journals (Sweden)

    Fahimeh Farahani

    2018-01-01

    Full Text Available Neuro-Linguistic Programming (NLP has potential to help language learners; however, it has received scant attention. The present study was an attempt to investigate the effect of NLP techniques on reading comprehension of English as a Foreign Language (EFL learners at an English for Specific Purposes (ESP course. To achieve this goal, two intact classes of students were selected to form an experimental group (n=30 and a control group (n=30. A reading pretest (based on the course content was given to all participants. The sensory learning styles of the participants were diagnosed using Reid's (1987 leaning style questionnaire, and the participants in the experimental group were familiarized with NLP techniques to be able to implement these techniques in their reading. In the control group, the conventional approach to teach ESP reading was used. Considering the analysis of posttest results through ANCOVA, it was found that implementation of NLP techniques can have significant effect on reading comprehension of Iranian undergraduate EFL learners. Pedagogical implications are discussed.

  6. Improved Childhood Diarrhea Treatment Practices in Ghana: A Pre-Post Evaluation of a Comprehensive Private-Sector Program

    Science.gov (United States)

    El-Khoury, Marianne; Banke, Kathryn; Sloane, Phoebe

    2016-01-01

    ABSTRACT Diarrhea is the fourth leading cause of child mortality in Ghana. In 2010, Ghana endorsed guidelines from the World Health Organization and the United Nations Children’s Fund for use of zinc with low-osmolarity oral rehydration salts (ORS) for the treatment of acute childhood diarrhea. From late 2011 through 2014, the Strengthening Health Outcomes through the Private Sector (SHOPS) project implemented a comprehensive program in 3 regions of Ghana to increase the availability and use of ORS and zinc and to decrease incorrect use of antibiotics and antidiarrheals. The program included (1) partnering with local pharmaceutical firms to introduce and market locally produced zinc products, (2) collaborating with the Ghanaian Pharmacy Council to provide training and supportive supervision of private-sector providers on diarrhea management, and (3) conducting mass media campaigns to raise caregiver awareness. We evaluated the effect of this program using a baseline survey of 754 caregivers of children under 5 with diarrhea at the start of the intervention in 2012 and a follow-up survey of 751 caregivers in 2014. Regression analysis showed that use of ORS with zinc increased from 0.8% in 2012 to 29.2% in 2014 (Pzinc. Additional efforts are required to reduce persistent incorrect antibiotic use. PMID:27353619

  7. AP-PA field orientation followed by IMRT reduces lung exposure in comparison to conventional 3D conformal and sole IMRT in centrally located lung tumors

    Directory of Open Access Journals (Sweden)

    Soyfer Viacheslav

    2012-02-01

    Full Text Available Abstract Little attention has been paid to the fact that intensity modulated radiation therapy (IMRT techniques do not easily enable treatment with opposed beams. Three treatment plans (3 D conformal, IMRT, and combined (anterior-posterior-posterio-anterior (AP-PA + IMRT of 7 patients with centrally-located lung cancer were compared for exposure of lung, spinal cord and esophagus. Combined IMRT and AP-PA techniques offer better lung tissue sparing compared to plans predicated solely on IMRT for centrally-located lung tumors.

  8. Implementation of a comprehensive blood conservation program can reduce blood use in a community cardiac surgery program.

    Science.gov (United States)

    Xydas, Steve; Magovern, Christopher J; Slater, James P; Brown, John M; Bustami, Rami; Parr, Grant V; Thurer, Robert L

    2012-04-01

    The study objective was to determine the effects of implementing a blood conservation algorithm on blood product use and outcomes in a community cardiac surgery program. A blood management strategy including lower hemoglobin transfusion threshold and algorithm-driven decisions was adopted. Intraoperatively, point-of-care testing was used to avoid inappropriate component transfusion. A low prime perfusion circuit was adopted. Blood was withdrawn from patients before initiating bypass when possible. Patients undergoing coronary and valve procedures were included. Outlier patients receiving more than 10 units packed red blood cells were excluded. Data were collected for 6 months as a baseline group (group I). A 3-month period of program implementation was allotted. Data were subsequently collected for 6 months and comprised the study patients (group II). Prospective data were collected on demographics, blood use, and outcomes. Group I comprised 481 patients, and group II comprised 551 patients. Group II received fewer units of packed red blood cells, fresh-frozen plasma, and cryoprecipitate than group I. There was no difference in platelets transfused. Total blood product use was reduced by 40% in group II (P conservation algorithm can be rapidly introduced, leading to reductions in blood and component use with no detrimental effect on early outcomes. Point-of-care testing can direct component transfusion in coagulopathic cases, with most coagulopathic patients requiring platelets. Further research will determine the effects of reduced transfusions on long-term outcomes. Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  9. Implementation of a free software for quality control of IMRT; Puesta en marcha de un soltware de libre distribucion para el control de calidad IMRT

    Energy Technology Data Exchange (ETDEWEB)

    Chinillace, N.; Alonso, S.; Cortina, T.; Reinado, D.; Ricos, B.; Diaz, S.; Campayo, J. M.

    2011-07-01

    In this paper we focus on implementation and launch of software that allows us to compare quantitatively the two-dimensional dose distributions calculated and measured experimentally in IMRT treatment. The tool we are using to make this comparison is the free software DoseLab. This is a program written in MatLab and open source, thereby allowing in some cases adapt the program to the needs of each user. This program will be able to calculate the gamma function of these distributions, a parameter that simultaneously evaluates the difference in dose between two pixels of the image and the distance between them, giving us an objective and quantitative, allowing us to decide if both distributions are compatible or not.

  10. Recruitment Methods and Show Rates to a Prostate Cancer Early Detection Program for High-Risk Men: A Comprehensive Analysis

    Science.gov (United States)

    Giri, Veda N.; Coups, Elliot J.; Ruth, Karen; Goplerud, Julia; Raysor, Susan; Kim, Taylor Y.; Bagden, Loretta; Mastalski, Kathleen; Zakrzewski, Debra; Leimkuhler, Suzanne; Watkins-Bruner, Deborah

    2009-01-01

    Purpose Men with a family history (FH) of prostate cancer (PCA) and African American (AA) men are at higher risk for PCA. Recruitment and retention of these high-risk men into early detection programs has been challenging. We report a comprehensive analysis on recruitment methods, show rates, and participant factors from the Prostate Cancer Risk Assessment Program (PRAP), which is a prospective, longitudinal PCA screening study. Materials and Methods Men 35–69 years are eligible if they have a FH of PCA, are AA, or have a BRCA1/2 mutation. Recruitment methods were analyzed with respect to participant demographics and show to the first PRAP appointment using standard statistical methods Results Out of 707 men recruited, 64.9% showed to the initial PRAP appointment. More individuals were recruited via radio than from referral or other methods (χ2 = 298.13, p < .0001). Men recruited via radio were more likely to be AA (p<0.001), less educated (p=0.003), not married or partnered (p=0.007), and have no FH of PCA (p<0.001). Men recruited via referrals had higher incomes (p=0.007). Men recruited via referral were more likely to attend their initial PRAP visit than those recruited by radio or other methods (χ2 = 27.08, p < .0001). Conclusions This comprehensive analysis finds that radio leads to higher recruitment of AA men with lower socioeconomic status. However, these are the high-risk men that have lower show rates for PCA screening. Targeted motivational measures need to be studied to improve show rates for PCA risk assessment for these high-risk men. PMID:19758657

  11. Analysis of a comprehensive quality assurance program with computer-enhanced monitors

    International Nuclear Information System (INIS)

    Arenson, R.L.; Mintz, M.C.; Goldstein, E.; Stevens, J.F.; Jovais, C.

    1987-01-01

    The authors' quality assurance (QA) program provides communication pathways among its constituent committees, which include patient care, professional review, medical staff, missed case, quality control, safety, and management committees. The QA monitors are based on data from these committees but also include data from the information management system, such as patient delays, contrast reactions, incidents, complications, time-flow analyses, film library retrieval, cancellations, missing reports, and missing clinical data. Committee data include complaints, missed diagnoses, patient identification problems, and equipment failure. The QA monitors have now been incorporated into summary reports as part of their computer networks. A systematic method for follow-up ensures corrective action and documentation. Examples of improved quality of care resulting from this approach includes reductions in delays for report signature and in repeat films

  12. HITRAN Application Programming Interface (HAPI): A comprehensive approach to working with spectroscopic data

    Science.gov (United States)

    Kochanov, R. V.; Gordon, I. E.; Rothman, L. S.; Wcisło, P.; Hill, C.; Wilzewski, J. S.

    2016-07-01

    The HITRAN Application Programming Interface (HAPI) is presented. HAPI is a free Python library, which extends the capabilities of the HITRANonline interface (www.hitran.org) and can be used to filter and process the structured spectroscopic data. HAPI incorporates a set of tools for spectra simulation accounting for the temperature, pressure, optical path length, and instrument properties. HAPI is aimed to facilitate the spectroscopic data analysis and the spectra simulation based on the line-by-line data, such as from the HITRAN database [JQSRT (2013) 130, 4-50], allowing the usage of the non-Voigt line profile parameters, custom temperature and pressure dependences, and partition sums. The HAPI functions allow the user to control the spectra simulation and data filtering process via a set of the function parameters. HAPI can be obtained at its homepage www.hitran.org/hapi.

  13. On correlations in IMRT planning aims

    Science.gov (United States)

    Roy, Arkajyoti; Das, Indra J.

    2016-01-01

    The purpose was to study correlations amongst IMRT DVH evaluation points and how their relaxation impacts the overall plan. 100 head‐and‐neck cancer cases, using the Eclipse treatment planning system with the same protocol, are statistically analyzed for PTV, brainstem, and spinal cord. To measure variations amongst the plans, we use (i) interquartile range (IQR) of volume as a function of dose, (ii) interquartile range of dose as a function of volume, and (iii) dose falloff. To determine correlations for institutional and ICRU goals, conditional probabilities and medians are computed. We observe that most plans exceed the median PTV dose (average D50 = 104% prescribed dose). Furthermore, satisfying D50 reduced the probability of also satisfying D98, constituting a negative correlation of these goals. On the other hand, satisfying D50 increased the probability of satisfying D2, suggesting a positive correlation. A positive correlation is also observed between the PTV V105 and V110. Similarly, a positive correlation between the brainstem V45 and V50 is measured by an increase in the conditional median of V45, when V50 is violated. Despite the imposed institutional and international recommendations, significant variations amongst DVH points can occur. Even though DVH aims are evaluated independently, sizable correlations amongst them are possible, indicating that some goals cannot be satisfied concurrently, calling for unbiased plan criteria. PACS number(s): 87.55.dk, 87.53.Bn, 87.55.Qr, 87.55.de. PMID:27929480

  14. Randomized controlled trial of a comprehensive stroke education program for patients and caregivers.

    Science.gov (United States)

    Rodgers, H; Atkinson, C; Bond, S; Suddes, M; Dobson, R; Curless, R

    1999-12-01

    We report the findings of a randomized controlled trial to determine the effectiveness of a multidisciplinary Stroke Education Program (SEP) for patients and their informal carers. Two hundred four patients admitted with acute stroke and their 176 informal carers were randomized to receive an invitation to the SEP or to receive conventional stroke unit care. The SEP consisted of one 1-hour small group educational session for inpatients followed by six 1-hour sessions after discharge. The primary outcome measure was patient- and carer-perceived health status (SF-36) at 6 months after stroke. Knowledge of stroke, satisfaction with services, emotional outcome, disability, and handicap and were secondary outcome measures. Only 51 of 108 (47%) surviving patients randomized to the SEP completed the program, as did 20 of 93 (22%) informal carers of surviving patients. Perceived health status (Short Form 36 [SF-36] health survey) scores were similar for SEP patients and controls. Informal carers in the control group scored better on the social functioning component of the SF-36 than the SEP group (P=0.04). Patients and informal carers in the SEP group scored higher on the stroke knowledge scale than controls (patients, P=0.02; carers, P=0. 01). Patients in the SEP group were more satisfied with the information that they had received about stroke (P=0.004). There were no differences in emotional or functional outcomes between groups. Although the SEP improved patient and informal carer knowledge about stroke and patient satisfaction with some components of stroke services, this was not associated with an improvement in their perceived health status. Indeed, the social functioning of informal carers randomized to the SEP was less than in the control group.

  15. Efficacy, complications, and cost of a comprehensive blood conservation program for cardiac operations.

    Science.gov (United States)

    Scott, W J; Rode, R; Castlemain, B; Kessler, R; Follis, F; Pett, S B; Wernly, J A

    1992-05-01

    We reviewed blood use in 118 consecutive patients who underwent primary, elective cardiac operations in 1989. In June 1989 we initiated a blood conservation program that included attempts to limit preoperative aspirin use, intraoperative phlebotomy and hemodilution, use of a cell conservation device (Electromedics, Inc., Englewood, Colo.) to concentrate residual oxygenator contents, reinfusion of chest drainage, and acceptance of a minimum hemoglobin level of 8.0 gm/dl in stable patients. Patient characteristics were similar for patients operated on both before (n = 58) and after (n = 60) initiation of the blood conservation program, except for age and preoperative aspirin use (both greater in postconservation patients). Fewer blood products were transfused (5.8 +/- 5.7 units per patient before conservation versus 4.0 +/- 7.4 units per patient after conservation; p = 0.005). More complete data were available for 82 patients (40 patients before conservation and 42 after conservation). In the postconservation patients, 20 of 42 had 575 +/- 140 ml of blood withdrawn before cardiopulmonary bypass and reinfused afterward, 26 of 42 had 806 +/- 376 ml of blood processed with the cell conservation device returned, and 21 of 42 patients had an average of 287 +/- 127 ml of chest drainage reinfused. Chest tube drainage, postoperative hematologic parameters, and the prevalence of complications were not significantly different between groups. Stepwise linear regression analysis identified intraoperative withdrawal of blood before cardiopulmonary bypass, bypass duration, and preoperative hematocrit value as predictors of blood use. Intraoperative withdrawal of blood before cardiopulmonary bypass is an important conservation measure, and its use should be expanded.

  16. Virtual EPID standard phantom audit (VESPA) for remote IMRT and VMAT credentialing

    Science.gov (United States)

    Miri, Narges; Lehmann, Joerg; Legge, Kimberley; Vial, Philip; Greer, Peter B.

    2017-06-01

    A virtual EPID standard phantom audit (VESPA) has been implemented for remote auditing in support of facility credentialing for clinical trials using IMRT and VMAT. VESPA is based on published methods and a clinically established IMRT QA procedure, here extended to multi-vendor equipment. Facilities are provided with comprehensive instructions and CT datasets to create treatment plans. They deliver the treatment directly to their EPID without any phantom or couch in the beam. In addition, they deliver a set of simple calibration fields per instructions. Collected EPID images are uploaded electronically. In the analysis, the dose is projected back into a virtual cylindrical phantom. 3D gamma analysis is performed. 2D dose planes and linear dose profiles are provided and can be considered when needed for clarification. In addition, using a virtual flat-phantom, 2D field-by-field or arc-by-arc gamma analyses are performed. Pilot facilities covering a range of planning and delivery systems have performed data acquisition and upload successfully. Advantages of VESPA are (1) fast turnaround mainly driven by the facility’s capability of providing the requested EPID images, (2) the possibility for facilities performing the audit in parallel, as there is no need to wait for a phantom, (3) simple and efficient credentialing for international facilities, (4) a large set of data points, and (5) a reduced impact on resources and environment as there is no need to transport heavy phantoms or audit staff. Limitations of the current implementation of VESPA for trials credentialing are that it does not provide absolute dosimetry, therefore a Level I audit is still required, and that it relies on correctly delivered open calibration fields, which are used for system calibration. The implemented EPID based IMRT and VMAT audit system promises to dramatically improve credentialing efficiency for clinical trials and wider applications.

  17. Wellness through a comprehensive Yogic breathing program – A controlled pilot trial

    Directory of Open Access Journals (Sweden)

    Norlander Torsten

    2007-12-01

    Full Text Available Abstract Background Increasing rates of psychosocial disturbances give rise to increased risks and vulnerability for a wide variety of stress-related chronic pain and other illnesses. Relaxation exercises aim at reducing stress and thereby help prevent these unwanted outcomes. One of the widely used relaxation practices is yoga and yogic breathing exercises. One specific form of these exercises is Sudarshan Kriya and related practices (SK&P which are understood to have favourable effects on the mind-body system. The goal of this pilot study was to design a protocol that can investigate whether SK&P can lead to increased feeling of wellness in healthy volunteers. Methods Participants were recruited in a small university city in Sweden and were instructed in a 6-day intensive program of SK&P which they practiced daily for six weeks. The control group was instructed to relax in an armchair each day during the same period. Subjects included a total of 103 adults, 55 in the intervention (SK&P group and 48 in the control group. Various instruments were administered before and after the intervention. Hospital Anxiety Depression Scale measured the degree of anxiety and depression, Life Orientation Test measured dispositional optimism, Stress and Energy Test measured individual's energy and stress experiences. Experienced Deviation from Normal State measured the experience of altered state of consciousness. Results There were no safety issues. Compliance was high (only 1 dropout in the SK&P group, and 5 in the control group. Outcome measures appeared to be appropriate for assessing the differences between the groups. Subjective reports generally correlated with the findings from the instruments. The data suggest that participants in the SK&P group, but not the control group, lowered their degree of anxiety, depression and stress, and also increased their degree of optimism (ANOVA; p Conclusion These data indicate that the experimental protocol that is

  18. Improved Childhood Diarrhea Treatment Practices in Ghana: A Pre-Post Evaluation of a Comprehensive Private-Sector Program.

    Science.gov (United States)

    El-Khoury, Marianne; Banke, Kathryn; Sloane, Phoebe

    2016-06-20

    Diarrhea is the fourth leading cause of child mortality in Ghana. In 2010, Ghana endorsed guidelines from the World Health Organization and the United Nations Children's Fund for use of zinc with low-osmolarity oral rehydration salts (ORS) for the treatment of acute childhood diarrhea. From late 2011 through 2014, the Strengthening Health Outcomes through the Private Sector (SHOPS) project implemented a comprehensive program in 3 regions of Ghana to increase the availability and use of ORS and zinc and to decrease incorrect use of antibiotics and antidiarrheals. The program included (1) partnering with local pharmaceutical firms to introduce and market locally produced zinc products, (2) collaborating with the Ghanaian Pharmacy Council to provide training and supportive supervision of private-sector providers on diarrhea management, and (3) conducting mass media campaigns to raise caregiver awareness. We evaluated the effect of this program using a baseline survey of 754 caregivers of children under 5 with diarrhea at the start of the intervention in 2012 and a follow-up survey of 751 caregivers in 2014. Regression analysis showed that use of ORS with zinc increased from 0.8% in 2012 to 29.2% in 2014 (P<.001), and antibiotic use declined from 66.2% to 38.2% (P<.001) during the same period. The magnitude and statistical significance of these results remained the same after including potential confounding factors as covariates. Inappropriate antibiotic use, however, remained high at follow-up. We conclude that similar programs applied in other settings have the potential to rapidly scale up use of ORS and zinc. Additional efforts are required to reduce persistent incorrect antibiotic use. © El-Khoury et al.

  19. FIELD TEST PROGRAM TO DEVELOP COMPREHENSIVE DESIGN, OPERATING, AND COST DATA FOR MERCURY CONTROL SYSTEMS

    Energy Technology Data Exchange (ETDEWEB)

    Michael D. Durham

    2004-10-01

    PG&E NEG Salem Harbor Station Unit 1 was successfully tested for applicability of activated carbon injection as a mercury control technology. Test results from this site have enabled a thorough evaluation of mercury control at Salem Harbor Unit 1, including performance, estimated cost, and operation data. This unit has very high native mercury removal, thus it was important to understand the impacts of process variables on native mercury capture. The team responsible for executing this program included plant and PG&E headquarters personnel, EPRI and several of its member companies, DOE, ADA, Norit Americas, Inc., Hamon Research-Cottrell, Apogee Scientific, TRC Environmental Corporation, Reaction Engineering, as well as other laboratories. The technical support of all of these entities came together to make this program achieve its goals. Overall the objectives of this field test program were to determine the mercury control and balance-of-plant impacts resulting from activated carbon injection into a full-scale ESP on Salem Harbor Unit 1, a low sulfur bituminous-coal-fired 86 MW unit. It was also important to understand the impacts of process variables on native mercury removal (>85%). One half of the gas stream was used for these tests, or 43 MWe. Activated carbon, DARCO FGD supplied by NORIT Americas, was injected upstream of the cold side ESP, just downstream of the air preheater. This allowed for approximately 1.5 seconds residence time in the duct before entering the ESP. Conditions tested in this field evaluation included the impacts of the Selective Non-Catalytic Reduction (SNCR) system on mercury capture, of unburned carbon in the fly ash, of adjusting ESP inlet flue gas temperatures, and of boiler load on mercury control. The field evaluation conducted at Salem Harbor looked at several sorbent injection concentrations at several flue gas temperatures. It was noted that at the mid temperature range of 322-327 F, the LOI (unburned carbon) lost some of its

  20. Leveraging lean principles in creating a comprehensive quality program: The UCLA health readmission reduction initiative.

    Science.gov (United States)

    Afsar-Manesh, Nasim; Lonowski, Sarah; Namavar, Aram A

    2017-12-01

    UCLA Health embarked to transform care by integrating lean methodology in a key clinical project, Readmission Reduction Initiative (RRI). The first step focused on assembling a leadership team to articulate system-wide priorities for quality improvement. The lean principle of creating a culture of change and accountability was established by: 1) engaging stakeholders, 2) managing the process with performance accountability, and, 3) delivering patient-centered care. The RRI utilized three major lean principles: 1) A3, 2) root cause analyses, 3) value stream mapping. Baseline readmission rate at UCLA from 9/2010-12/2011 illustrated a mean of 12.1%. After the start of the RRI program, for the period of 1/2012-6/2013, the readmission rate decreased to 11.3% (p<0.05). To impact readmissions, solutions must evolve from smaller service- and location-based interventions into strategies with broader approach. As elucidated, a systematic clinical approach grounded in lean methodologies is a viable solution to this complex problem. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. HITRAN Application Programming Interface (HAPI): A comprehensive approach to working with spectroscopic data

    International Nuclear Information System (INIS)

    Kochanov, R.V.; Gordon, I.E.; Rothman, L.S.; Wcisło, P.; Hill, C.; Wilzewski, J.S.

    2016-01-01

    The HITRAN Application Programming Interface (HAPI) is presented. HAPI is a free Python library, which extends the capabilities of the HITRANonline interface ( (www.hitran.org)) and can be used to filter and process the structured spectroscopic data. HAPI incorporates a set of tools for spectra simulation accounting for the temperature, pressure, optical path length, and instrument properties. HAPI is aimed to facilitate the spectroscopic data analysis and the spectra simulation based on the line-by-line data, such as from the HITRAN database [JQSRT (2013) 130, 4–50], allowing the usage of the non-Voigt line profile parameters, custom temperature and pressure dependences, and partition sums. The HAPI functions allow the user to control the spectra simulation and data filtering process via a set of the function parameters. HAPI can be obtained at its homepage (www.hitran.org/hapi). - Highlights: • HAPI extends the HITRANonline portal and provides an access to the HITRAN data. • Free, flexible, and portable Python library for working with the spectroscopic data. • Incorporates functions for querying, filtering and processing the spectroscopic data. • Provides functionality for single-layer spectra simulation. • Can be used in the radiative transfer codes, spectroscopic data validation, etc.

  2. Methodology of the comprehensive program on prevention and control of overweight and obesity in Iranian children and adolescents: The IRAN-Ending childhood obesity (IRAN-ECHO program

    Directory of Open Access Journals (Sweden)

    Ali-Akbar Sayyari

    2017-01-01

    Full Text Available Background: The World Health Organization program on Ending Childhood Obesity (WHO-ECHO has developed a comprehensive and integrated package of recommendations to address childhood obesity. The present study, entitled IRAN-ECHO, was designed and implemented in the framework of the WHO-ECHO program. Methods: The IRAN-ECHO program is implementing multicomponent interventions by considering life course dimensions. The program has two parts: a population approach and an individual approach. The population approach considers different periods in life, including prenatal, infancy, childhood, and adolescence, as well as family and society. The individual approach targets those children or adolescents with overweight or obesity; this part is conducted as a referral system that is now integrated in the current national health system. As part of the population approach, a quasi-experimental study was conducted in six provinces to compare the status before and after implementing parts of the interventions. By intersectoral collaboration with different organizations, multicomponent interventions are conducted for different age groups. Results: The IRAN-ECHO program is being conducted in six provinces, and will be considered in all provinces in the near future. Its main effects could be assessed in future years. Part of this program that was conducted as a quasi-experimental survey comprised 7149 students and showed that a high percentage of students had acceptable knowledge about adverse health effects of overweight and obesity. However, the knowledge about the low nutritional value of unhealthy snacks such as potato chips, puffs, industrial juices, and carbonated drinks was not appropriate. Many participants had the undesirable attitude of skipping one of the main meals when attempting to lose weight. Conclusions: The IRAN-ECHO program is presenting the feasibility of conducting the WHO-ECHO recommendations in Iran. The scope of potential policy

  3. Methodology of the Comprehensive Program on Prevention and Control of Overweight and Obesity in Iranian Children and Adolescents: The IRAN-Ending Childhood Obesity (IRAN-ECHO) Program

    Science.gov (United States)

    Sayyari, Ali-Akbar; Abdollahi, Zahra; Ziaodini, Hassan; Olang, Beheshteh; Fallah, Hossein; Salehi, Forouzan; Heidari-Beni, Motahar; Imanzadeh, Farid; Abasalti, Zahra; Fozouni, Fereshteh; Jafari, Sakineh; Lashkarlouki, Farhad; Sahebdel, Mahnoush; Siadati, Arash; Aslani, Hamideh; Hosseini, Mostafa; Goodarzi, Azam; Yngve, Agneta; Kelishadi, Roya

    2017-01-01

    Background: The World Health Organization program on Ending Childhood Obesity (WHO-ECHO) has developed a comprehensive and integrated package of recommendations to address childhood obesity. The present study, entitled IRAN-ECHO, was designed and implemented in the framework of the WHO-ECHO program. Methods: The IRAN-ECHO program is implementing multicomponent interventions by considering life course dimensions. The program has two parts: a population approach and an individual approach. The population approach considers different periods in life, including prenatal, infancy, childhood, and adolescence, as well as family and society. The individual approach targets those children or adolescents with overweight or obesity; this part is conducted as a referral system that is now integrated in the current national health system. As part of the population approach, a quasi-experimental study was conducted in six provinces to compare the status before and after implementing parts of the interventions. By intersectoral collaboration with different organizations, multicomponent interventions are conducted for different age groups. Results: The IRAN-ECHO program is being conducted in six provinces, and will be considered in all provinces in the near future. Its main effects could be assessed in future years. Part of this program that was conducted as a quasi-experimental survey comprised 7149 students and showed that a high percentage of students had acceptable knowledge about adverse health effects of overweight and obesity. However, the knowledge about the low nutritional value of unhealthy snacks such as potato chips, puffs, industrial juices, and carbonated drinks was not appropriate. Many participants had the undesirable attitude of skipping one of the main meals when attempting to lose weight. Conclusions: The IRAN-ECHO program is presenting the feasibility of conducting the WHO-ECHO recommendations in Iran. The scope of potential policy recommendations to decrease

  4. Comprehensive report to Congress Clean Coal Technology Program. Four Rivers Energy Modernization Project

    Energy Technology Data Exchange (ETDEWEB)

    1994-06-01

    One of the five projects selected for funding within the Clean Coal Technology Program is a project proposed by Air Products and Chemicals, Inc. (APCI) of Allentown, Pennsylvania. APCI requested financial assistance from DOE for the design, construction, and operation of a 95 megawatt-electric (MWe) gross equivalent, second generation, pressurized, circulating fluidized bed (PCFB) combustor cogeneration facility. The project, named the Four Rivers Energy Modernization Project, is co be located adjacent to an existing APCI chemicals manufacturing facility in Calvert City, Kentucky. Four Rivers Energy Partners, L.P. (FREP), will execute the project. The demonstration plant will produce approximately 70 MWe for the utility grid and an average of 310,000 pounds per hour of process steam for the chemicals manufacturing facility. The project, including the demonstration phase, will last 80 months at a total cost of $360,707,500. DOE`s share of the project cost will be 39.5 percent, or $142,460,000. The objective of the proposed project is to demonstrate a second generation PCFB system based on technology being supplied by Foster Wheeler Energy Corporation (FWEC), Westinghouse Electric Corporation (Westinghouse), and LLB Lurgi Lentjes Babcock Energietechnik GmbH (LLB). The integrated performance to be demonstrated will involve all of the process systems, including coal preparation and feed, sorbent feed, carbonizer, char transfer, PCFB combustor, carbonizer and combustor hot-gas filtration, carbonizer and combustor alkali removal, topping combustor, gas turbine-generator, heat recovery steam generator (HRSG), steam turbine-generator, and balance-of-plant systems. The project will utilize Western Kentucky and Southern Illinois bituminous coal.

  5. FIELD TEST PROGRAM TO DEVELOP COMPREHENSIVE DESIGN, OPERATING, AND COST DATA FOR MERCURY CONTROL SYSTEMS

    Energy Technology Data Exchange (ETDEWEB)

    Michael D. Durham

    2005-03-17

    Brayton Point Unit 1 was successfully tested for applicability of activated carbon injection as a mercury control technology. Test results from this site have enabled a thorough evaluation of the impacts of future mercury regulations to Brayton Point Unit 1, including performance, estimated cost, and operation data. This unit has variable (29-75%) native mercury removal, thus it was important to understand the impacts of process variables and activated carbon on mercury capture. The team responsible for executing this program included: (1) Plant and PG&E National Energy Group corporate personnel; (2) Electric Power Research Institute (EPRI); (3) United States Department of Energy National Energy Technology Laboratory (DOE/NETL); (4) ADA-ES, Inc.; (5) NORIT Americas, Inc.; (6) Apogee Scientific, Inc.; (7) TRC Environmental Corporation; (8) URS Corporation; (9) Quinapoxet Solutions; (10) Energy and Environmental Strategies (EES); and (11) Reaction Engineering International (REI). The technical support of all of these entities came together to make this program achieve its goals. Overall, the objectives of this field test program were to determine the impact of activated carbon injection on mercury control and balance-of-plant processes on Brayton Point Unit 1. Brayton Point Unit 1 is a 250-MW unit that fires a low-sulfur eastern bituminous coal. Particulate control is achieved by two electrostatic precipitators (ESPs) in series. The full-scale tests were conducted on one-half of the flue gas stream (nominally 125 MW). Mercury control sorbents were injected in between the two ESPs. The residence time from the injection grid to the second ESP was approximately 0.5 seconds. In preparation for the full-scale tests, 12 different sorbents were evaluated in a slipstream of flue gas via a packed-bed field test apparatus for mercury adsorption. Results from these tests were used to determine the five carbon-based sorbents that were tested at full-scale. Conditions of interest

  6. The National Heart, Lung, and Blood Institute Small Business Program: A Comprehensive Ecosystem for Biomedical Product Development.

    Science.gov (United States)

    Marek, Kurt W

    2016-12-01

    Small companies working to develop products in the cardiovascular space face numerous challenges, from regulatory, intellectual property, and reimbursement barriers to securing funds to keep the lights on and reach the next development milestone. Most small companies that spin out from universities have the scientific knowledge, but product development expertise and business acumen are also needed to be successful. Other challenges include reduced interest in early stage technologies (Pharma & Biotech 2015 in Review, EP Vantage) and limited deal flow for cardiovascular products (Gormley B., Wall Street Journal, September 15, 2014). The NHLBI small business program is a comprehensive ecosystem designed to address these critical challenges and to provide resources and expertise to assist early stage companies developing cardiovascular and other products within the institute's mission. This article describes steps that NHLBI has taken to enhance our small business program to more effectively translate basic discoveries into commercial products to benefit patients and public health, including enhancing internal expertise and developing non-financial resources to assist small businesses as they develop their products and seek private sector investment and partnership.

  7. Latent tuberculosis infection in a Malaysian prison: implications for a comprehensive integrated control program in prisons.

    Science.gov (United States)

    Al-Darraji, Haider Abdulrazzaq Abed; Kamarulzaman, Adeeba; Altice, Frederick L

    2014-01-10

    . The prevalence of LTBI was extraordinary high in this sample of Malaysian prisoners, regardless of their age or HIV status. This warrants further examination of the size of the problem of TB in other congregate settings and the establishment of an evidence-based TB control program in Malaysian prisons with integrated TB, HIV and substance abuse components.

  8. Pre-trial quality assurance processes for an intensity-modulated radiation therapy (IMRT) trial: PARSPORT, a UK multicentre Phase III trial comparing conventional radiotherapy and parotid-sparing IMRT for locally advanced head and neck cancer.

    Science.gov (United States)

    Clark, C H; Miles, E A; Urbano, M T Guerrero; Bhide, S A; Bidmead, A M; Harrington, K J; Nutting, C M

    2009-07-01

    The purpose of this study was to compare conventional radiotherapy with parotid gland-sparing intensity-modulated radiation therapy (IMRT) using the PARSPORT trial. The validity of such a trial depends on the radiotherapy planning and delivery meeting a defined standard across all centres. At the outset, many of the centres had little or no experience of delivering IMRT; therefore, quality assurance processes were devised to ensure consistency and standardisation of all processes for comparison within the trial. The pre-trial quality assurance (QA) programme and results are described. Each centre undertook exercises in target volume definition and treatment planning, completed a resource questionnaire and produced a process document. Additionally, the QA team visited each participating centre. Each exercise had to be accepted before patients could be recruited into the trial. 10 centres successfully completed the quality assurance exercises. A range of treatment planning systems, linear accelerators and delivery methods were used for the planning exercises, and all the plans created reached the standard required for participation in this multicentre trial. All 10 participating centres achieved implementation of a comprehensive and robust IMRT programme for treatment of head and neck cancer.

  9. Dosimetric comparison of standard three-dimensional conformal radiotherapy followed by intensity-modulated radiotherapy boost schedule (sequential IMRT plan) with simultaneous integrated boost-IMRT (SIB IMRT) treatment plan in patients with localized carcinoma prostate.

    Science.gov (United States)

    Bansal, A; Kapoor, R; Singh, S K; Kumar, N; Oinam, A S; Sharma, S C

    2012-07-01

    DOSIMETERIC AND RADIOBIOLOGICAL COMPARISON OF TWO RADIATION SCHEDULES IN LOCALIZED CARCINOMA PROSTATE: Standard Three-Dimensional Conformal Radiotherapy (3DCRT) followed by Intensity Modulated Radiotherapy (IMRT) boost (sequential-IMRT) with Simultaneous Integrated Boost IMRT (SIB-IMRT). Thirty patients were enrolled. In all, the target consisted of PTV P + SV (Prostate and seminal vesicles) and PTV LN (lymph nodes) where PTV refers to planning target volume and the critical structures included: bladder, rectum and small bowel. All patients were treated with sequential-IMRT plan, but for dosimetric comparison, SIB-IMRT plan was also created. The prescription dose to PTV P + SV was 74 Gy in both strategies but with different dose per fraction, however, the dose to PTV LN was 50 Gy delivered in 25 fractions over 5 weeks for sequential-IMRT and 54 Gy delivered in 27 fractions over 5.5 weeks for SIB-IMRT. The treatment plans were compared in terms of dose-volume histograms. Also, Tumor Control Probability (TCP) and Normal Tissue Complication Probability (NTCP) obtained with the two plans were compared. The volume of rectum receiving 70 Gy or more (V > 70 Gy) was reduced to 18.23% with SIB-IMRT from 22.81% with sequential-IMRT. SIB-IMRT reduced the mean doses to both bladder and rectum by 13% and 17%, respectively, as compared to sequential-IMRT. NTCP of 0.86 ± 0.75% and 0.01 ± 0.02% for the bladder, 5.87 ± 2.58% and 4.31 ± 2.61% for the rectum and 8.83 ± 7.08% and 8.25 ± 7.98% for the bowel was seen with sequential-IMRT and SIB-IMRT plans respectively. For equal PTV coverage, SIB-IMRT markedly reduced doses to critical structures, therefore should be considered as the strategy for dose escalation. SIB-IMRT achieves lesser NTCP than sequential-IMRT.

  10. ISFAHAN HEALTHY HEART PROGRAM:A COMPREHENSIVE INTEGRATED COMMUNITY-BASED PROGRAM FOR CARDIOVASCULAR DISEASE PREVENTION AND CONTROL. DESIGN, METHODS AND INITIAL EXPERIENCE 2000-2001

    Directory of Open Access Journals (Sweden)

    N MOHAMMADI FARD

    2002-03-01

    Full Text Available Isfahan Healthy Heart Program (IHHP is a five to six year comprehensive integrated community based program for preventing and controlling of cardiovascular diseases (CVD via reducing CVD risk factors and improvement of cardiovascular healthy behavior in target population. IHHP has been started in 1999 and will be last since 2004. Primary survey was done to collect baseline data from interventional (Isfahan and Najafabad Cities and reference (Arak communities. In a multistage sampling method, we select randomly 5 to 10 percent of households in clusters. Then individuals aged equal or higher than 19 years old were selected for entering to survey. In this way, data from 12600 individuals (6300 in interventional counties and 6300 in reference county was collected and stratified due to their living area (urban vs. rural and different age and sex groups. Cardiovascular risk factors (Hypercholesterolemia, Smoking, Hypertension, Diabetes Mellitus, Obesity were investigated by laboratory tests (Lipid profile, FBS, OGTT, physical exam and standard questionnaires, in all ones. Nutritional habits, socioeconomic states, physical activity profiles and other healthy behaviors regarding to cardiovascular disease were assessed by validated questionnaires via interviewing to all individuals. Twelve leads electrocardiogram was done in all persons older than 35 years old. The prevalence of CVDs and distribution of CVD risk factors were estimated in this phase. In the 2nd phase, based on primary survey findings, we arranged a series of teams (worksite, children, women, health personnel, high risk patients, nutrition for planning and implementation of program through interventional community for a 5-year period. Every team has its own target population and objectives and monitors its process during the study. At intervals (annually, some local and small surveys with a random sampling will be conducted to assess and monitor the program and its potency to cope with

  11. Investigation of the use of MOSFET for clinical IMRT dosimetric verification

    International Nuclear Information System (INIS)

    Chuang, Cynthia F.; Verhey, Lynn J.; Xia Ping

    2002-01-01

    With advanced conformal radiotherapy using intensity modulated beams, it is important to have radiation dose verification measurements prior to treatment. Metal oxide semiconductor field effect transistors (MOSFET) have the advantage of a faster and simpler reading procedure compared to thermoluminescent dosimeters (TLD), and with the commercial MOSFET system, multiple detectors can be used simultaneously. In addition, the small size of the detector could be advantageous, especially for point dose measurements in small homogeneous dose regions. To evaluate the feasibility of MOSFET for routine IMRT dosimetry, a comprehensive set of experiments has been conducted, to investigate the stability, linearity, energy, and angular dependence. For a period of two weeks, under a standard measurement setup, the measured dose standard deviation using the MOSFETs was ±0.015 Gy with the mean dose being 1.00 Gy. For a measured dose range of 0.3 Gy to 4.2 Gy, the MOSFETs present a linear response, with a linearity coefficient of 0.998. Under a 10x10 cm 2 square field, the dose variations measured by the MOSFETs for every 10 degrees from 0 to 180 degrees is ±2.5%. The percent depth dose (PDD) measurements were used to verify the energy dependence. The measured PDD using the MOSFETs from 0.5 cm to 34 cm depth agreed to within ±3% when compared to that of the ionization chamber. For IMRT dose verification, two special phantoms were designed. One is a solid water slab with 81 possible MOSFET placement holes, and another is a cylindrical phantom with 48 placement holes. For each IMRT phantom verification, an ionization chamber and 3 to 5 MOSFETs were used to measure multiple point doses at different locations. Preliminary results show that the agreement between dose measured by MOSFET and that calculated by Corvus is within 5% error, while the agreement between ionization chamber measurement and the calculation is within 3% error. In conclusion, MOSFET detectors are suitable for

  12. Dosimetric pre-treatment verification of IMRT using an EPID; clinical experience

    International Nuclear Information System (INIS)

    Zijtveld, Mathilda van; Dirkx, Maarten L.P.; Boer, Hans C.J. de; Heijmen, Ben J.M.

    2006-01-01

    Background and purpose: In our clinic a QA program for IMRT verification, fully based on dosimetric measurements with electronic portal imaging devices (EPID), has been running for over 3 years. The program includes a pre-treatment dosimetric check of all IMRT fields. During a complete treatment simulation at the linac, a portal dose image (PDI) is acquired with the EPID for each patient field and compared with a predicted PDI. In this paper, the results of this pre-treatment procedure are analysed, and intercepted errors are reported. An automated image analysis procedure is proposed to limit the number of fields that need human intervention in PDI comparison. Materials and methods: Most of our analyses are performed using the γ index with 3% local dose difference and 3 mm distance to agreement as reference values. Scalar parameters are derived from the γ values to summarize the agreement between measured and predicted 2D PDIs. Areas with all pixels having γ values larger than one are evaluated, making decisions based on clinically relevant criteria more straightforward. Results: In 270 patients, the pre-treatment checks revealed four clinically relevant errors. Calculation of statistics for a group of 75 patients showed that the patient-averaged mean γ value inside the field was 0.43 ± 0.13 (1 SD) and only 6.1 ± 6.8% of pixels had a γ value larger than one. With the proposed automated image analysis scheme, visual inspection of images can be avoided in 2/3 of the cases. Conclusion: EPIDs may be used for high accuracy and high resolution routine verification of IMRT fields to intercept clinically relevant dosimetric errors prior to the start of treatment. For the majority of fields, PDI comparison can fully rely on an automated procedure, avoiding excessive workload

  13. The effect of concomitant chemotherapy on parotid gland function following head and neck IMRT.

    Science.gov (United States)

    Miah, Aisha B; Gulliford, Sarah L; Bhide, Shreerang A; Zaidi, Shane H; Newbold, Kate L; Harrington, Kevin J; Nutting, Christopher M

    2013-03-01

    To determine whether concomitant chemotherapy increases the incidence of high grade xerostomia following parotid-sparing intensity-modulated radiotherapy (IMRT) in patients with locally advanced head and neck squamous cell cancer. The incidence of high grade (≥G2) acute (CTCAEv3.0) and late (LENTSOMA and RTOG) xerostomia was compared between patients treated with either IMRT or concomitant chemo-IMRT (c-IMRT) in 2 prospective studies. Parotid gland mean tolerance doses (D₅₀) were reported using non-linear logistic regression analysis. Thirty-six patients received IMRT alone and 60 patients received c-IMRT. Patients received 65 Gy in 30 daily fractions to the primary site and involved nodal groups and 54 Gy in 30 fractions to elective nodal groups, mean doses to the parotid glands were comparable. Concomitant cisplatin 100mg/m(2) was administered on days 1 and 29 of IMRT. The incidence of ≥G2 subjective xerostomia was similar in both groups; acute-64.7% (IMRT) versus 60.3% (c-IMRT), p=0.83; late-43% (IMRT) versus 34% (c-IMRT), p=0.51. Recovery of parotid salivary flow at 1 year was higher with IMRT (64% vs 50%), but not statistically significant (p=0.15). D₅₀ for absence of parotid saliva flow at 1 year was 23.2 Gy (95% CI: 17.7-28.7) for IMRT and 21.1 Gy (11.8-30.3) for c-IMRT. Concomitant c-IMRT does not increase the incidence of acute or late xerostomia relative to IMRT alone. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  14. The effect of concomitant chemotherapy on parotid gland function following head and neck IMRT

    International Nuclear Information System (INIS)

    Miah, Aisha B.; Gulliford, Sarah L.; Bhide, Shreerang A.; Zaidi, Shane H.; Newbold, Kate L.; Harrington, Kevin J.; Nutting, Christopher M.

    2013-01-01

    Purpose: To determine whether concomitant chemotherapy increases the incidence of high grade xerostomia following parotid-sparing intensity-modulated radiotherapy (IMRT) in patients with locally advanced head and neck squamous cell cancer. Materials and methods: The incidence of high grade (⩾G2) acute (CTCAEv3.0) and late (LENTSOMA and RTOG) xerostomia was compared between patients treated with either IMRT or concomitant chemo-IMRT (c-IMRT) in 2 prospective studies. Parotid gland mean tolerance doses (D 50 ) were reported using non-linear logistic regression analysis. Results: Thirty-six patients received IMRT alone and 60 patients received c-IMRT. Patients received 65 Gy in 30 daily fractions to the primary site and involved nodal groups and 54 Gy in 30 fractions to elective nodal groups, mean doses to the parotid glands were comparable. Concomitant cisplatin 100 mg/m 2 was administered on days 1 and 29 of IMRT. The incidence of ⩾G2 subjective xerostomia was similar in both groups; acute-64.7% (IMRT) versus 60.3% (c-IMRT), p = 0.83; late-43% (IMRT) versus 34% (c-IMRT), p = 0.51. Recovery of parotid salivary flow at 1 year was higher with IMRT (64% vs 50%), but not statistically significant (p = 0.15). D 50 for absence of parotid saliva flow at 1 year was 23.2 Gy (95% CI: 17.7–28.7) for IMRT and 21.1 Gy (11.8–30.3) for c-IMRT. Conclusion: Concomitant c-IMRT does not increase the incidence of acute or late xerostomia relative to IMRT alone

  15. Peripheral doses of cranial pediatric IMRT performed with attenuator blocks

    International Nuclear Information System (INIS)

    Soboll, Danyel Scheidegger; Schitz, Ivette; Schelin, Hugo Reuters; Silva, Ricardo Goulart da; Viamonte, Alfredo

    2011-01-01

    This paper presents values of peripheral doses measured at six vital points of simulator objects which represent the ages of 2, 5 and 10 years old, submitted to a cranial IMRT procedure that applied compensator blocks interposed to 6 MV beams. The found values indicate that there is independence of dose with position of measurements and age of the patient, as the peripheral dose at the points nearest and the 2 year old simulator object where larger. The doses in thyroid reached the range of 1.4 to 2.9% of the dose prescribed in the isocenter, indicating that the peripheral doses for IMRT that employ compensator blocks can be greater than for the IMRT produced with sliding window technique

  16. Short-term results of a 5-week comprehensive cardiac rehabilitation program after first-time myocardial infarction.

    Science.gov (United States)

    Fallavollita, Luca; Marsili, Bruno; Castelli, Sandro; Cucchi, Francesca; Santillo, Elpidio; Marini, Luciano; Balestrini, Fabrizio

    2016-03-01

    A prospective single-center interventional cohort study was conducted to evaluate the effects of a 5-week comprehensive cardiac rehabilitation program on terms exercise capacity, quality of life, echocardiographic findings and autonomic modulation after first-time myocardial infarction. We studied 37 consecutive post-myocardial infartion patients (mean age 66 years). All patients began a 5-week cardiac rehabilitation supervised training. The exercise program consisted of 40 minutes of training, three times a week, on a cycle ergometer at 60-80% of the maximal heart rate. At baseline and after training program we analyzed: the distance walked after the Six-Minutes Walking Test (6MWT); quality of life (QoL) assesed using the Psychological General Well-Being Inventory (PGWBI) questionnaire; echocardiographic finding and autonomic balance assesed heart rate variability (HRV). We observed statistically significant improvement in exercise capacity (from 423±94 to 496±13 m; P<0.05). Also we observed statistically significant improvements in the many PGWBI dimensions; particularly, anxiety +5.8% (from 18.11±5.2 to 19.12±4.4); depression +6.0% (from 12.00±3.0 to 12.73±2.4); positive well-being +6% (from 11.55±3.5 to 12.23±4.0); general health +10.3% (from 9.48±3.5 to 10.46±2.87); vitality +6.8% (from 12.96±4.2 to 13.85±4.2). Finally, we observed changes in HRV indices after training program: RR (from 903±169 ms to 952±163 ms; P<0.05), pNN50% (from 4.74±4.89 to 6.23±5.53; P<0.05), in time-domain; LF (from 274±169 to 362±233 ms2; P<0,05); HF (from 214±154 to 314±194 ms2; P<0.05) and LF/HF (from 1.53±0.54 to 1.24±0.47; P<0.05) in frequency-domain. The study suggest that a cardiac rehabilitation program in postmyocardial infarction improves exercise capacity, QoL and autonomic modulation.

  17. Surviving Hypopharynx-Larynx Carcinoma in the Era of IMRT

    International Nuclear Information System (INIS)

    Studer, Gabriela; Peponi, Evangelia; Kloeck, Stephan; Dossenbach, Thomas; Huber, Gerhard; Glanzmann, Christoph

    2010-01-01

    Purpose: Outcome in locoregionally advanced laryngeal carcinoma and hypopharyngeal carcinoma after conventional radiation techniques is known for modest disease control and considerable late toxicity. Considering the lack of standardization in prescription dose for intensity-modulated radiotherapy (IMRT), we aimed to compare the results after our methods of simultaneously integrated boost IMRT with published results. Methods and Materials: Between March 2002 and December 2008, 65 hypopharyngeal, 31 supraglottic, and 27 locoregionally advanced glottic tumor patients underwent definitive IMRT (with simultaneous chemotherapy in 86%). Of these, 64% presented with locoregionally advanced disease. Mean follow-up was 26 months (range, 3-83 months), with a median of 21 months. Treatment (2.0-2.2Gy per fraction, 66-72.6Gy) followed a prospectively defined protocol. If the boost volume included more than half of the larynx or a substantial part of the pharynx, dose was limited to 2.0Gy per fraction. Results: The 2-year local, nodal, and locoregional control (LRC) rates for the entire cohort were 82%, 90%, and 77%, respectively; the disease-free and overall survival rates were 75% and 83%, respectively. The ultimate 2-year LRC rate, including salvage surgery, was 86%. Laryngectomy was required in 2 LRC patients needing tracheostoma already before; 2 further LRC patients needed tracheostomy before IMRT and remained tracheostoma dependent, and 3 patients remained feeding tube dependent after IMRT. Salvage laryngectomy was successful in 8 of 11. Of all 123 patients, 91 patients (74%) are locoregionally controlled and live with a functional laryngopharynx. Conclusions: Simultaneously integrated boost IMRT with limited acceptance of dose inhomogeneity resulted in very satisfactory disease control despite a slight left shift of planning target volume curves on the dose-volume histogram. Considering the treatment tolerance, a careful increase in dose in our patients seems possible

  18. Comprehensive Care

    Science.gov (United States)

    ... Comprehensive Care Share this page Facebook Twitter Email Comprehensive Care Understand the importance of comprehensive MS care ... In this article A complex disease requires a comprehensive approach Today multiple sclerosis (MS) is not a ...

  19. Peripheral doses of cranial pediatric IMRT performed with attenuator blocks; Doses perifericas de IMRT cranial pediatrica realizada com blocos atenuadores

    Energy Technology Data Exchange (ETDEWEB)

    Soboll, Danyel Scheidegger; Schitz, Ivette; Schelin, Hugo Reuters, E-mail: soboll@utfpr.edu.b, E-mail: iveteschitz@yahoo.com.b, E-mail: schelin@utfpr.edu.b [Universidade Tecnologica Federal do Parana (UTFPR), Curitiba, PR (Brazil); Silva, Ricardo Goulart da, E-mail: ricardo.goulart@ymail.co [Hospital Angelina Caron, Campina Grande do Sul, PR (Brazil); Viamonte, Alfredo, E-mail: aviamonte@inca.gov.b [Instituto Nacional do Cancer (INCa), Rio de Janeiro, RJ (Brazil)

    2011-10-26

    This paper presents values of peripheral doses measured at six vital points of simulator objects which represent the ages of 2, 5 and 10 years old, submitted to a cranial IMRT procedure that applied compensator blocks interposed to 6 MV beams. The found values indicate that there is independence of dose with position of measurements and age of the patient, as the peripheral dose at the points nearest and the 2 year old simulator object where larger. The doses in thyroid reached the range of 1.4 to 2.9% of the dose prescribed in the isocenter, indicating that the peripheral doses for IMRT that employ compensator blocks can be greater than for the IMRT produced with sliding window technique

  20. Using behavior change communication to lead a comprehensive family planning program: the Nigerian Urban Reproductive Health Initiative

    Science.gov (United States)

    Krenn, Susan; Cobb, Lisa; Babalola, Stella; Odeku, Mojisola; Kusemiju, Bola

    2014-01-01

    ABSTRACT Background: The Nigerian Urban Reproductive Health Initiative (NURHI), a 6-year comprehensive family planning program (2009–2015) in 4 cities, intentionally applies communication theories to all program elements, not just the demand generation ones, relying mainly on a theory called ideation—the concept that contraceptive use is influenced by people's beliefs, ideas, and feelings and that changing these ideational factors can change people's behavior. Program Description: The project used multiple communication channels to foster dialogue about family planning, increase social approval for it, and improve accurate knowledge about contraceptives. Mobile service delivery was started in the third year to improve access to clinical methods in slums. Methods: Data from representative baseline (2010–11) and midterm (2012) surveys of women of reproductive age in the project cities were analyzed. We also used propensity score matching to create a statistically equivalent control group of women not exposed to project activities, and we examined service delivery data from NURHI-supported clinics (January 2011–May 2013) to determine the contribution of mobile services to total family planning services. Results: Three years into the initiative, analysis of longitudinal data shows that use of modern contraceptives has increased in each city, varying from 2.3 to 15.5 percentage points, and that the observed increases were predicted by exposure to NURHI activities. Of note is that modern method use increased substantially among the poorest wealth quintiles in project cities, on average, by 8.4 percentage points. The more project activities women were exposed to, the greater their contraceptive use. For example, among women not using a modern method at baseline, contraceptive prevalence among those with no exposure by midterm was 19.1% vs. 43.4% among those with high exposure. Project exposure had a positive dose-response relationship with ideation, as did

  1. Implementation of a method for patient-specific IMRT treatment verification using dynalog files; Aplicacion de un metodo para la verificacion de tratamientos de imrt sobre la anatomia del paciente utilizando archivos dynalog

    Energy Technology Data Exchange (ETDEWEB)

    Calama Santiago, J. A.; Infante Utrilla, M. A.; Lavado Rodriguez, M. E.

    2011-07-01

    The aim of this work is to implement a simple method of intensity modulated radiation therapy (IMRT) verification on the patient anatomy using dynalog files. Monitor units (MU) fraction and leaf positions, both planned and actually positioned during treatment, are sampled every 55 ms and stored in these files. This information was used in the treatment planning system to reconstruct the given fluence and to recalculate the absorbed dose in the patients CT, comparing absorbed dose distributions and histograms with those initially planned. Differences mainly appeared in areas with high absorbed dose gradients at the beginning and at the end of the radiation fields. These differences were lower than 3% in absorbed dose for most cases. No significant differences were found on dose-volume histograms. With proper linac and multileaf collimator commissioning, and a more stringent linac, treatment planning and record and verify system quality assurance program, this procedure allows patient-specific IMRT treatment verification, unlike conventional methods. (Author) 15 refs.

  2. Long-Term Electroclinical and Employment Follow up in Temporal Lobe Epilepsy Surgery. A Cuban Comprehensive Epilepsy Surgery Program

    Science.gov (United States)

    Garcia Maeso, Ivan; Baez Martin, Margarita M.; Bender del Busto, Juan E.; García Navarro, María Eugenia; Quintanal Cordero, Nelson; Estupiñan Díaz, Bárbara; Lorigados Pedre, Lourdes; Valdés Yerena, Ricardo; Gonzalez, Judith; Garbey Fernandez, Randy; Sánchez Coroneux, Abel

    2018-01-01

    The purpose of this paper is to present a long- term electroclinical and employment follow up in temporal lobe epilepsy (TLE) patients in a comprehensive epilepsy surgery program. Forty adult patients with pharmacoresistant TLE underwent detailed presurgical evaluation. Electroencephalogram (EEG) and clinical follow up assessment for each patient were carried out. The occurrence of interictal epileptiform activity (IEA) and absolute spike frequency (ASF) were tabulated before and after 1, 6, 12, 24 and 72 months surgical treatment. Employment status pre- to post-surgery at the last evaluated period was also examined. Engel scores follow-up was described as follows: at 12 months 70% (28) class I, 10% (4) class II and 19% (8) class III-IV; at 24 months after surgery 55.2% (21) of the patients were class I, 28.9% (11) class II and 15.1% (6) class III-IV. After one- year follow up 23 (57.7%) patients were seizure and aura-free (Engel class IA). These figures changed to 47.3%, and 48.6% respectively two and five years following surgery whereas 50% maintained this condition in the last follow up period. A decline in the ASF was observed from the first year until the sixth year after surgery in relation to the preoperative EEG. The ASF one year after surgery allowed to distinguish “satisfactory” from “unsatisfactory” seizure relief outcome at the last follow up. An adequate social functioning in terms of education and employment in more than 50% of the patients was also found. Results revealed the feasibility of conducting a successful epilepsy surgery program with favorable long term electroclinical and psychosocial functioning outcomes in a developing country as well. PMID:29389846

  3. Long-Term Electroclinical and Employment Follow up in Temporal Lobe Epilepsy Surgery. A Cuban Comprehensive Epilepsy Surgery Program

    Directory of Open Access Journals (Sweden)

    Lilia Maria Morales Chacón

    2018-02-01

    Full Text Available The purpose of this paper is to present a long- term electroclinical and employment follow up in temporal lobe epilepsy (TLE patients in a comprehensive epilepsy surgery program. Forty adult patients with pharmacoresistant TLE underwent detailed presurgical evaluation. Electroencephalogram (EEG and clinical follow up assessment for each patient were carried out. The occurrence of interictal epileptiform activity (IEA and absolute spike frequency (ASF were tabulated before and after 1, 6, 12, 24 and 72 months surgical treatment. Employment status pre- to post-surgery at the last evaluated period was also examined. Engel scores follow-up was described as follows: at 12 months 70% (28 class I, 10% (4 class II and 19% (8 class III-IV; at 24 months after surgery 55.2% (21 of the patients were class I, 28.9% (11 class II and 15.1% (6 class III-IV. After one- year follow up 23 (57.7% patients were seizure and aura-free (Engel class IA. These figures changed to 47.3%, and 48.6% respectively two and five years following surgery whereas 50% maintained this condition in the last follow up period. A decline in the ASF was observed from the first year until the sixth year after surgery in relation to the preoperative EEG. The ASF one year after surgery allowed to distinguish “satisfactory” from “unsatisfactory” seizure relief outcome at the last follow up. An adequate social functioning in terms of education and employment in more than 50% of the patients was also found. Results revealed the feasibility of conducting a successful epilepsy surgery program with favorable long term electroclinical and psychosocial functioning outcomes in a developing country as well.

  4. Can All Centers Plan Intensity-Modulated Radiotherapy (IMRT) Effectively? An External Audit of Dosimetric Comparisons Between Three-Dimensional Conformal Radiotherapy and IMRT for Adjuvant Chemoradiation for Gastric Cancer

    International Nuclear Information System (INIS)

    Chung, Hans T.; Lee, Brian; Park, Eileen; Lu, Jiade J.; Xia Ping

    2008-01-01

    Purpose: To compare dosimetric endpoints between three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) at our center with limited IMRT experience, and to perform an external audit of the IMRT plans. Methods and Materials: Ten patients, who received adjuvant chemoradiation for gastric cancer, formed the study cohort. For standardization, the planning target volume (PTV) and organs at risk were recontoured with the assistance of a study protocol radiologic atlas. The cohort was replanned with CMS Xio to generate coplanar 3D-CRT and IMRT plans. All 10 datasets, including volumes but without the plans (i.e., blinded), were transmitted to an experienced center where IMRT plans were designed using Nomos Corvus (IMRT-C) and ADAC Pinnacle (IMRT-P). All IMRT plans were normalized to D95% receiving 45 Gy. Results: Intensity-modulated radiotherapy yielded higher PTV V45 (volume that receives ≥45 Gy) (p < 0.001) than 3D-CRT. No difference in V20 was seen in the right (p = 0.9) and left (p 0.3) kidneys, but the liver mean dose (p < 0.001) was superior with IMRT. For the external audit, IMRT-C (p = 0.002) and IMRT-P (p < 0.001) achieved significantly lower left kidney V20 than IMRT, and IMRT-P (p < 0.001) achieved lower right kidney V20 than IMRT. The IMRT-C (p = 0.003) but not IMRT-P (p = 0.6) had lower liver mean doses than IMRT. Conclusions: At our institution with early IMRT experience, IMRT improved PTV dose coverage and liver doses but not kidney doses. An external audit of IMRT plans showed that an experienced center can yield superior IMRT plans

  5. DESIGN OF A VIBRATION AND STRESS MEASUREMENT SYSTEM FOR AN ADVANCED POWER REACTOR 1400 REACTOR VESSEL INTERNALS COMPREHENSIVE VIBRATION ASSESSMENT PROGRAM

    OpenAIRE

    KO, DO-YOUNG; KIM, KYU-HYUNG

    2013-01-01

    In accordance with the US Nuclear Regulatory Commission (US NRC), Regulatory Guide 1.20, the reactor vessel internals comprehensive vibration assessment program (RVI CVAP) has been developed for an Advanced Power Reactor 1400 (APR1400). The purpose of the RVI CVAP is to verify the structural integrity of the reactor internals to flow-induced loads prior to commercial operation. The APR1400 RVI CVAP consists of four programs (analysis, measurement, inspection, and assessment). Thoughtful prepa...

  6. Effect of Comprehensive Health Promotion Program on Quality of Life, Weight, and Physical Activity among Iranian Overweight School-age Girls

    OpenAIRE

    Saeedeh Jafarzadeh; Sima Mohammad Khan Kermanshahi; Ali Khani Jeihooni

    2017-01-01

    Background Prevalence of overweight and obesity in children and its trend in recent years has taken a worrying figure. Overweight in childhood is the most important cause of adulthood obesity. Therefore, the present study aimed to investigate the effect ofcomprehensive health program on quality of life, weight and physical activity in Iranian overweight school-age girls. Materials and Methods In this quasi-experimental study, 80 overweight girls participated in a comprehensive health program ...

  7. Effect of Comprehensive School Physical Activity Programming on Cardiometabolic Health Markers in Children From Low-Income Schools.

    Science.gov (United States)

    Burns, Ryan D; Brusseau, Timothy A; Hannon, James C

    2017-09-01

    The purpose of this study was to examine the effect of a 36-week Comprehensive School Physical Activity Program (CSPAP) on cardiometabolic health markers in children from low-income schools. Participants were 217 school-aged children (mean age = 10.1 ± 1.1 years; 114 girls, 103 boys) recruited from 5 low-income elementary schools. Cardiometabolic health markers were collected in a fasted state at 2 time-points, before commencement of the CSPAP for classroom and school level clustering and the modifying effects of grade level and sex, there were statistically significant improvements in HDL cholesterol (Δ = 3.6 mg/dL, 95% CI: 1.4 mg/dL to 5.8 mg/dL, P = .039), triglycerides (Δ = -14.1 mg/dL, 95% CI: -21.4 mg/dL to -6.8 mg/dL, P = .022), and mean arterial pressure (Δ = -4.3 mmHg, 95% CI: -8.5 mmHg to -0.1 mmHg, P = .041) following the 36-week CSPAP intervention. Sixth-grade children showed decreases in LDL cholesterol (Δ = -15.3 mg/dL, 95% CI: -30.5 mg/dL to -0.1 mg/dL, P = .033). Improvements in specific cardiometabolic health markers were found following a 36-week CSPAP in children from low-income schools.

  8. Retention of Children and Their Families in the Longitudinal Outcome Study of the Comprehensive Community Mental Health Services for Children and Their Families Program: A Multilevel Analysis

    Science.gov (United States)

    Gebreselassie, Tesfayi; Stephens, Robert L.; Maples, Connie J.; Johnson, Stacy F.; Tucker, Alyce L.

    2014-01-01

    Predictors of retention of participants in a longitudinal study and heterogeneity between communities were investigated using a multilevel logistic regression model. Data from the longitudinal outcome study of the national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families program and information on…

  9. The Effectiveness of a Self Regulated Learning-Based Training Program on Improving Cognitive and Metacognitive EFL Reading Comprehension of 9th Graders with Reading Disabilities

    Science.gov (United States)

    Eissa, Mourad Ali

    2015-01-01

    The purpose of this study was to explore the effect of a self regulated learning intervention program on cognitive and metacognitive EFL reading comprehension of 9th graders with reading disabilities. The participants in this study were 40 9th Graders with reading disabilities, selected from two schools located in Baltim Educational Edara. A…

  10. A systematic benchmark method for analysis and comparison of IMRT treatment planning algorithms.

    Science.gov (United States)

    Mayo, Charles S; Urie, Marcia M

    2003-01-01

    Tools and procedures for evaluating and comparing different intensity-modulated radiation therapy (IMRT) systems are presented. IMRT is increasingly in demand and there are numerous systems available commercially. These programs introduce significantly different software to dosimetrists and physicists than conventional planning systems, and the options often seem initially overwhelmingly complex to the user. By creating geometric target volumes and critical normal tissues, the characteristics of the algorithms may be investigated, and the influence of the different parameters explored. Overall optimization strategies of the algorithm may be characterized by treating a square target volume (TV) with 2 perpendicular beams, with and without heterogeneities. A half-donut (hemi-annulus) TV with a "donut hole" (central cylinder) critical normal tissue (CNT) on a CT of a simulated quality assurance phantom is suggested as a good geometry to explore the IMRT algorithm parameters. Using this geometry, the order of varying parameters is suggested. First is to determine the effects of the number of stratifications of optimized intensity fluence on the resulting dose distribution, and selecting a fixed number of stratifications for further studies. To characterize the dose distributions, a dose-homogeneity index (DHI) is defined as the ratio of the dose received by 90% of the volume to the minimum dose received by the "hottest" 10% of the volume. The next step is to explore the effects of priority and penalty on both the TV and the CNT. Then, choosing and fixing these parameters, the effects of varying the number of beams can be looked at. As well as evaluating the dose distributions (and DHI), the number of subfields and the number of monitor units required for different numbers of stratifications and beams can be evaluated.

  11. Development of independent MU/treatment time verification algorithm for non-IMRT treatment planning: A clinical experience

    Science.gov (United States)

    Tatli, Hamza; Yucel, Derya; Yilmaz, Sercan; Fayda, Merdan

    2018-02-01

    The aim of this study is to develop an algorithm for independent MU/treatment time (TT) verification for non-IMRT treatment plans, as a part of QA program to ensure treatment delivery accuracy. Two radiotherapy delivery units and their treatment planning systems (TPS) were commissioned in Liv Hospital Radiation Medicine Center, Tbilisi, Georgia. Beam data were collected according to vendors' collection guidelines, and AAPM reports recommendations, and processed by Microsoft Excel during in-house algorithm development. The algorithm is designed and optimized for calculating SSD and SAD treatment plans, based on AAPM TG114 dose calculation recommendations, coded and embedded in MS Excel spreadsheet, as a preliminary verification algorithm (VA). Treatment verification plans were created by TPSs based on IAEA TRS 430 recommendations, also calculated by VA, and point measurements were collected by solid water phantom, and compared. Study showed that, in-house VA can be used for non-IMRT plans MU/TT verifications.

  12. Exclusive image guided IMRT vs. radical prostatectomy followed by postoperative IMRT for localized prostate cancer: a matched-pair analysis based on risk-groups

    International Nuclear Information System (INIS)

    Azelie, Caroline; Créhange, Gilles; Gauthier, Mélanie; Mirjolet, Céline; Cormier, Luc; Martin, Etienne; Peignaux-Casasnovas, Karine; Truc, Gilles; Chamois, Jérôme; Maingon, Philippe

    2012-01-01

    To investigate whether patients treated for a localized prostate cancer (PCa) require a radical prostatectomy followed by postoperative radiotherapy or exclusive radiotherapy, in the modern era of image guided IMRT. 178 patients with PCa were referred for daily exclusive image guided IMRT (IG-IMRT) using an on-line 3D ultra-sound based system and 69 patients were referred for postoperative IMRT without image guidance after radical prostatectomy (RP + IMRT). Patients were matched in a 1:1 ratio according to their baseline risk group before any treatment. Late toxicity was scored using the CTV v3.0 scale. Biochemical failure was defined as a postoperative PSA ≤ 0.1 ng/mL followed by 1 consecutive rising PSA for the postoperative group of patients and by the Phoenix definition (nadir + 2 ng/mL) for the group of patients treated with exclusive radiotherapy. A total of 98 patients were matched (49:49). From the start of any treatment, the median follow-up was 56.6 months (CI 95% = [49.6-61.2], range [18.2-115.1]). No patient had late gastrointestinal grade ≥ 2 toxicity in the IG-IMRT group vs. 4% in the RP + IMRT group. Forty two percent of the patients in both groups had late grade ≥ 2 genitourinary toxicity. The 5-year FFF rates in the IG-IMRT group and in the RP + IMRT groups were 93.1% [80.0-97.8] and 76.5% [58.3-87.5], respectively (p = 0.031). Patients with a localized PCa treated with IG-IMRT had better oncological outcome than patients treated with RP + IMRT. Further improvements in postoperative IMRT using image guidance and dose escalation are urgently needed

  13. Current status of intensity-modulated radiation therapy (IMRT)

    International Nuclear Information System (INIS)

    Hatano, Kazuo; Araki, Hitoshi; Sakai, Mitsuhiro

    2007-01-01

    External-beam radiation therapy has been one of the treatment options for prostate cancer. The dose response has been observed for a dose range of 64.8-81 Gy. The problem of external-beam radiotherapy (RT) for prostate cancer is that as the dose increases, adverse effects also increase. Three-dimensional conformal radiation therapy (3D-CRT) has enabled us to treat patients with up to 72-76 Gy to the prostate, with a relatively acceptable risk of late rectal bleeding. Recently, intensity-modulated radiation therapy (IMRT) has been shown to deliver a higher dose to the target with acceptable low rates of rectal and bladder complications. The most important things to keep in mind when using an IMRT technique are that there is a significant trade-off between coverage of the target, avoidance of adjacent critical structures, and the inhomogeneity of the dose within the target. Lastly, even with IMRT, it should be kept in mind that a ''perfect'' plan that creates completely homogeneous coverage of the target volume and zero or small dose to the adjacent organs at risk is not always obtained. Participating in many treatment planning sessions and arranging the beams and beam weights create the best approach to the best IMRT plan. (author)

  14. Consequences of leaf calibration errors on IMRT delivery

    International Nuclear Information System (INIS)

    Sastre-Padro, M; Welleweerd, J; Malinen, E; Eilertsen, K; Olsen, D R; Heide, U A van der

    2007-01-01

    IMRT treatments using multi-leaf collimators may involve a large number of segments in order to spare the organs at risk. When a large proportion of these segments are small, leaf positioning errors may become relevant and have therapeutic consequences. The performance of four head and neck IMRT treatments under eight different cases of leaf positioning errors has been studied. Systematic leaf pair offset errors in the range of ±2.0 mm were introduced, thus modifying the segment sizes of the original IMRT plans. Thirty-six films were irradiated with the original and modified segments. The dose difference and the gamma index (with 2%/2 mm criteria) were used for evaluating the discrepancies between the irradiated films. The median dose differences were linearly related to the simulated leaf pair errors. In the worst case, a 2.0 mm error generated a median dose difference of 1.5%. Following the gamma analysis, two out of the 32 modified plans were not acceptable. In conclusion, small systematic leaf bank positioning errors have a measurable impact on the delivered dose and may have consequences for the therapeutic outcome of IMRT

  15. ICANREAD: The Effects of an Online Reading Program on Grade 1 Students' Engagement and Comprehension Strategy Use

    Science.gov (United States)

    Ciampa, Katia

    2012-01-01

    This pilot study explores the impact of online electronic storybooks (e-books) on the reading motivation and listening comprehension of six grade 1 students (aged 7 years) from Ontario, Canada. The researcher measured participants' perceived enjoyment of the online e-book reading experience using standardized listening comprehension tests,…

  16. Matching tomographic IMRT fields with static photon fields

    International Nuclear Information System (INIS)

    Sethi, A.; Leybovich, L.; Dogan, N.; Emami, B.

    2001-01-01

    The matching of abutting radiation fields presents a challenging problem in radiation therapy. Due to sharp penumbra of linear accelerator beams, small (1-2 mm) errors in field positioning can lead to large (>30%) hot or cold spots in the abutment region. With head and neck immobilization devices (thermoplastic mask/aquaplast) an average setup error of 3 mm has been reported. Therefore hot or cold spots approaching 50% of the prescription dose may occur along the matchline. Although abutting radiation fields have been investigated for static fields, there is no reported study regarding matching of tomographic IMRT and static fields. Compared to static fields, the matching of tomographic IMRT fields with static fields is more complicated. Since IMRT and static fields are planned on separate treatment planning computers, the dose in the abutment region is not specified. In addition, commonly used techniques for matching fields, such as feathering of junctions, are not practical. We have developed a method that substantially reduces dose inhomogeneity in the abutment region. In this method, a 'buffer zone' around the matchline was created and was included as part of the target for both IMRT and static field plans. In both fields, a small dose gradient (≤3%/mm) in the buffer zone was created. In the IMRT plan, the buffer zone was divided into three sections with dose varying from 83% to 25% of prescription dose. The static field dose profile was modified using either a specially designed physical (hard) or a dynamic (soft) wedge. When these modified fields were matched, the combined dose in the abutment region varied by ≤10% in the presence of setup errors spanning 4 mm (±2 mm) when the hard wedge was used and 10 mm (±5 mm) with the soft wedge

  17. Fiscal 2000 research report on the study on management program for comprehensive assessment of chemical materials; 2000 nendo kagaku busshitsu sogo hyoka kanri program ni kansuru chosa kenkyu

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-03-01

    For the realization of environmentally friendly, sound economic activities and the assurance of a safe and peaceful daily life for people, studies were conducted about comprehensive risk assessment and management techniques to use in dealing with chemical substances. Concerning the above-named management program, a workshop was called, where panel discussion and exchange of views and opinions were held. In the study of overseas technological trends, visits were paid to interested institutes and corporations in Denmark, Sweden, and Germany, where hearings were held over the management and manufacture of chemical substances. Concerning the control of chemical substances, surveys were conducted of the control in Japan and abroad and of the methods that businesses and other organizations followed in meeting the control. It was found that the control was being dealt with earnestly in every country and that chemical substances would stay managed under international collaborative conditions. Efforts were being positively exerted by businesses and other organizations to properly manage and reduce chemical substances and to develop and use substitutes. It was found that measures for handling chemical substances were closely knit into business management. (NEDO)

  18. Implementing the Comprehensive Unit-Based Safety Program (CUSP) to Improve Patient Safety in an Academic Primary Care Practice.

    Science.gov (United States)

    Pitts, Samantha I; Maruthur, Nisa M; Luu, Ngoc-Phuong; Curreri, Kimberly; Grimes, Renee; Nigrin, Candace; Sateia, Heather F; Sawyer, Melinda D; Pronovost, Peter J; Clark, Jeanne M; Peairs, Kimberly S

    2017-11-01

    While there is growing awareness of the risk of harm in ambulatory health care, most patient safety efforts have focused on the inpatient setting. The Comprehensive Unit-based Safety Program (CUSP) has been an integral part of highly successful safety efforts in inpatient settings. In 2014 CUSP was implemented in an academic primary care practice. As part of CUSP implementation, staff and clinicians underwent training on the science of safety and completed a two-question safety assessment survey to identify safety concerns in the practice. The concerns identified by team members were used to select two initial safety priorities. The impact of CUSP on safety climate and teamwork was assessed through a pre-post comparison of results on the validated Safety Attitudes Questionnaire. Ninety-six percent of staff completed science of safety training as part of CUSP implementation, and 100% of staff completed the two-question safety assessment. The most frequently identified safety concerns were related to medications (n = 11, 28.2), diagnostic testing (n = 9, 25), and communication (n = 5, 14). The CUSP team initially prioritized communication and infection control, which led to standardization of work flows within the practice. Six months following CUSP implementation, large but nonstatistically significant increases were found for the percentage of survey respondents who reported knowledge of the proper channels for questions about patient safety, felt encouraged to report safety concerns, and believed that the work setting made it easy to learn from the errors of others. CUSP is a promising tool to improve safety climate and to identify and address safety concerns within ambulatory health care. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

  19. Evaluating outcomes of patients lost to follow-up in a large comprehensive care treatment program in western Kenya

    Science.gov (United States)

    Rachlis, B; Ochieng, D; Geng, E; Rotich, E; Ochieng, V; Maritim, B; Ndege, S; Naanyu, V; Martin, J; Keter, A; Ayuo, P; Diero, L; Nyambura, M; Braitstein, P

    2014-01-01

    Background The Academic Model Providing Access To Healthcare (AMPATH) program provides comprehensive HIV care and treatment services. Approximately 30% of patients have become lost to follow-up (LTFU). We sought to actively trace and identify outcomes for a sample of these patients. Methods LTFU was defined as missing a scheduled visit by ≥ 3 months. A randomly selected sample of 17% of patients identified as LTFU between January 2009 and June 2011 was generated, with sample stratification on age, antiretroviral therapy (ART) status at last visit, and facility. Chart reviews were conducted followed by active tracing. Tracing was completed by trained HIV-positive outreach workers July 2011 to February 2012. Outcomes were compared between adults and children and by ART status. Results Of 14,811 LTFU patients, 2,540 were randomly selected for tracing (2,179 adults, 1,071 on ART). The chart reviews indicated that 326 (12.8%) patients were not actually LTFU. Outcomes for 71% of sampled patients were determined including 85% of those physically traced. Of those with known outcomes, 21% had died while 29% had disengaged from care for various reasons. The remaining patients had moved away (n=458, 25%) or were still receiving HIV care (n=443 total, 25%). Conclusions Our findings demonstrate the feasibility of a large scale sampling-based approach. A significant proportion of patients were found not to be LTFU and further, high numbers of patients who were LTFU could not be located. Over a quarter of patients disengaged from care for various reasons including access challenges and familial influences. PMID:25692336

  20. A comprehensive linear programming tool to optimize formulations of ready-to-use therapeutic foods: an application to Ethiopia.

    Science.gov (United States)

    Ryan, Kelsey N; Adams, Katherine P; Vosti, Stephen A; Ordiz, M Isabel; Cimo, Elizabeth D; Manary, Mark J

    2014-12-01

    Ready-to-use therapeutic food (RUTF) is the standard of care for children suffering from noncomplicated severe acute malnutrition (SAM). The objective was to develop a comprehensive linear programming (LP) tool to create novel RUTF formulations for Ethiopia. A systematic approach that surveyed international and national crop and animal food databases was used to create a global and local candidate ingredient database. The database included information about each ingredient regarding nutrient composition, ingredient category, regional availability, and food safety, processing, and price. An LP tool was then designed to compose novel RUTF formulations. For the example case of Ethiopia, the objective was to minimize the ingredient cost of RUTF; the decision variables were ingredient weights and the extent of use of locally available ingredients, and the constraints were nutritional and product-quality related. Of the new RUTF formulations found by the LP tool for Ethiopia, 32 were predicted to be feasible for creating a paste, and these were prepared in the laboratory. Palatable final formulations contained a variety of ingredients, including fish, different dairy powders, and various seeds, grains, and legumes. Nearly all of the macronutrient values calculated by the LP tool differed by <10% from results produced by laboratory analyses, but the LP tool consistently underestimated total energy. The LP tool can be used to develop new RUTF formulations that make more use of locally available ingredients. This tool has the potential to lead to production of a variety of low-cost RUTF formulations that meet international standards and thereby potentially allow more children to be treated for SAM. © 2014 American Society for Nutrition.

  1. A Comprehensive Quality Assurance Program for Personnel and Procedures in Radiation Oncology: Value of Voluntary Error Reporting and Checklists

    International Nuclear Information System (INIS)

    Kalapurakal, John A.; Zafirovski, Aleksandar; Smith, Jeffery; Fisher, Paul; Sathiaseelan, Vythialingam; Barnard, Cynthia; Rademaker, Alfred W.; Rave, Nick; Mittal, Bharat B.

    2013-01-01

    Purpose: This report describes the value of a voluntary error reporting system and the impact of a series of quality assurance (QA) measures including checklists and timeouts on reported error rates in patients receiving radiation therapy. Methods and Materials: A voluntary error reporting system was instituted with the goal of recording errors, analyzing their clinical impact, and guiding the implementation of targeted QA measures. In response to errors committed in relation to treatment of the wrong patient, wrong treatment site, and wrong dose, a novel initiative involving the use of checklists and timeouts for all staff was implemented. The impact of these and other QA initiatives was analyzed. Results: From 2001 to 2011, a total of 256 errors in 139 patients after 284,810 external radiation treatments (0.09% per treatment) were recorded in our voluntary error database. The incidence of errors related to patient/tumor site, treatment planning/data transfer, and patient setup/treatment delivery was 9%, 40.2%, and 50.8%, respectively. The compliance rate for the checklists and timeouts initiative was 97% (P<.001). These and other QA measures resulted in a significant reduction in many categories of errors. The introduction of checklists and timeouts has been successful in eliminating errors related to wrong patient, wrong site, and wrong dose. Conclusions: A comprehensive QA program that regularly monitors staff compliance together with a robust voluntary error reporting system can reduce or eliminate errors that could result in serious patient injury. We recommend the adoption of these relatively simple QA initiatives including the use of checklists and timeouts for all staff to improve the safety of patients undergoing radiation therapy in the modern era

  2. Independent dose calculation in IMRT for the Tps Iplan using the Clarkson modified integral; Calculo independiente de dosis en IMRT para el TPS Iplan usando la integral modificada de Clarkson

    Energy Technology Data Exchange (ETDEWEB)

    Adrada, A.; Tello, Z.; Garrigo, E.; Venencia, D., E-mail: jorge.alberto.adrada@gmail.com [Instituto Privado de Radioterapia, Obispo Oro 423, X5000BFI Cordoba (Argentina)

    2014-08-15

    Intensity-Modulated Radiation Therapy (IMRT) treatments require a quality assurance (Q A) specific patient before delivery. These controls include the experimental verification in dose phantom of the total plan as well as dose distributions. The use of independent dose calculation (IDC) is used in 3D-Crt treatments; however its application in IMRT requires the implementation of an algorithm that allows considering a non-uniform intensity beam. The purpose of this work was to develop IDC software in IMRT with MLC using the algorithm proposed by Kung (Kung et al. 2000). The software was done using Matlab programming. The Clarkson modified integral was implemented on each flowing, applying concentric rings for the dose determination. From the integral of each field was calculated the dose anywhere. One time finished a planning; all data are exported to a phantom where a Q A plan is generated. On this is calculated the half dose in a representative volume of the ionization chamber and the dose at the center of it. Until now 230 IMRT planning were analyzed carried out ??in the treatment planning system (Tps) Iplan. For each one of them Q A plan was generated, were calculated and compared calculated dose with the Tps, IDC system and measurement with ionization chamber. The average difference between measured and calculated dose with the IDC system was 0.4% ± 2.2% [-6.8%, 6.4%]. The difference between the measured and the calculated doses by the pencil-beam algorithm (Pb) of Tps was 2.6% ± 1.41% [-2.0%, 5.6%] and with the Monte Carlo algorithm was 0.4% ± 1.5% [-4.9%, 3.7%]. The differences of the carried out software are comparable to the obtained with the ionization chamber and Tps in Monte Carlo mode. (author)

  3. Comprehensive Auditing in Nuclear Medicine Through the International Atomic Energy Agency Quality Management Audits in Nuclear Medicine (QUANUM) Program. Part 1: the QUANUM Program and Methodology.

    Science.gov (United States)

    Dondi, Maurizio; Torres, Leonel; Marengo, Mario; Massardo, Teresa; Mishani, Eyal; Van Zyl Ellmann, Annare; Solanki, Kishor; Bischof Delaloye, Angelika; Lobato, Enrique Estrada; Miller, Rodolfo Nunez; Paez, Diana; Pascual, Thomas

    2017-11-01

    same tool could then be applied to assess any improvement after corrective actions are taken. This is the first comprehensive audit program in nuclear medicine that helps evaluate managerial aspects, safety of patients and workers, clinical practice, and radiopharmacy, and, above all, keeps them under control all together, with the intention of continuous improvement. Copyright © 2017. Published by Elsevier Inc.

  4. SU-F-T-296: Modulated Therapy Down Under: A Survey of IMRT & VMAT Physics Practice in Australia and New Zealand

    International Nuclear Information System (INIS)

    Barber, J; Vial, P

    2016-01-01

    Purpose: A comprehensive survey of Australasian radiation oncology physics departments was undertaken to capture a snapshot of current usage, commissioning and QA practices for intensity-modulated therapies. Methods: An online survey was developed and advertised to Australian and New Zealand radiation oncology physicists through the local college (ACPSEM) in April 2015. The survey consisted of 147 questions in total, covering IMRT, VMAT and Tomotherapy, and details specific to different treatment planning systems. Questions captured detailed information on equipment, policies and procedures for the commissioning and QA of each treatment technique. Results: 41 partial or complete responses were collected, representing 59 departments out of the 78 departments operational. 137 and 84 linacs from these departments were using IMRT and VMAT respectively, from a total 150 linacs. 100% and 78% of respondents were treating with IMRT and VMAT respectively. There are at least 8 different treatment planning systems being used for IMRT or VMAT, and large variations in all aspects of QA policies and procedures. 29 responses indicated 72 methods routinely used for pre-treatment QA, when breaking down by device and analysis type. Similar numbers of departments use field-by-field analysis compared to composite analysis (56% to 44%) while a majority use true gantry angle delivery compared to fixed gantry at 0° (72% to 28%). 19 different implementations of gamma index analysis parameters were reported from 33 responses. A follow-up one-day workshop to highlight the results, discuss the role of QA and share equipment-specific knowledge across users was conducted in November 2015. Conclusion: While IMRT and VMAT are almost universally available in Australasia, large variations in practice indicate a need for national or consensus guidelines.

  5. Complexity of comprehensive care treatments in undergraduate dental programs: The benefits of observing and assisting experienced faculty members

    Directory of Open Access Journals (Sweden)

    Moataz Elgezawi

    2017-10-01

    Conclusions: Exposing students to manage complex oral rehabilitation including procedures like sinus lifting and bone augmentation, through an evidence-based interdisciplinary approach during the undergraduate comprehensive clinical dentistry course enhances their confidence and clinical acumen as an independent practitioner.

  6. Institutional Patient-specific IMRT QA Does Not Predict Unacceptable Plan Delivery

    Energy Technology Data Exchange (ETDEWEB)

    Kry, Stephen F., E-mail: sfkry@mdanderson.org [Imaging and Radiation Oncology Core at Houston, Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Molineu, Andrea [Imaging and Radiation Oncology Core at Houston, Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Kerns, James R.; Faught, Austin M.; Huang, Jessie Y.; Pulliam, Kiley B.; Tonigan, Jackie [Imaging and Radiation Oncology Core at Houston, Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); The University of Texas Health Science Center Houston, Graduate School of Biomedical Sciences, Houston, Texas (United States); Alvarez, Paola [Imaging and Radiation Oncology Core at Houston, Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Stingo, Francesco [The University of Texas Health Science Center Houston, Graduate School of Biomedical Sciences, Houston, Texas (United States); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Followill, David S. [Imaging and Radiation Oncology Core at Houston, Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); The University of Texas Health Science Center Houston, Graduate School of Biomedical Sciences, Houston, Texas (United States)

    2014-12-01

    Purpose: To determine whether in-house patient-specific intensity modulated radiation therapy quality assurance (IMRT QA) results predict Imaging and Radiation Oncology Core (IROC)-Houston phantom results. Methods and Materials: IROC Houston's IMRT head and neck phantoms have been irradiated by numerous institutions as part of clinical trial credentialing. We retrospectively compared these phantom results with those of in-house IMRT QA (following the institution's clinical process) for 855 irradiations performed between 2003 and 2013. The sensitivity and specificity of IMRT QA to detect unacceptable or acceptable plans were determined relative to the IROC Houston phantom results. Additional analyses evaluated specific IMRT QA dosimeters and analysis methods. Results: IMRT QA universally showed poor sensitivity relative to the head and neck phantom, that is, poor ability to predict a failing IROC Houston phantom result. Depending on how the IMRT QA results were interpreted, overall sensitivity ranged from 2% to 18%. For different IMRT QA methods, sensitivity ranged from 3% to 54%. Although the observed sensitivity was particularly poor at clinical thresholds (eg 3% dose difference or 90% of pixels passing gamma), receiver operator characteristic analysis indicated that no threshold showed good sensitivity and specificity for the devices evaluated. Conclusions: IMRT QA is not a reasonable replacement for a credentialing phantom. Moreover, the particularly poor agreement between IMRT QA and the IROC Houston phantoms highlights surprising inconsistency in the QA process.

  7. Institutional Patient-specific IMRT QA Does Not Predict Unacceptable Plan Delivery

    International Nuclear Information System (INIS)

    Kry, Stephen F.; Molineu, Andrea; Kerns, James R.; Faught, Austin M.; Huang, Jessie Y.; Pulliam, Kiley B.; Tonigan, Jackie; Alvarez, Paola; Stingo, Francesco; Followill, David S.

    2014-01-01

    Purpose: To determine whether in-house patient-specific intensity modulated radiation therapy quality assurance (IMRT QA) results predict Imaging and Radiation Oncology Core (IROC)-Houston phantom results. Methods and Materials: IROC Houston's IMRT head and neck phantoms have been irradiated by numerous institutions as part of clinical trial credentialing. We retrospectively compared these phantom results with those of in-house IMRT QA (following the institution's clinical process) for 855 irradiations performed between 2003 and 2013. The sensitivity and specificity of IMRT QA to detect unacceptable or acceptable plans were determined relative to the IROC Houston phantom results. Additional analyses evaluated specific IMRT QA dosimeters and analysis methods. Results: IMRT QA universally showed poor sensitivity relative to the head and neck phantom, that is, poor ability to predict a failing IROC Houston phantom result. Depending on how the IMRT QA results were interpreted, overall sensitivity ranged from 2% to 18%. For different IMRT QA methods, sensitivity ranged from 3% to 54%. Although the observed sensitivity was particularly poor at clinical thresholds (eg 3% dose difference or 90% of pixels passing gamma), receiver operator characteristic analysis indicated that no threshold showed good sensitivity and specificity for the devices evaluated. Conclusions: IMRT QA is not a reasonable replacement for a credentialing phantom. Moreover, the particularly poor agreement between IMRT QA and the IROC Houston phantoms highlights surprising inconsistency in the QA process

  8. The Comparison of Stereotactic Body Radiation Therapy (SBRT andIntensity Modulated Radiation Therapy (IMRT for prostate cancer byNCCN risk groups

    Directory of Open Access Journals (Sweden)

    Anthony Ricco

    2016-08-01

    Full Text Available OBJECTIVES: The primary objective of this study is to compare freedom from biochemical failure (FFBF between SBRT and IMRT for patients with organ confined prostate cancer treated between 2007 through 2012 utilizing the 2015 National Comprehensive Cancer Network (NCCN risk stratification guidelines. A secondary objective is to compare our updated toxicity at last follow up compared to pretreatment with respect to bowel, bladder, sexual functioning, and need for invasive procedures between the two groups.METHODS: We retrospectively reviewed 270 consecutive men treated with either SBRT (n=150 or IMRT (120 at a community hospital with two distinct radiation departments and referral patterns. Charts were reviewed for pretreatment and treatment factors including race, age, clinical T stage, initial PSA, Gleason score, use of androgen deprivation therapy (ADT, treatment with SBRT vs. IMRT as well as stratification by 2015 NCCN guidelines. Kaplan Meier (KM methodology was used to estimate freedom from biochemical failure, with statistical comparisons accomplished using log rank tests. Multivariable Cox proportional hazard modeling was used to establish independent factors prognostic of biochemical failure. Descriptive statistics were used to describe toxicity graded by a modified RTOG late radiation morbidity scoring system. RESULTS: Significant prognostic factors in univariate analysis for FFBF included NCCN risk groups (p=0.0032, grade (p=0.019, and PSA (p=0.008. There was no significant difference in FFBF between SBRT vs. IMRT (p=0.46 with 6 year actuarial FFBF of 91.9% for SBRT and 88.9% for IMRT. Multivariable analysis revealed only the NCCN risk stratification to be significant predictor for FFBF (p=0.04. 4 year actuarial FFBF by NCCN risk stratification was 100% very low risk, 100% low risk, 96.5% intermediate risk, 94.5% high risk, and 72.7% very high risk. There were no grade 3 gastrointestinal (GI or genitourinary (GU toxicities for either

  9. IMRT QA using machine learning: A multi-institutional validation.

    Science.gov (United States)

    Valdes, Gilmer; Chan, Maria F; Lim, Seng Boh; Scheuermann, Ryan; Deasy, Joseph O; Solberg, Timothy D

    2017-09-01

    To validate a machine learning approach to Virtual intensity-modulated radiation therapy (IMRT) quality assurance (QA) for accurately predicting gamma passing rates using different measurement approaches at different institutions. A Virtual IMRT QA framework was previously developed using a machine learning algorithm based on 498 IMRT plans, in which QA measurements were performed using diode-array detectors and a 3%local/3 mm with 10% threshold at Institution 1. An independent set of 139 IMRT measurements from a different institution, Institution 2, with QA data based on portal dosimetry using the same gamma index, was used to test the mathematical framework. Only pixels with ≥10% of the maximum calibrated units (CU) or dose were included in the comparison. Plans were characterized by 90 different complexity metrics. A weighted poison regression with Lasso regularization was trained to predict passing rates using the complexity metrics as input. The methodology predicted passing rates within 3% accuracy for all composite plans measured using diode-array detectors at Institution 1, and within 3.5% for 120 of 139 plans using portal dosimetry measurements performed on a per-beam basis at Institution 2. The remaining measurements (19) had large areas of low CU, where portal dosimetry has a larger disagreement with the calculated dose and as such, the failure was expected. These beams need further modeling in the treatment planning system to correct the under-response in low-dose regions. Important features selected by Lasso to predict gamma passing rates were as follows: complete irradiated area outline (CIAO), jaw position, fraction of MLC leafs with gaps smaller than 20 or 5 mm, fraction of area receiving less than 50% of the total CU, fraction of the area receiving dose from penumbra, weighted average irregularity factor, and duty cycle. We have demonstrated that Virtual IMRT QA can predict passing rates using different measurement techniques and across multiple

  10. Process control analysis of IMRT QA: implications for clinical trials

    International Nuclear Information System (INIS)

    Pawlicki, Todd; Rice, Roger K; Yoo, Sua; Court, Laurence E; McMillan, Sharon K; Russell, J Donald; Pacyniak, John M; Woo, Milton K; Basran, Parminder S; Boyer, Arthur L; Bonilla, Claribel

    2008-01-01

    The purpose of this study is two-fold: first is to investigate the process of IMRT QA using control charts and second is to compare control chart limits to limits calculated using the standard deviation (σ). Head and neck and prostate IMRT QA cases from seven institutions in both academic and community settings are considered. The percent difference between the point dose measurement in phantom and the corresponding result from the treatment planning system (TPS) is used for analysis. The average of the percent difference calculations defines the accuracy of the process and is called the process target. This represents the degree to which the process meets the clinical goal of 0% difference between the measurements and TPS. IMRT QA process ability defines the ability of the process to meet clinical specifications (e.g. 5% difference between the measurement and TPS). The process ability is defined in two ways: (1) the half-width of the control chart limits, and (2) the half-width of ±3σ limits. Process performance is characterized as being in one of four possible states that describes the stability of the process and its ability to meet clinical specifications. For the head and neck cases, the average process target across institutions was 0.3% (range: -1.5% to 2.9%). The average process ability using control chart limits was 7.2% (range: 5.3% to 9.8%) compared to 6.7% (range: 5.3% to 8.2%) using standard deviation limits. For the prostate cases, the average process target across the institutions was 0.2% (range: -1.8% to 1.4%). The average process ability using control chart limits was 4.4% (range: 1.3% to 9.4%) compared to 5.3% (range: 2.3% to 9.8%) using standard deviation limits. Using the standard deviation to characterize IMRT QA process performance resulted in processes being preferentially placed in one of the four states. This is in contrast to using control charts for process characterization where the IMRT QA processes were spread over three of the

  11. Automatic learning-based beam angle selection for thoracic IMRT

    International Nuclear Information System (INIS)

    Amit, Guy; Marshall, Andrea; Purdie, Thomas G.; Jaffray, David A.; Levinshtein, Alex; Hope, Andrew J.; Lindsay, Patricia; Pekar, Vladimir

    2015-01-01

    Purpose: The treatment of thoracic cancer using external beam radiation requires an optimal selection of the radiation beam directions to ensure effective coverage of the target volume and to avoid unnecessary treatment of normal healthy tissues. Intensity modulated radiation therapy (IMRT) planning is a lengthy process, which requires the planner to iterate between choosing beam angles, specifying dose–volume objectives and executing IMRT optimization. In thorax treatment planning, where there are no class solutions for beam placement, beam angle selection is performed manually, based on the planner’s clinical experience. The purpose of this work is to propose and study a computationally efficient framework that utilizes machine learning to automatically select treatment beam angles. Such a framework may be helpful for reducing the overall planning workload. Methods: The authors introduce an automated beam selection method, based on learning the relationships between beam angles and anatomical features. Using a large set of clinically approved IMRT plans, a random forest regression algorithm is trained to map a multitude of anatomical features into an individual beam score. An optimization scheme is then built to select and adjust the beam angles, considering the learned interbeam dependencies. The validity and quality of the automatically selected beams evaluated using the manually selected beams from the corresponding clinical plans as the ground truth. Results: The analysis included 149 clinically approved thoracic IMRT plans. For a randomly selected test subset of 27 plans, IMRT plans were generated using automatically selected beams and compared to the clinical plans. The comparison of the predicted and the clinical beam angles demonstrated a good average correspondence between the two (angular distance 16.8° ± 10°, correlation 0.75 ± 0.2). The dose distributions of the semiautomatic and clinical plans were equivalent in terms of primary target volume

  12. Incorporating prior knowledge into beam orientation optimization in IMRT

    International Nuclear Information System (INIS)

    Pugachev, Andrei M.S.; Lei Xing

    2002-01-01

    Purpose: Selection of beam configuration in currently available intensity-modulated radiotherapy (IMRT) treatment planning systems is still based on trial-and-error search. Computer beam orientation optimization has the potential to improve the situation, but its practical implementation is hindered by the excessive computing time associated with the calculation. The purpose of this work is to provide an effective means to speed up the beam orientation optimization by incorporating a priori geometric and dosimetric knowledge of the system and to demonstrate the utility of the new algorithm for beam placement in IMRT. Methods and Materials: Beam orientation optimization was performed in two steps. First, the quality of each possible beam orientation was evaluated using beam's-eye-view dosimetrics (BEVD) developed in our previous study. A simulated annealing algorithm was then employed to search for the optimal set of beam orientations, taking into account the BEVD scores of different incident beam directions. During the calculation, sampling of gantry angles was weighted according to the BEVD score computed before the optimization. A beam direction with a higher BEVD score had a higher probability of being included in the trial configuration, and vice versa. The inclusion of the BEVD weighting in the stochastic beam angle sampling process made it possible to avoid spending valuable computing time unnecessarily at 'bad' beam angles. An iterative inverse treatment planning algorithm was used for beam intensity profile optimization during the optimization process. The BEVD-guided beam orientation optimization was applied to an IMRT treatment of paraspinal tumor. The advantage of the new optimization algorithm was demonstrated by comparing the calculation with the conventional scheme without the BEVD weighting in the beam sampling. Results: The BEVD tool provided useful guidance for the selection of the potentially good directions for the beams to incident and was used

  13. A silicon strip detector dose magnifying glass for IMRT dosimetry

    International Nuclear Information System (INIS)

    Wong, J. H. D.; Carolan, M.; Lerch, M. L. F.; Petasecca, M.; Khanna, S.; Perevertaylo, V. L.; Metcalfe, P.; Rosenfeld, A. B.

    2010-01-01

    Purpose: Intensity modulated radiation therapy (IMRT) allows the delivery of escalated radiation dose to tumor while sparing adjacent critical organs. In doing so, IMRT plans tend to incorporate steep dose gradients at interfaces between the target and the organs at risk. Current quality assurance (QA) verification tools such as 2D diode arrays, are limited by their spatial resolution and conventional films are nonreal time. In this article, the authors describe a novel silicon strip detector (CMRP DMG) of high spatial resolution (200 μm) suitable for measuring the high dose gradients in an IMRT delivery. Methods: A full characterization of the detector was performed, including dose per pulse effect, percent depth dose comparison with Farmer ion chamber measurements, stem effect, dose linearity, uniformity, energy response, angular response, and penumbra measurements. They also present the application of the CMRP DMG in the dosimetric verification of a clinical IMRT plan. Results: The detector response changed by 23% for a 390-fold change in the dose per pulse. A correction function is derived to correct for this effect. The strip detector depth dose curve agrees with the Farmer ion chamber within 0.8%. The stem effect was negligible (0.2%). The dose linearity was excellent for the dose range of 3-300 cGy. A uniformity correction method is described to correct for variations in the individual detector pixel responses. The detector showed an over-response relative to tissue dose at lower photon energies with the maximum dose response at 75 kVp nominal photon energy. Penumbra studies using a Varian Clinac 21EX at 1.5 and 10.0 cm depths were measured to be 2.77 and 3.94 mm for the secondary collimators, 3.52 and 5.60 mm for the multileaf collimator rounded leaf ends, respectively. Point doses measured with the strip detector were compared to doses measured with EBT film and doses predicted by the Philips Pinnacle treatment planning system. The differences were 1.1%

  14. Quality correction factors of composite IMRT beam deliveries: Theoretical considerations

    International Nuclear Information System (INIS)

    Bouchard, Hugo

    2012-01-01

    Purpose: In the scope of intensity modulated radiation therapy (IMRT) dosimetry using ionization chambers, quality correction factors of plan-class-specific reference (PCSR) fields are theoretically investigated. The symmetry of the problem is studied to provide recommendable criteria for composite beam deliveries where correction factors are minimal and also to establish a theoretical limit for PCSR delivery k Q factors. Methods: The concept of virtual symmetric collapsed (VSC) beam, being associated to a given modulated composite delivery, is defined in the scope of this investigation. Under symmetrical measurement conditions, any composite delivery has the property of having a k Q factor identical to its associated VSC beam. Using this concept of VSC, a fundamental property of IMRT k Q factors is demonstrated in the form of a theorem. The sensitivity to the conditions required by the theorem is thoroughly examined. Results: The theorem states that if a composite modulated beam delivery produces a uniform dose distribution in a volume V cyl which is symmetric with the cylindrical delivery and all beams fulfills two conditions in V cyl : (1) the dose modulation function is unchanged along the beam axis, and (2) the dose gradient in the beam direction is constant for a given lateral position; then its associated VSC beam produces no lateral dose gradient in V cyl , no matter what beam modulation or gantry angles are being used. The examination of the conditions required by the theorem lead to the following results. The effect of the depth-dose gradient not being perfectly constant with depth on the VSC beam lateral dose gradient is found negligible. The effect of the dose modulation function being degraded with depth on the VSC beam lateral dose gradient is found to be only related to scatter and beam hardening, as the theorem holds also for diverging beams. Conclusions: The use of the symmetry of the problem in the present paper leads to a valuable theorem showing

  15. Comprehensive pelvic floor physical therapy program for men with idiopathic chronic pelvic pain syndrome: a prospective study.

    Science.gov (United States)

    Masterson, Thomas A; Masterson, John M; Azzinaro, Jessica; Manderson, Lattoya; Swain, Sanjaya; Ramasamy, Ranjith

    2017-10-01

    Male chronic pelvic pain syndrome (CPPS) is a heterogeneous constellation of symptoms that causes significant impairment and is often challenging to treat. In this prospective study, we evaluated men with CPPS who underwent comprehensive pelvic floor physical therapy (PFPT) program. We used the previously validated Genitourinary Pain Index (GUPI) to measure outcomes. We included 14 men who underwent physical therapy for idiopathic CPPS from October 2015 to October 2016. Men with clearly identifiable causes of pelvic pain, such as previous surgery, chronic infection, trauma, prostatitis and epididymitis were excluded. Treatment included: (I) manual therapy (internal and external) of pelvic floor and abdominal musculature to facilitate relaxation of muscles; (II) therapeutic exercises to promote range of motion, improve mobility/flexibility and strengthen weak muscles; (III) biofeedback to facilitate strengthening and relaxation of pelvic floor musculature; (IV) neuromodulation for pelvic floor muscle relaxation and pain relief. GUPI questionnaires were collected at initial evaluation and after the 10th visit. Higher scores reflect worse symptoms. Previous validation of the GUPI calculated a reduction of 7 points to robustly predict being a treatment responder (sensitivity 100%, specificity 76%) and a change in 4 points to predict modest response. Data are presented as medians (ranges). A total of 10 patients completed 10 visits, and the remaining four patients completed between 5 and 9 visits. The median National Institute of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) score at initial evaluation was 30.8 [16-39] and decreased to 22.2 [7-37] at the tenth visit. Five of the 10 patients (50%) in the study had a reduction of greater than 7 points indicating a robust treatment response, and two (20%) had a change of greater than 4 indicating moderate response. Three patients (30%) did not have any meaningful change in NIH-CPSI and the remaining four are in the

  16. Patient reported outcome measures (PROMs) following forward planned field-in field IMRT: Results from the Cambridge Breast IMRT trial

    International Nuclear Information System (INIS)

    Mukesh, Mukesh B.; Qian, Wendi; Wilkinson, Jennifer S.; Dorling, Leila; Barnett, Gillian C.; Moody, Anne M.; Wilson, Charles; Twyman, Nicola; Burnet, Neil G.; Wishart, Gordon C.; Coles, Charlotte E.

    2014-01-01

    Background: The use of intensity-modulated radiotherapy (IMRT) in breast cancer reduces clinician-assessed breast tissue toxicity including fibrosis, telangectasia and sub-optimal cosmesis. Patient reported outcome measures (PROMs) are also important as they provide the patient’s perspective. This longitudinal study reports on (a) the effect of forward planned field-in-field IMRT (∼simple IMRT) on PROMs compared to standard RT at 5 years after RT, (b) factors affecting PROMs at 5 years after RT and (c) the trend of PROMs over 5 years of follow up. Methods: PROMs were assessed at baseline (pre-RT), 6, 24 and 60 months after completion of RT using global health (EORTC QLQ C30) and 4 breast symptom questions (BR23). Also, 4 breast RT-specific questions were included at 6, 24 and 60 months: change in skin appearance, firmness to touch, reduction in breast size and overall change in breast appearance since RT. The benefits of simple IMRT over standard RT at 5 years after RT were assessed using standard t-test for global health and logistic regression analysis for breast symptom questions and breast RT-specific questions. Clinical factors affecting PROMs at 5 years were investigated using a multivariate analysis. A repeated mixed model was applied to explore the trend over time for each of PROMs. Results: (89%) 727/815, 84%, 81% and 61% patients completed questionnaires at baseline, 6, 24 and 60 months respectively. Patients reported worse toxicity for all four BR23 breast symptoms at 6 months, which then improved over time (p < 0.0001). They also reported improvement in skin appearance and breast hardness over time (p < 0.0001), with no significant change for breast shrinkage (p = 0.47) and overall breast appearance (p = 0.13). At 5 years, PROMs assessments did not demonstrate a benefit for simple IMRT over standard radiotherapy. Large breast volume, young age, baseline surgical cosmesis and post-operative infection were the most important variables to affect PROMs

  17. A mathematical framework for virtual IMRT QA using machine learning.

    Science.gov (United States)

    Valdes, G; Scheuermann, R; Hung, C Y; Olszanski, A; Bellerive, M; Solberg, T D

    2016-07-01

    It is common practice to perform patient-specific pretreatment verifications to the clinical delivery of IMRT. This process can be time-consuming and not altogether instructive due to the myriad sources that may produce a failing result. The purpose of this study was to develop an algorithm capable of predicting IMRT QA passing rates a priori. From all treatment, 498 IMRT plans sites were planned in eclipse version 11 and delivered using a dynamic sliding window technique on Clinac iX or TrueBeam Linacs. 3%/3 mm local dose/distance-to-agreement (DTA) was recorded using a commercial 2D diode array. Each plan was characterized by 78 metrics that describe different aspects of their complexity that could lead to disagreements between the calculated and measured dose. A Poisson regression with Lasso regularization was trained to learn the relation between the plan characteristics and each passing rate. Passing rates 3%/3 mm local dose/DTA can be predicted with an error smaller than 3% for all plans analyzed. The most important metrics to describe the passing rates were determined to be the MU factor (MU per Gy), small aperture score, irregularity factor, and fraction of the plan delivered at the corners of a 40 × 40 cm field. The higher the value of these metrics, the worse the passing rates. The Virtual QA process predicts IMRT passing rates with a high likelihood, allows the detection of failures due to setup errors, and it is sensitive enough to detect small differences between matched Linacs.

  18. Simulation of respiratory motion during IMRT dose delivery

    International Nuclear Information System (INIS)

    Mohn, Silje; Wasboe, Ellen

    2011-01-01

    Background. When intensity modulated radiation therapy (IMRT) is realised with dynamic multi-leaf collimators (MLC) and given under respiratory motion, dosimetric errors may occur. These errors are a consequence of the dose blurring and the interplay between the organ motion and the leaf motion. In the present study, a model for evaluating these dosimetric effects for patient-specific cases has been developed and tested. Material and methods. In the purpose written software, three dimensional (3D) dose distributions can be calculated both with and without a generated breathing cycle. To validate the presented model and illustrate its application, periodic breathing cycles were generated, where the starting phase was set randomly for each field during the calculations. Respiration in the anterior-posterior (AP), superior-inferior (SI) and left-right (LR) direction was tested and verified. To illustrate the application of the presented model, two 5-fields IMRT plans with different complexity were calculated with a 2 cm peak-to-peak motion in the AP direction for one fraction and for 25 fractions. Results. The results showed that the calculation method is of good accuracy, in particular for IMRT plans consisting of several fields, where 97% of the pixels within the body fulfilled a tolerance set to 4% dose difference and 4 mm distance to agreement (DTA). For the two IMRT plans with different complexity, pronounced respiratory induced dose errors, which increased with increasing complexity, were found for both one fraction and 25 fractions, but due to the random stating phase the interplay effect was considerably reduced for the plans consisting of 25 fractions. This illustrates how the dosimetric effects will vary depending on the dose plan and on the number of fractions investigated. Conclusion. For patient specific cases, the model can with good accuracy calculate 3D dose distributions both with and without respiratory motion, and evaluate the dosimetric effects

  19. Retrospective analysis of 'gamma distribution' based IMRT QA criteria

    International Nuclear Information System (INIS)

    Wen, C.; Chappell, R.A.

    2010-01-01

    Full text: IMRT has been implemented into clinical practice at Royal Hobart Hospital (RHH) since mid 2006 for treating patients with Head and Neck (H and N) or prostate tumours. A local quality assurance (QA) acceptance criteria based on 'gamma distribution' for approving IMRT plan was developed and implemented in early 2007. A retrospective analysis of such criteria over 194 clinical cases will be presented. The RHH IMRT criteria was established with assumption that gamma distribution obtained through inter-comparison of 2 D dose maps between planned and delivered was governed by a positive-hail' normal distribution. A commercial system-MapCheck was used for 2 D dose map comparison with a built-in gamma analysis tool. Gamma distribution histogram was generated and recorded for all cases. By retrospectively analysing those distributions using curve fitting technique, a statistical gamma distribution can be obtained and evaluated. This analytical result can be used for future IMRT planing and treatment delivery. The analyses indicate that gamma distribution obtained through MapCheckTM is well under the normal distribution, particularly for prostate cases. The applied pass/fail criteria is not overly sensitive to identify 'false fails' but can be further tighten-up for smaller field while for larger field found in both H and N and prostate cases, the criteria was correctly applied. Non-uniform distribution of detectors in MapCheck and experience level of planners are two major factors to variation in gamma distribution among clinical cases. This criteria derived from clinical statistics is superior and more accurate than single-valued criteria for lMRT QA acceptance procedure. (author)

  20. Endocavitary in vivo Dosimetry for IMRT Treatments of Gynecologic Tumors

    International Nuclear Information System (INIS)

    Cilla, Savino; Macchia, Gabriella; Digesù, Cinzia; Deodato, Francesco; Sabatino, Domenico; Morganti, Alessio G.; Piermattei, Angelo

    2011-01-01

    The accuracy and reproducibility of endometrial carcinoma treatment with intensity-modulated radiotherapy (IMRT) was assessed by means of in vivo dosimetry. Six patients who had previously undergone radical hysterectomy for endometrial carcinoma were treated with IMRT using a vaginal applicator with radio-opaque fiducial markers. An ion-chamber inserted into the applicator supplied an endocavitary in vivo dosimetry for quality assurance purposes. The ratio R = D/D TPS between the in vivo measured dose D and the predicted dose by the treatment planning system D TPS was determined for every fraction of the treatment. Results showed that 90% and 100% of the ratios resulted equal to 1 within 5% and 10%, respectively. The mean value of the ratios distribution for the 6 patients was R = 0.995 and the SD = 0.034. The ratio R* between the measured and predicted total doses for each patient was near to 1, within 2%. The dosimetric results suggest that the use of a vaginal applicator in an image-guided approach could make the interfractions target position stable and reproducible, allowing a safe use of the IMRT technique in the treatment of postoperative vaginal vault. In vivo dosimetry may supply useful information about the discrimination of random vs. systematic errors. The workload is minimum and this in vivo dosimetry can be applied also in the clinical routine.

  1. A Method for Correcting IMRT Optimizer Heterogeneity Dose Calculations

    International Nuclear Information System (INIS)

    Zacarias, Albert S.; Brown, Mellonie F.; Mills, Michael D.

    2010-01-01

    Radiation therapy treatment planning for volumes close to the patient's surface, in lung tissue and in the head and neck region, can be challenging for the planning system optimizer because of the complexity of the treatment and protected volumes, as well as striking heterogeneity corrections. Because it is often the goal of the planner to produce an isodose plan with uniform dose throughout the planning target volume (PTV), there is a need for improved planning optimization procedures for PTVs located in these anatomical regions. To illustrate such an improved procedure, we present a treatment planning case of a patient with a lung lesion located in the posterior right lung. The intensity-modulated radiation therapy (IMRT) plan generated using standard optimization procedures produced substantial dose nonuniformity across the tumor caused by the effect of lung tissue surrounding the tumor. We demonstrate a novel iterative method of dose correction performed on the initial IMRT plan to produce a more uniform dose distribution within the PTV. This optimization method corrected for the dose missing on the periphery of the PTV and reduced the maximum dose on the PTV to 106% from 120% on the representative IMRT plan.

  2. Acute toxicity of postoperative IMRT and chemotherapy for endometrial cancer

    International Nuclear Information System (INIS)

    Tierney, R.M.; Powell, M.A.; Mutch, D.G.; Gibb, R.K.; Rader, J.S.; Grigsby, P.W.

    2007-01-01

    The aim of this study was to determine the acute toxicity of postoperative intensity-modulated radiotherapy (IMRT) with and without chemotherapy in patients with endometrial cancer. A total of 19 patients with stages IB-IVB endometrial cancer who underwent surgery and postoperative IMRT were reviewed. The treatment planning goal was to cover the tissue at risk and minimize the dose to the bladder, bowel, and bone marrow. Median dose was 50.4 Gy (range 49.6-51.2 Gy). Altogether, 14 patients underwent chemotherapy; most were given carboplatin and paclitaxel. Toxicity was scored according to the Common Terminology Criteria for Adverse Events version 3.0 (CTCAE). The prescribed radiation treatment was completed in all patients. The prescribed cycles of chemotherapy were completed in all 14 patients, except one who received five of six cycles limited by prolonged thrombocytopenia. Chemotherapy was delayed in two patients (14%). Three patients required growth factor support during chemotherapy, and one patient required a blood transfusion. Acute grades 3-4 hematological toxicity occurred in 9 of the 14 patients (64%) who underwent chemotherapy. None experienced acute grade 3 or 4 genitourinary or gastrointestinal toxicity. Adjuvant IMRT and chemotherapy following surgery in patients with endometrial cancer is well tolerated and did not lead to treatment modification in most patients. (author)

  3. Statistical process control analysis for patient-specific IMRT and VMAT QA.

    Science.gov (United States)

    Sanghangthum, Taweap; Suriyapee, Sivalee; Srisatit, Somyot; Pawlicki, Todd

    2013-05-01

    This work applied statistical process control to establish the control limits of the % gamma pass of patient-specific intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) quality assurance (QA), and to evaluate the efficiency of the QA process by using the process capability index (Cpml). A total of 278 IMRT QA plans in nasopharyngeal carcinoma were measured with MapCHECK, while 159 VMAT QA plans were undertaken with ArcCHECK. Six megavolts with nine fields were used for the IMRT plan and 2.5 arcs were used to generate the VMAT plans. The gamma (3%/3 mm) criteria were used to evaluate the QA plans. The % gamma passes were plotted on a control chart. The first 50 data points were employed to calculate the control limits. The Cpml was calculated to evaluate the capability of the IMRT/VMAT QA process. The results showed higher systematic errors in IMRT QA than VMAT QA due to the more complicated setup used in IMRT QA. The variation of random errors was also larger in IMRT QA than VMAT QA because the VMAT plan has more continuity of dose distribution. The average % gamma pass was 93.7% ± 3.7% for IMRT and 96.7% ± 2.2% for VMAT. The Cpml value of IMRT QA was 1.60 and VMAT QA was 1.99, which implied that the VMAT QA process was more accurate than the IMRT QA process. Our lower control limit for % gamma pass of IMRT is 85.0%, while the limit for VMAT is 90%. Both the IMRT and VMAT QA processes are good quality because Cpml values are higher than 1.0.

  4. USING QUESTION GENERATING TECHNIQUE IN TEACHING READING COMPREHENSION FOR THE THIRD SEMESTER STUDENTS AT ENGLISH STUDY PROGRAM OF MUHAMMADIYAH UNIVERSITY OF BENGKULU

    Directory of Open Access Journals (Sweden)

    Washlurachim Safitri Safitri

    2016-04-01

    Full Text Available The objective of this research was to find out Using Question Generating Technique Toward Students Reading Comprehension At The Third Semester Students At English Study Program Of Muhammadiyah University Of Bengkulu. The design of this research was Quasi experimental research. The subject of this research is students at the third semester of English study program. They were A class  that consist of 20 students and D class that consist of 20 students. In collecting data, the researcher used some steps; firstly the students were given a pre-test before the researcher applied Question Generating Technique. Then, the researcher did the treatment for three meetings to the experimental class, after that the researcher did post test to both classes. The last, the researcher analyzed the result of reading test by using criteria for the assessment. The final step was the researcher discussed and concluded the data. The result of this research showed that the tobt was  4,880. Whereas, the degree of freedom of post-test is 68, means that the ttable was 2.021. Based on the scores gained, it shows that tobt is higher than ttable (9,911>4,880. There is a significant difference between the post-test mean of the experimental and control class. The result also showed that the students’ comprehension in reading was significantly. In conclusion, the Question Generating Technique had been successfully gave positive effect to the students’ reading comprehension particularly in reading subject in English study program of University Muhammadiyah of Bengkulu.  Key Words : Question Generating Technique, Reading comprehension,

  5. Improving Eighth Grade Students' Reading Comprehension through the Use of the Collision Plus Arts-Integrated Program

    Science.gov (United States)

    Knight, Taneka L.

    2016-01-01

    African American and Latino students attending Title I schools in the metropolitan Atlanta area were not reading on grade level. The majority of students are low performing readers and minimally met the reading comprehension requirements. The 2015 average 8th grade reading score for these students was 246 out of 500. This applied dissertation was…

  6. A two isocenter IMRT technique with a controlled junction dose for long volume targets

    International Nuclear Information System (INIS)

    Zeng, G G; Heaton, R K; Catton, C N; Chung, P W; O'Sullivan, B; Lau, M; Parent, A; Jaffray, D A

    2007-01-01

    Most IMRT techniques have been designed to treat targets smaller than the field size of conventional linac accelerators. In order to overcome the field size restrictions in applying IMRT, we developed a two isocenter IMRT technique to treat long volume targets. The technique exploits an extended dose gradient throughout a junction region of 4-6 cm to minimize the impact of field match errors on a junction dose and manipulates the inverse planning and IMRT segments to fill in the dose gradient and achieve dose uniformity. Techniques for abutting both conventional fields with IMRT ('Static + IMRT') and IMRT fields ('IMRT + IMRT') using two separate isocenters have been developed. Five long volume sarcoma cases have been planned in Pinnacle (Philips, Madison, USA) using Elekta Synergy and Varian 2100EX linacs; two of the cases were clinically treated with this technique. Advantages were demonstrated with well-controlled junction target uniformity and tolerance to setup uncertainties. The junction target dose heterogeneity was controlled at a level of ±5%; for 3 mm setup errors at the field edges, the junction target dose changed less than 5% and the dose sparing to organs at risk (OARs) was maintained. Film measurements confirmed the treatment planning results

  7. Reducing dose calculation time for accurate iterative IMRT planning

    International Nuclear Information System (INIS)

    Siebers, Jeffrey V.; Lauterbach, Marc; Tong, Shidong; Wu Qiuwen; Mohan, Radhe

    2002-01-01

    A time-consuming component of IMRT optimization is the dose computation required in each iteration for the evaluation of the objective function. Accurate superposition/convolution (SC) and Monte Carlo (MC) dose calculations are currently considered too time-consuming for iterative IMRT dose calculation. Thus, fast, but less accurate algorithms such as pencil beam (PB) algorithms are typically used in most current IMRT systems. This paper describes two hybrid methods that utilize the speed of fast PB algorithms yet achieve the accuracy of optimizing based upon SC algorithms via the application of dose correction matrices. In one method, the ratio method, an infrequently computed voxel-by-voxel dose ratio matrix (R=D SC /D PB ) is applied for each beam to the dose distributions calculated with the PB method during the optimization. That is, D PB xR is used for the dose calculation during the optimization. The optimization proceeds until both the IMRT beam intensities and the dose correction ratio matrix converge. In the second method, the correction method, a periodically computed voxel-by-voxel correction matrix for each beam, defined to be the difference between the SC and PB dose computations, is used to correct PB dose distributions. To validate the methods, IMRT treatment plans developed with the hybrid methods are compared with those obtained when the SC algorithm is used for all optimization iterations and with those obtained when PB-based optimization is followed by SC-based optimization. In the 12 patient cases studied, no clinically significant differences exist in the final treatment plans developed with each of the dose computation methodologies. However, the number of time-consuming SC iterations is reduced from 6-32 for pure SC optimization to four or less for the ratio matrix method and five or less for the correction method. Because the PB algorithm is faster at computing dose, this reduces the inverse planning optimization time for our implementation

  8. Effect of beamlet step-size on IMRT plan quality

    International Nuclear Information System (INIS)

    Zhang Guowei; Jiang Ziping; Shepard, David; Earl, Matt; Yu, Cedric

    2005-01-01

    We have studied the degree to which beamlet step-size impacts the quality of intensity modulated radiation therapy (IMRT) treatment plans. Treatment planning for IMRT begins with the application of a grid that divides each beam's-eye-view of the target into a number of smaller beamlets (pencil beams) of radiation. The total dose is computed as a weighted sum of the dose delivered by the individual beamlets. The width of each beamlet is set to match the width of the corresponding leaf of the multileaf collimator (MLC). The length of each beamlet (beamlet step-size) is parallel to the direction of leaf travel. The beamlet step-size represents the minimum stepping distance of the leaves of the MLC and is typically predetermined by the treatment planning system. This selection imposes an artificial constraint because the leaves of the MLC and the jaws can both move continuously. Removing the constraint can potentially improve the IMRT plan quality. In this study, the optimized results were achieved using an aperture-based inverse planning technique called direct aperture optimization (DAO). We have tested the relationship between pencil beam step-size and plan quality using the American College of Radiology's IMRT test case. For this case, a series of IMRT treatment plans were produced using beamlet step-sizes of 1, 2, 5, and 10 mm. Continuous improvements were seen with each reduction in beamlet step size. The maximum dose to the planning target volume (PTV) was reduced from 134.7% to 121.5% and the mean dose to the organ at risk (OAR) was reduced from 38.5% to 28.2% as the beamlet step-size was reduced from 10 to 1 mm. The smaller pencil beam sizes also led to steeper dose gradients at the junction between the target and the critical structure with gradients of 6.0, 7.6, 8.7, and 9.1 dose%/mm achieved for beamlet step sizes of 10, 5, 2, and 1 mm, respectively

  9. Effect of Comprehensive Health Promotion Program on Quality of Life, Weight, and Physical Activity among Iranian Overweight School-age Girls

    Directory of Open Access Journals (Sweden)

    Saeedeh Jafarzadeh

    2017-04-01

    Full Text Available Background Prevalence of overweight and obesity in children and its trend in recent years has taken a worrying figure. Overweight in childhood is the most important cause of adulthood obesity. Therefore, the present study aimed to investigate the effect ofcomprehensive health program on quality of life, weight and physical activity in Iranian overweight school-age girls. Materials and Methods In this quasi-experimental study, 80 overweight girls participated in a comprehensive health program for 12 weeks in 2014. The participants were randomly selected and were assigned to intervention (n=40, and control (n=40 groups. Quality of life, weight, and physical activity scores were measured in both groups before and after the program. The data were collected by using the general quality of life questionnaire Pediatric Health-Related Quality of Life (Ped- sQL4.0 in two forms (child and parent self-report, physical activity checklist, and a Digital Stadiometer. Then in the intervention group, comprehensive health program including three stages assessment, supportive planning and evaluation was administered for three months. Data were analyzed by the SPSS version 22.0 software. Results Theresults showed no significant differences between the two groups in terms of demographic characteristics, weight, physical activity, and quality of life, before intervention (P>0.05. However, statistically significant difference was found between the two groups regarding changes in body weight, body mass index (BMI, physical activity scores, and quality of life, before and after intervention (P

  10. IMRT QA: Selecting gamma criteria based on error detection sensitivity

    Energy Technology Data Exchange (ETDEWEB)

    Steers, Jennifer M. [Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California 90048 and Physics and Biology in Medicine IDP, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California 90095 (United States); Fraass, Benedick A., E-mail: benedick.fraass@cshs.org [Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California 90048 (United States)

    2016-04-15

    Purpose: The gamma comparison is widely used to evaluate the agreement between measurements and treatment planning system calculations in patient-specific intensity modulated radiation therapy (IMRT) quality assurance (QA). However, recent publications have raised concerns about the lack of sensitivity when employing commonly used gamma criteria. Understanding the actual sensitivity of a wide range of different gamma criteria may allow the definition of more meaningful gamma criteria and tolerance limits in IMRT QA. We present a method that allows the quantitative determination of gamma criteria sensitivity to induced errors which can be applied to any unique combination of device, delivery technique, and software utilized in a specific clinic. Methods: A total of 21 DMLC IMRT QA measurements (ArcCHECK®, Sun Nuclear) were compared to QA plan calculations with induced errors. Three scenarios were studied: MU errors, multi-leaf collimator (MLC) errors, and the sensitivity of the gamma comparison to changes in penumbra width. Gamma comparisons were performed between measurements and error-induced calculations using a wide range of gamma criteria, resulting in a total of over 20 000 gamma comparisons. Gamma passing rates for each error class and case were graphed against error magnitude to create error curves in order to represent the range of missed errors in routine IMRT QA using 36 different gamma criteria. Results: This study demonstrates that systematic errors and case-specific errors can be detected by the error curve analysis. Depending on the location of the error curve peak (e.g., not centered about zero), 3%/3 mm threshold = 10% at 90% pixels passing may miss errors as large as 15% MU errors and ±1 cm random MLC errors for some cases. As the dose threshold parameter was increased for a given %Diff/distance-to-agreement (DTA) setting, error sensitivity was increased by up to a factor of two for select cases. This increased sensitivity with increasing dose

  11. A feasibility study of using conventional jaws to deliver complex IMRT plans for head and neck cancer

    International Nuclear Information System (INIS)

    Mu, G; Xia, P

    2009-01-01

    Previous studies have demonstrated that simple intensity-modulated radiotherapy (IMRT) plans can be produced with a series of rectangular segments formed by conventional jaws. This study investigates whether complex IMRT plans for head and neck cancer can be delivered with the conventional jaws efficiently. Six nasopharyngeal cancer patients, previously treated with multi-leaf collimator (MLC)-IMRT plans, were re-planned using conventional jaw delivery options. All IMRT plans were subject to the plan acceptance criteria of the RTOG-0225 protocol. For a selected patient, the maximum number of segments varied from five to nine per beam, and was tested for both jaws-only IMRT (JO-IMRT) plans and MLC-IMRT plans. Subsequently, JO-IMRT plans and MLC-IMRT on the same treatment planning system were attempted for all patients with identical beams. The dose distribution, dose volume histograms (DVH), the conformal index (COIN), the uniformity index and delivery efficiency were compared between the MLC-IMRT and JO-IMRT plans. All JO-IMRT plans met the RTOG-0225 criteria for tumor coverage and sensitive structures sparing. The corresponding MLC-IMRT and JO-IMRT plans show comparable conformality and uniformity, with average COINs of the planning gross tumor volume(pGTV) 37.7% ± 18.7% versus 37.9% ± 18.1%, and the average uniformity index 82.8% ± 2.5% versus 83.6% ± 3.1%, respectively. The average monitor unit for JO-IMRT plans was about twice that of MLC-IMRT plans. In conclusion, conventional jaws can be used solely to deliver complex IMRT plans for patients with nasopharyngeal cancer yet still within a practical delivery time.

  12. Parotid-sparing intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma: Preserved parotid function after IMRT on quantitative salivary scintigraphy, and comparison with historical data after conventional radiotherapy

    International Nuclear Information System (INIS)

    Hsiung, C.-Y.; Ting, H.-M.; Huang, H.-Y.; Lee, C.-H.; Huang, E.-Y.; Hsu, H.-C.

    2006-01-01

    Purpose: To evaluate the parotid function after parotid-sparing intensity-modulated radiotherapy (IMRT) in patients with nasopharyngeal carcinoma (NPC). Methods and Materials: From March 2003 to May 2004, 16 patients with nonmetastatic NPC underwent parotid-sparing IMRT. Eight of these patients had Stage III or IV NPC based on the 1997 American Joint Committee on Cancer staging system. The post-IMRT parotid function was evaluated by quantitative salivary scintigraphy and represented by the maximal excretion ratio (MER) of the parotid gland after sialogogue stimulation. The parotid function of 16 NPC patients who were previously treated with conventional radiotherapy was reviewed as the historical control. Results: In the parotid-sparing IMRT group, all 16 patients were alive and without cancer at the end of follow-up period (median, 24.2 months). The mean parotid MER was 53.5% before radiotherapy, 10.7% at 1 month post-IMRT, and 23.3% at 9 months post-IMRT. In the conventional radiotherapy group, the mean parotid MER was 0.6% at 6 to 12 months postradiotherapy. The difference was statistically significant (23.3% vs. 0.6%, p < 0.001, Mann-Whitney test). In the IMRT group, the mean parotid doses ranged from 33.2 Gy to 58.8 Gy (average, 43.9 Gy). The correlation between the mean parotid dose and the percentage decrease of parotid MER at 9 months post-IMRT (dMER) was statically significant (p = 0.008, Pearson correlation). Conclusions: Although the mean parotid doses are relatively high, the significant preservation of parotid function is achieved with IMRT for NPC patients. The significant correlation between mean parotid dose and parotid dMER demonstrates the dose-function relationship of the parotid gland

  13. Head-and-neck IMRT treatments assessed with a Monte Carlo dose calculation engine

    International Nuclear Information System (INIS)

    Seco, J; Adams, E; Bidmead, M; Partridge, M; Verhaegen, F

    2005-01-01

    IMRT is frequently used in the head-and-neck region, which contains materials of widely differing densities (soft tissue, bone, air-cavities). Conventional methods of dose computation for these complex, inhomogeneous IMRT cases involve significant approximations. In the present work, a methodology for the development, commissioning and implementation of a Monte Carlo (MC) dose calculation engine for intensity modulated radiotherapy (MC-IMRT) is proposed which can be used by radiotherapy centres interested in developing MC-IMRT capabilities for research or clinical evaluations. The method proposes three levels for developing, commissioning and maintaining a MC-IMRT dose calculation engine: (a) development of a MC model of the linear accelerator, (b) validation of MC model for IMRT and (c) periodic quality assurance (QA) of the MC-IMRT system. The first step, level (a), in developing an MC-IMRT system is to build a model of the linac that correctly predicts standard open field measurements for percentage depth-dose and off-axis ratios. Validation of MC-IMRT, level (b), can be performed in a rando phantom and in a homogeneous water equivalent phantom. Ultimately, periodic quality assurance of the MC-IMRT system is needed to verify the MC-IMRT dose calculation system, level (c). Once the MC-IMRT dose calculation system is commissioned it can be applied to more complex clinical IMRT treatments. The MC-IMRT system implemented at the Royal Marsden Hospital was used for IMRT calculations for a patient undergoing treatment for primary disease with nodal involvement in the head-and-neck region (primary treated to 65 Gy and nodes to 54 Gy), while sparing the spinal cord, brain stem and parotid glands. Preliminary MC results predict a decrease of approximately 1-2 Gy in the median dose of both the primary tumour and nodal volumes (compared with both pencil beam and collapsed cone). This is possibly due to the large air-cavity (the larynx of the patient) situated in the centre

  14. Effect of a comprehensive health education program on pre-hospital delay intentions in high-risk stroke population and caregivers.

    Science.gov (United States)

    Yang, Li; Zhao, Qiuli; Zhu, Xuemei; Shen, Xiaoying; Zhu, Yulan; Yang, Liu; Gao, Wei; Li, Minghui

    2017-08-01

    Many factors influence pre-hospital delays in the event of stroke. This study aimed to develop and evaluate a comprehensive educational program for decreasing pre-hospital delays in high-risk stroke population. We enrolled 220 high-risk stroke population and caregivers from six urban communities in Harbin from May 2013 to May 2015, and randomly divided them into intervention and control groups. We implemented a comprehensive educational program (intervention group), comprising public lectures, instructional brochures, case videos, simulations, and role-playing from May 2013 to May 2015. We delivered conventional oral education in the control group. We compared stroke pre-hospital delay behavioral intention (SPDBI), pre-hospital stroke symptom coping test (PSSCT), and stroke pre-symptoms alert test (SPSAT) results between the groups before and 6, 12, and 18 months after health intervention. There were significant differences between before and after intervention (P educational program was significantly effective in decreasing SPDBI, improving knowledge, enhancing stroke pre-symptoms alert, and reducing the possibility of pre-hospital delays.

  15. Retention time prediction in temperature-​programmed, comprehensive two-​dimensional gas chromatography: Modeling and error assessment

    NARCIS (Netherlands)

    Barcaru, A.; Anroedh-Sampat, A.; Janssen, H.-G.; Vivó-Truyols, G.

    2014-01-01

    In this paper we present a model relating exptl. factors (column lengths, diams. and thickness, modulation times, pressures and temp. programs) with retention times. Unfortunately, an anal. soln. to calc. the retention in temp. programmed GC×GC is impossible, making thus necessary to perform a

  16. "I Want My Robot to Look for Food": Comparing Kindergartner's Programming Comprehension Using Tangible, Graphic, and Hybrid User Interfaces

    Science.gov (United States)

    Strawhacker, Amanda; Bers, Marina U.

    2015-01-01

    In recent years, educational robotics has become an increasingly popular research area. However, limited studies have focused on differentiated learning outcomes based on type of programming interface. This study aims to explore how successfully young children master foundational programming concepts based on the robotics user interface (tangible,…

  17. Investigation of effective decision criteria for multiobjective optimization in IMRT.

    Science.gov (United States)

    Holdsworth, Clay; Stewart, Robert D; Kim, Minsun; Liao, Jay; Phillips, Mark H

    2011-06-01

    To investigate how using different sets of decision criteria impacts the quality of intensity modulated radiation therapy (IMRT) plans obtained by multiobjective optimization. A multiobjective optimization evolutionary algorithm (MOEA) was used to produce sets of IMRT plans. The MOEA consisted of two interacting algorithms: (i) a deterministic inverse planning optimization of beamlet intensities that minimizes a weighted sum of quadratic penalty objectives to generate IMRT plans and (ii) an evolutionary algorithm that selects the superior IMRT plans using decision criteria and uses those plans to determine the new weights and penalty objectives of each new plan. Plans resulting from the deterministic algorithm were evaluated by the evolutionary algorithm using a set of decision criteria for both targets and organs at risk (OARs). Decision criteria used included variation in the target dose distribution, mean dose, maximum dose, generalized equivalent uniform dose (gEUD), an equivalent uniform dose (EUD(alpha,beta) formula derived from the linear-quadratic survival model, and points on dose volume histograms (DVHs). In order to quantatively compare results from trials using different decision criteria, a neutral set of comparison metrics was used. For each set of decision criteria investigated, IMRT plans were calculated for four different cases: two simple prostate cases, one complex prostate Case, and one complex head and neck Case. When smaller numbers of decision criteria, more descriptive decision criteria, or less anti-correlated decision criteria were used to characterize plan quality during multiobjective optimization, dose to OARs and target dose variation were reduced in the final population of plans. Mean OAR dose and gEUD (a = 4) decision criteria were comparable. Using maximum dose decision criteria for OARs near targets resulted in inferior populations that focused solely on low target variance at the expense of high OAR dose. Target dose range, (D

  18. Soft-Rt: software for IMRT simulations based on MCNPX

    International Nuclear Information System (INIS)

    Ferreira F, T. C.; Campos, T.

    2015-10-01

    Intensity Modulated Radiation Therapy (IMRT) is an advanced treatment technique, widely used in external radiotherapy. This paper presents the Soft-Rt which allows the simulation of an entire IMRT treatment protocol. The Soft-Rt performs a full three-dimensional rendering of a set of patient images, including the definitions of region of interest with organs in risk, and the target tumor volume and margins (PTV). Thus, a more accurate analysis and planning can be performed, taking into account the features and orientation of the radiation beams. The exposed tissues as well as the amount of absorbed dose is depicted in healthy and/or cancerous tissues. As conclusion, Soft-Rt can predict dose on the PTV accurately, preserving the surrounding healthy tissues. Soft-Rt is coupled with SISCODES code. The SISCODES code is firstly applied to segment the set of CT or MRI patient images in distinct tissues pointing out its respective density and chemical compositions. Later, the voxel model is export to the Soft-Rt IMRT planning module in which a full treatment planning is created. All geometrical parameters are sent to the general purpose Monte Carlo transport code - MCNP - to simulate the interaction of each incident beam towards to the PTV avoiding organs in risk. The normalized dose results are exported to the Soft-Rt out-module, in which the three-dimensional model visualization is shown in a transparent glass procedure adopting gray scale for the dependence on the mass density of the correlated tissue; while, a color scale to depict dose values in a superimpose protocol. (Author)

  19. Influence of MLC leaf width on biologically adapted IMRT plans

    Energy Technology Data Exchange (ETDEWEB)

    Roedal, Jan; Soevik, Aaste; Malinen, Eirik (Dept. of Medical Physics, The Norwegian Radium Hospital, Oslo Univ. Hospital, Oslo (Norway)), E-mail: jan.rodal@radiumhospitalet.no

    2010-10-15

    Introduction. High resolution beam delivery may be required for optimal biology-guided adaptive therapy. In this work, we have studied the influence of multi leaf collimator (MLC) leaf widths on the treatment outcome following adapted IMRT of a hypoxic tumour. Material and methods. Dynamic contrast enhanced MR images of a dog with a spontaneous tumour in the nasal region were used to create a tentative hypoxia map following a previously published procedure. The hypoxia map was used as a basis for generating compartmental gross tumour volumes, which were utilised as planning structures in biologically adapted IMRT. Three different MLCs were employed in inverse treatment planning, with leaf widths of 2.5 mm, 5 mm and 10 mm. The number of treatment beams and the degree of step-and-shoot beam modulation were varied. By optimising the tumour control probability (TCP) function, optimal compartmental doses were derived and used as target doses in the inverse planning. Resulting IMRT dose distributions and dose volume histograms (DVHs) were exported and analysed, giving estimates of TCP and compartmental equivalent uniform doses (EUDs). The impact of patient setup accuracy was simulated. Results. The MLC with the smallest leaf width (2.5 mm) consistently gave the highest TCPs and compartmental EUDs, assuming no setup error. The difference between this MLC and the 5 mm MLC was rather small, while the MLC with 10 mm leaf width gave considerably lower TCPs. When including random and systematic setup errors, errors larger than 5 mm gave only small differences between the MLC types. For setup errors larger than 7 mm no differences were found between non-uniform and uniform dose distributions. Conclusions. Biologically adapted radiotherapy may require MLCs with leaf widths smaller than 10 mm. However, for a high probability of cure it is crucial that accurate patient setup is ensured.

  20. A new plan quality index for nasopharyngeal cancer SIB IMRT.

    Science.gov (United States)

    Jin, X; Yi, J; Zhou, Y; Yan, H; Han, C; Xie, C

    2014-02-01

    A new plan quality index integrating dosimetric and radiobiological indices was proposed to facilitate the evaluation and comparison of simultaneous integrated boost (SIB) intensity modulated radiotherapy (IMRT) plans for nasopharyngeal cancer (NPC) patients. Ten NPC patients treated by SIB-IMRT were enrolled in the study. Custom software was developed to read dose-volume histogram (DVH) curves from the treatment planning system (TPS). A plan filtering matrix was introduced to filter plans that fail to satisfy treatment protocol. Target plan quality indices and organ at risk (OAR) plan quality indices were calculated for qualified plans. A unique composite plan quality index (CPQI) was proposed based on the relative weight of these indices to evaluate and compare competing plans. Plan ranking results were compared with detailed statistical analysis, radiation oncology quality system (ROQS) scoring results and physician's evaluation results to verify the accuracy of this new plan quality index. The average CPQI values for plans with OAR priority of low, normal, high, and PTV only were 0.22 ± 0.08, 0.49 ± 0.077, 0.71 ± 0.062, and -0.21 ± 0.16, respectively. There were significant differences among these plan quality indices (One-way ANOVA test, p plans were selected. Plan filtering matrix was able to speed up the plan evaluation process. The new matrix plan quality index CPQI showed good consistence with physician ranking results. It is a promising index for NPC SIB-IMRT plan evaluation. Copyright © 2013 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  1. Soft-Rt: software for IMRT simulations based on MCNPX

    Energy Technology Data Exchange (ETDEWEB)

    Ferreira F, T. C. [Centro de Desenvolvimento da Tecnologia Nuclear / CNEN, Av. Pte. Antonio Carlos 6627, 31270-901 Belo Horizonte, Minas Gerais (Brazil); Campos, T., E-mail: tcff01@gmail.com [Universidade Federal de Minas Gerais, Departamento de Engenharia Nuclear, Programa de Pos Graduacao em Ciencias e Tecnicas Nucleares, Av. Pte. Antonio Carlos 6627, 31270-901 Belo Horizonte, Minas Gerais (Brazil)

    2015-10-15

    Intensity Modulated Radiation Therapy (IMRT) is an advanced treatment technique, widely used in external radiotherapy. This paper presents the Soft-Rt which allows the simulation of an entire IMRT treatment protocol. The Soft-Rt performs a full three-dimensional rendering of a set of patient images, including the definitions of region of interest with organs in risk, and the target tumor volume and margins (PTV). Thus, a more accurate analysis and planning can be performed, taking into account the features and orientation of the radiation beams. The exposed tissues as well as the amount of absorbed dose is depicted in healthy and/or cancerous tissues. As conclusion, Soft-Rt can predict dose on the PTV accurately, preserving the surrounding healthy tissues. Soft-Rt is coupled with SISCODES code. The SISCODES code is firstly applied to segment the set of CT or MRI patient images in distinct tissues pointing out its respective density and chemical compositions. Later, the voxel model is export to the Soft-Rt IMRT planning module in which a full treatment planning is created. All geometrical parameters are sent to the general purpose Monte Carlo transport code - MCNP - to simulate the interaction of each incident beam towards to the PTV avoiding organs in risk. The normalized dose results are exported to the Soft-Rt out-module, in which the three-dimensional model visualization is shown in a transparent glass procedure adopting gray scale for the dependence on the mass density of the correlated tissue; while, a color scale to depict dose values in a superimpose protocol. (Author)

  2. IMRT treatment of anal cancer with a scrotal shield

    International Nuclear Information System (INIS)

    Hood, Rodney C.; Wu, Q. Jackie; McMahon, Ryan; Czito, Brian; Willett, Christopher

    2012-01-01

    The risk of sterility in males undergoing radiotherapy in the pelvic region indicates the use of a shielding device, which offers protection to the testes for patients wishing to maintain fertility. The use of such devices in the realm of intensity-modulated radiotherapy (IMRT) in the pelvic region can pose many obstacles during simulation, treatment planning, and delivery of radiotherapy. This work focuses on the development and execution of an IMRT plan for the treatment of anal cancer using a scrotal shielding device on a clinical patient. An IMRT plan was developed using Eclipse treatment planning system (Varian Medical Systems, Palo Alto, CA), using a wide array of gantry angles as well as fixed jaw and fluence editing techniques. When possible, the entire target volume was encompassed by the treatment field. When the beam was incident on the scrotal shield, the jaw was fixed to avoid the device and the collimator rotation optimized to irradiate as much of the target as possible. This technique maximizes genital sparing and allows minimal irradiation of the gonads. When this fixed-jaw technique was found to compromise adequate coverage of the target, manual fluence editing techniques were used to avoid the shielding device. Special procedures for simulation, imaging, and treatment verification were also developed. In vivo dosimetry was used to verify and ensure acceptable dose to the gonads. The combination of these techniques resulted in a highly conformal plan that spares organs and risk and avoids the genitals as well as entrance of primary radiation onto the shielding device.

  3. IMRT treatment of anal cancer with a scrotal shield.

    Science.gov (United States)

    Hood, Rodney C; Wu, Q Jackie; McMahon, Ryan; Czito, Brian; Willett, Christopher

    2012-01-01

    The risk of sterility in males undergoing radiotherapy in the pelvic region indicates the use of a shielding device, which offers protection to the testes for patients wishing to maintain fertility. The use of such devices in the realm of intensity-modulated radiotherapy (IMRT) in the pelvic region can pose many obstacles during simulation, treatment planning, and delivery of radiotherapy. This work focuses on the development and execution of an IMRT plan for the treatment of anal cancer using a scrotal shielding device on a clinical patient. An IMRT plan was developed using Eclipse treatment planning system (Varian Medical Systems, Palo Alto, CA), using a wide array of gantry angles as well as fixed jaw and fluence editing techniques. When possible, the entire target volume was encompassed by the treatment field. When the beam was incident on the scrotal shield, the jaw was fixed to avoid the device and the collimator rotation optimized to irradiate as much of the target as possible. This technique maximizes genital sparing and allows minimal irradiation of the gonads. When this fixed-jaw technique was found to compromise adequate coverage of the target, manual fluence editing techniques were used to avoid the shielding device. Special procedures for simulation, imaging, and treatment verification were also developed. In vivo dosimetry was used to verify and ensure acceptable dose to the gonads. The combination of these techniques resulted in a highly conformal plan that spares organs and risk and avoids the genitals as well as entrance of primary radiation onto the shielding device. Copyright © 2012 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

  4. Verification of eye lens dose in IMRT by MOSFET measurement.

    Science.gov (United States)

    Wang, Xuetao; Li, Guangjun; Zhao, Jianling; Song, Ying; Xiao, Jianghong; Bai, Sen

    2018-04-17

    The eye lens is recognized as one of the most radiosensitive structures in the human body. The widespread use of intensity-modulated radiotherapy (IMRT) complicates dose verification and necessitates high standards of dose computation. The purpose of this work was to assess the computed dose accuracy of eye lens through measurements using a metal-oxide-semiconductor field-effect transistor (MOSFET) dosimetry system. Sixteen clinical IMRT plans of head and neck patients were copied to an anthropomorphic head phantom. Measurements were performed using the MOSFET dosimetry system based on the head phantom. Two MOSFET detectors were imbedded in the eyes of the head phantom as the left and the right lens, covered by approximately 5-mm-thick paraffin wax. The measurement results were compared with the calculated values with a dose grid size of 1 mm. Sixteen IMRT plans were delivered, and 32 measured lens doses were obtained for analysis. The MOSFET dosimetry system can be used to verify the lens dose, and our measurements showed that the treatment planning system used in our clinic can provide adequate dose assessment in eye lenses. The average discrepancy between measurement and calculation was 6.7 ± 3.4%, and the largest discrepancy was 14.3%, which met the acceptability criterion set by the American Association of Physicists in Medicine Task Group 53 for external beam calculation for multileaf collimator-shaped fields in buildup regions. Copyright © 2018 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

  5. Direct aperture optimization for IMRT using Monte Carlo generated beamlets

    International Nuclear Information System (INIS)

    Bergman, Alanah M.; Bush, Karl; Milette, Marie-Pierre; Popescu, I. Antoniu; Otto, Karl; Duzenli, Cheryl

    2006-01-01

    This work introduces an EGSnrc-based Monte Carlo (MC) beamlet does distribution matrix into a direct aperture optimization (DAO) algorithm for IMRT inverse planning. The technique is referred to as Monte Carlo-direct aperture optimization (MC-DAO). The goal is to assess if the combination of accurate Monte Carlo tissue inhomogeneity modeling and DAO inverse planning will improve the dose accuracy and treatment efficiency for treatment planning. Several authors have shown that the presence of small fields and/or inhomogeneous materials in IMRT treatment fields can cause dose calculation errors for algorithms that are unable to accurately model electronic disequilibrium. This issue may also affect the IMRT optimization process because the dose calculation algorithm may not properly model difficult geometries such as targets close to low-density regions (lung, air etc.). A clinical linear accelerator head is simulated using BEAMnrc (NRC, Canada). A novel in-house algorithm subdivides the resulting phase space into 2.5x5.0 mm 2 beamlets. Each beamlet is projected onto a patient-specific phantom. The beamlet dose contribution to each voxel in a structure-of-interest is calculated using DOSXYZnrc. The multileaf collimator (MLC) leaf positions are linked to the location of the beamlet does distributions. The MLC shapes are optimized using direct aperture optimization (DAO). A final Monte Carlo calculation with MLC modeling is used to compute the final dose distribution. Monte Carlo simulation can generate accurate beamlet dose distributions for traditionally difficult-to-calculate geometries, particularly for small fields crossing regions of tissue inhomogeneity. The introduction of DAO results in an additional improvement by increasing the treatment delivery efficiency. For the examples presented in this paper the reduction in the total number of monitor units to deliver is ∼33% compared to fluence-based optimization methods

  6. Cost analysis of a school-based comprehensive malaria program in primary schools in Sikasso region, Mali.

    Science.gov (United States)

    Maccario, Roberta; Rouhani, Saba; Drake, Tom; Nagy, Annie; Bamadio, Modibo; Diarra, Seybou; Djanken, Souleymane; Roschnik, Natalie; Clarke, Siân E; Sacko, Moussa; Brooker, Simon; Thuilliez, Josselin

    2017-06-12

    The expansion of malaria prevention and control to school-aged children is receiving increasing attention, but there are still limited data on the costs of intervention. This paper analyses the costs of a comprehensive school-based intervention strategy, delivered by teachers, that included participatory malaria educational activities, distribution of long lasting insecticide-treated nets (LLIN), and Intermittent Parasite Clearance in schools (IPCs) in southern Mali. Costs were collected alongside a randomised controlled trial conducted in 80 primary schools in Sikasso Region in Mali in 2010-2012. Cost data were compiled between November 2011 and March 2012 for the 40 intervention schools (6413 children). A provider perspective was adopted. Using an ingredients approach, costs were classified by cost category and by activity. Total costs and cost per child were estimated for the actual intervention, as well as for a simpler version of the programme more suited for scale-up by the government. Univariate sensitivity analysis was performed. The economic cost of the comprehensive intervention was estimated to $10.38 per child (financial cost $8.41) with malaria education, LLIN distribution and IPCs costing $2.13 (20.5%), $5.53 (53.3%) and $2.72 (26.2%) per child respectively. Human resources were found to be the key cost driver, and training costs were the greatest contributor to overall programme costs. Sensitivity analysis showed that an adapted intervention delivering one LLIN instead of two would lower the economic cost to $8.66 per child; and that excluding LLIN distribution in schools altogether, for example in settings where malaria control already includes universal distribution of LLINs at community-level, would reduce costs to $4.89 per child. A comprehensive school-based control strategy may be a feasible and affordable way to address the burden of malaria among schoolchildren in the Sahel.

  7. Cost analysis of a school-based comprehensive malaria program in primary schools in Sikasso region, Mali

    Directory of Open Access Journals (Sweden)

    Roberta Maccario

    2017-06-01

    Full Text Available Abstract Background The expansion of malaria prevention and control to school-aged children is receiving increasing attention, but there are still limited data on the costs of intervention. This paper analyses the costs of a comprehensive school-based intervention strategy, delivered by teachers, that included participatory malaria educational activities, distribution of long lasting insecticide-treated nets (LLIN, and Intermittent Parasite Clearance in schools (IPCs in southern Mali. Methods Costs were collected alongside a randomised controlled trial conducted in 80 primary schools in Sikasso Region in Mali in 2010-2012. Cost data were compiled between November 2011 and March 2012 for the 40 intervention schools (6413 children. A provider perspective was adopted. Using an ingredients approach, costs were classified by cost category and by activity. Total costs and cost per child were estimated for the actual intervention, as well as for a simpler version of the programme more suited for scale-up by the government. Univariate sensitivity analysis was performed. Results The economic cost of the comprehensive intervention was estimated to $10.38 per child (financial cost $8.41 with malaria education, LLIN distribution and IPCs costing $2.13 (20.5%, $5.53 (53.3% and $2.72 (26.2% per child respectively. Human resources were found to be the key cost driver, and training costs were the greatest contributor to overall programme costs. Sensitivity analysis showed that an adapted intervention delivering one LLIN instead of two would lower the economic cost to $8.66 per child; and that excluding LLIN distribution in schools altogether, for example in settings where malaria control already includes universal distribution of LLINs at community-level, would reduce costs to $4.89 per child. Conclusions A comprehensive school-based control strategy may be a feasible and affordable way to address the burden of malaria among schoolchildren in the Sahel.

  8. Six years of experience in the planning and verification of the IMRT dynamics with portal dosimetry

    International Nuclear Information System (INIS)

    Molina Lopez, M. Y.; Pardo Perez, E.; Ruiz Maqueda, S.; Castro Novais, J.; Diaz Gavela, A. A.

    2013-01-01

    The objective of this study is the make a review of the method of verification of the IMRT throughout the 6 years of functioning of the service of-radiophysics and radiology protection, analyzing the parameters of each field evaluation to the 718 made IMRT during this period. (Author)

  9. Radiotherapy through intensity modulation (IMRT). A new modality in the treatment of head and neck cancer

    International Nuclear Information System (INIS)

    Besa de C, Pelayo; Venencia M, Daniel

    2006-01-01

    Objective: To describe the treatment and evaluate the advantages of IMRT in the treatment of head and neck cancer. Material and methods: Four years ago, at the Cancer Center of the Pontificia Universidad Catolica, the IMRT technique for the treatment of head and neck tumors was implemented. The IMRT technique is based on modifying the intensity of the radiation beam through a multisheet collimator in order to produce a more exact distribution in the radiation doses. The results are evaluated with dose/ volume histograms. The distributions of doses and toxicity for tridimensional con formed therapy (CRT-3D) and IMRT are compared. Results: The distribution of the dose in the dose/volume histograms showed a better coverage of the white volume (PTV), with IMRT. The doses received by the organs under risk: salivary glands, eyes, ears and brain diminish with IMRT. The spinal marrow is protected with IMRT without dividing the treatment area, preventing points with lower dosage that could reduce control of the tumor. Conclusions: IMRT achieves a better conformation of the dose obtaining a better coverage of the tumor and higher protection of the organs under risk

  10. Prostate Dose Escalation by a Innovative Inverse Planning-Driven IMRT

    National Research Council Canada - National Science Library

    Xing, Lei

    2008-01-01

    ...) Developed a voxel-specific penalty scheme for TRV-based inverse planning; (iv) Established a cine-EPID image retrospective dose reconstruction in IMRT dose delivery for adaptive planning and IMRT dose verification. These works are both timely and important and should lead to widespread impact on prostate cancer management.

  11. Poster - Thur Eve - 29: Detecting changes in IMRT QA using statistical process control.

    Science.gov (United States)

    Drever, L; Salomons, G

    2012-07-01

    Statistical process control (SPC) methods were used to analyze 239 measurement based individual IMRT QA events. The selected IMRT QA events were all head and neck (H&N) cases with 70Gy in 35 fractions, and all prostate cases with 76Gy in 38 fractions planned between March 2009 and 2012. The results were used to determine if the tolerance limits currently being used for IMRT QA were able to indicate if the process was under control. The SPC calculations were repeated for IMRT QA of the same type of cases that were planned after the treatment planning system was upgraded from Eclipse version 8.1.18 to version 10.0.39. The initial tolerance limits were found to be acceptable for two of the three metrics tested prior to the upgrade. After the upgrade to the treatment planning system the SPC analysis found that the a priori limits were no longer capable of indicating control for 2 of the 3 metrics analyzed. The changes in the IMRT QA results were clearly identified using SPC, indicating that it is a useful tool for finding changes in the IMRT QA process. Routine application of SPC to IMRT QA results would help to distinguish unintentional trends and changes from the random variation in the IMRT QA results for individual plans. © 2012 American Association of Physicists in Medicine.

  12. Validation of the implementation of IMRT with three dosimetric methods of independent verification

    International Nuclear Information System (INIS)

    Tortosa Oliver, R. A.; Chinillach ferrando, N.; Alonso Arrizabalaga, S.; Campayo Esteban, J. M.; Morales Marco, J. C.; Soler Catalan, P.; Andreu Martinez, F. J.

    2013-01-01

    The TG119 is a simple and clear framework to verify the implementation of IMRT technique in a radiotherapy service. Verifications of this document recommended tests conducted with the three dosimetric methods listed above, allow to affirm that our Center is within the margins of tolerance considered suitable in the TG119 for the clinical implementation of IMRT. (Author)

  13. GPU-Monte Carlo based fast IMRT plan optimization

    Directory of Open Access Journals (Sweden)

    Yongbao Li

    2014-03-01

    Full Text Available Purpose: Intensity-modulated radiation treatment (IMRT plan optimization needs pre-calculated beamlet dose distribution. Pencil-beam or superposition/convolution type algorithms are typically used because of high computation speed. However, inaccurate beamlet dose distributions, particularly in cases with high levels of inhomogeneity, may mislead optimization, hindering the resulting plan quality. It is desire to use Monte Carlo (MC methods for beamlet dose calculations. Yet, the long computational time from repeated dose calculations for a number of beamlets prevents this application. It is our objective to integrate a GPU-based MC dose engine in lung IMRT optimization using a novel two-steps workflow.Methods: A GPU-based MC code gDPM is used. Each particle is tagged with an index of a beamlet where the source particle is from. Deposit dose are stored separately for beamlets based on the index. Due to limited GPU memory size, a pyramid space is allocated for each beamlet, and dose outside the space is neglected. A two-steps optimization workflow is proposed for fast MC-based optimization. At first step, a rough dose calculation is conducted with only a few number of particle per beamlet. Plan optimization is followed to get an approximated fluence map. In the second step, more accurate beamlet doses are calculated, where sampled number of particles for a beamlet is proportional to the intensity determined previously. A second-round optimization is conducted, yielding the final result.Results: For a lung case with 5317 beamlets, 105 particles per beamlet in the first round, and 108 particles per beam in the second round are enough to get a good plan quality. The total simulation time is 96.4 sec.Conclusion: A fast GPU-based MC dose calculation method along with a novel two-step optimization workflow are developed. The high efficiency allows the use of MC for IMRT optimizations.--------------------------------Cite this article as: Li Y, Tian Z

  14. Monte Carlo investigation of collapsed versus rotated IMRT plan verification.

    Science.gov (United States)

    Conneely, Elaine; Alexander, Andrew; Ruo, Russell; Chung, Eunah; Seuntjens, Jan; Foley, Mark J

    2014-05-08

    IMRT QA requires, among other tests, a time-consuming process of measuring the absorbed dose, at least to a point, in a high-dose, low-dose-gradient region. Some clinics use a technique of measuring this dose with all beams delivered at a single gantry angle (collapsed delivery), as opposed to the beams delivered at the planned gantry angle (rotated delivery). We examined, established, and optimized Monte Carlo simulations of the dosimetry for IMRT verification of treatment plans for these two different delivery modes (collapsed versus rotated). The results of the simulations were compared to the treatment planning system dose calculations for the two delivery modes, as well as to measurements taken. This was done in order to investigate the validity of the use of a collapsed delivery technique for IMRT QA. The BEAMnrc, DOSXYZnrc, and egs_chamber codes were utilized for the Monte Carlo simulations along with the MMCTP system. A number of different plan complexity metrics were also used in the analysis of the dose distributions in a bid to qualify why verification in a collapsed delivery may or may not be optimal for IMRT QA. Following the Alfonso et al. formalism, the kfclin,frefQclin,Q correction factor was calculated to correct the deviation of small fields from the reference conditions used for beam calibration. We report on the results obtained for a cohort of 20 patients. The plan complexity was investigated for each plan using the complexity metrics of homogeneity index, conformity index, modulation complexity score, and the fraction of beams from a particular plan that intersect the chamber when performing the QA. Rotated QA gives more consistent results than the collapsed QA technique. The kfclin,frefQclin,Qfactor deviates less from 1 for rotated QA than for collapsed QA. If the homogeneity index is less than 0.05 then the kfclin,frefQclin,Q factor does not deviate from unity by more than 1%. A value this low for the homogeneity index can only be obtained

  15. Prostate Dose Escalation by Innovative Inverse Planning-Driven IMRT

    Science.gov (United States)

    2006-11-01

    fLJ and at each step, we find the minimizer u,\\ of J’. The Euler-Lagrange equation for the regularized J’ functional is u- div ( 1 Vu )= f E S1,2A...GD, Agazaryan N, Solberg TD . 2003. The effects of tumor motion on planning and delivery of respiratory-gated IMRT. Med Phys 30:1052-1066. Jaffray DA...modulated) radiation therapy: a review. Phys Med Biol 51 :R403-425. Wink NM, McNitt-Gray MF, Solberg TD . 2005. Optimization of multi-slice helical

  16. 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

  17. 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

  18. Development of the Supported Employment, Comprehensive Cognitive Enhancement, and Social Skills program for adults on the autism spectrum: Results of initial study.

    Science.gov (United States)

    Baker-Ericzén, Mary J; Fitch, Meghan A; Kinnear, Mikaela; Jenkins, Melissa M; Twamley, Elizabeth W; Smith, Linda; Montano, Gabriel; Feder, Joshua; Crooke, Pamela J; Winner, Michelle G; Leon, Juan

    2018-01-01

    The population of adults on the autism spectrum continues to increase, and vocational outcomes are particularly poor. Longitudinal studies of adults with autism spectrum and without intellectual disability have shown consistent and persistent deficits across cognitive, social, and vocational domains, indicating a need for effective treatments of functional disabilities as each impact employment. This initial pilot study is an open trial investigation of the feasibility, acceptability, and initial estimates of outcomes for the newly developed Supported Employment, Comprehensive Cognitive Enhancement, and Social Skills intervention, a manualized "soft skills" curriculum, to enhance both cognitive and social development in adults with autism spectrum. A total of eight adults with autism spectrum, without intellectual disability (78% males), participated in the study. Results support the original hypothesis that adults with autism spectrum can improve both cognitive (i.e. executive functioning) and social cognitive (i.e. social thinking and social communication) abilities. Further Supported Employment, Comprehensive Cognitive Enhancement, and Social Skills was found to be feasible, acceptable, and highly satisfactory for participants and parents. Employment rates more than doubled post-intervention, with an increase from 22% to 56% of participants employed. Conclusion is that Supported Employment, Comprehensive Cognitive Enhancement, and Social Skills has promise as an intervention that can be easily embedded into exiting supported employment vocational training programs to improve cognitive, social, and vocational outcomes.

  19. Per-beam, planar IMRT QA passing rates do not predict clinically relevant patient dose errors

    Energy Technology Data Exchange (ETDEWEB)

    Nelms, Benjamin E.; Zhen Heming; Tome, Wolfgang A. [Canis Lupus LLC and Department of Human Oncology, University of Wisconsin, Merrimac, Wisconsin 53561 (United States); Department of Medical Physics, University of Wisconsin, Madison, Wisconsin 53705 (United States); Departments of Human Oncology, Medical Physics, and Biomedical Engineering, University of Wisconsin, Madison, Wisconsin 53792 (United States)

    2011-02-15

    Purpose: The purpose of this work is to determine the statistical correlation between per-beam, planar IMRT QA passing rates and several clinically relevant, anatomy-based dose errors for per-patient IMRT QA. The intent is to assess the predictive power of a common conventional IMRT QA performance metric, the Gamma passing rate per beam. Methods: Ninety-six unique data sets were created by inducing four types of dose errors in 24 clinical head and neck IMRT plans, each planned with 6 MV Varian 120-leaf MLC linear accelerators using a commercial treatment planning system and step-and-shoot delivery. The error-free beams/plans were used as ''simulated measurements'' (for generating the IMRT QA dose planes and the anatomy dose metrics) to compare to the corresponding data calculated by the error-induced plans. The degree of the induced errors was tuned to mimic IMRT QA passing rates that are commonly achieved using conventional methods. Results: Analysis of clinical metrics (parotid mean doses, spinal cord max and D1cc, CTV D95, and larynx mean) vs IMRT QA Gamma analysis (3%/3 mm, 2/2, 1/1) showed that in all cases, there were only weak to moderate correlations (range of Pearson's r-values: -0.295 to 0.653). Moreover, the moderate correlations actually had positive Pearson's r-values (i.e., clinically relevant metric differences increased with increasing IMRT QA passing rate), indicating that some of the largest anatomy-based dose differences occurred in the cases of high IMRT QA passing rates, which may be called ''false negatives.'' The results also show numerous instances of false positives or cases where low IMRT QA passing rates do not imply large errors in anatomy dose metrics. In none of the cases was there correlation consistent with high predictive power of planar IMRT passing rates, i.e., in none of the cases did high IMRT QA Gamma passing rates predict low errors in anatomy dose metrics or vice versa

  20. Per-beam, planar IMRT QA passing rates do not predict clinically relevant patient dose errors

    International Nuclear Information System (INIS)

    Nelms, Benjamin E.; Zhen Heming; Tome, Wolfgang A.

    2011-01-01

    Purpose: The purpose of this work is to determine the statistical correlation between per-beam, planar IMRT QA passing rates and several clinically relevant, anatomy-based dose errors for per-patient IMRT QA. The intent is to assess the predictive power of a common conventional IMRT QA performance metric, the Gamma passing rate per beam. Methods: Ninety-six unique data sets were created by inducing four types of dose errors in 24 clinical head and neck IMRT plans, each planned with 6 MV Varian 120-leaf MLC linear accelerators using a commercial treatment planning system and step-and-shoot delivery. The error-free beams/plans were used as ''simulated measurements'' (for generating the IMRT QA dose planes and the anatomy dose metrics) to compare to the corresponding data calculated by the error-induced plans. The degree of the induced errors was tuned to mimic IMRT QA passing rates that are commonly achieved using conventional methods. Results: Analysis of clinical metrics (parotid mean doses, spinal cord max and D1cc, CTV D95, and larynx mean) vs IMRT QA Gamma analysis (3%/3 mm, 2/2, 1/1) showed that in all cases, there were only weak to moderate correlations (range of Pearson's r-values: -0.295 to 0.653). Moreover, the moderate correlations actually had positive Pearson's r-values (i.e., clinically relevant metric differences increased with increasing IMRT QA passing rate), indicating that some of the largest anatomy-based dose differences occurred in the cases of high IMRT QA passing rates, which may be called ''false negatives.'' The results also show numerous instances of false positives or cases where low IMRT QA passing rates do not imply large errors in anatomy dose metrics. In none of the cases was there correlation consistent with high predictive power of planar IMRT passing rates, i.e., in none of the cases did high IMRT QA Gamma passing rates predict low errors in anatomy dose metrics or vice versa. Conclusions: There is a lack of correlation between

  1. The Effect of a Comprehensive Lifestyle Modification Program on Glycemic Control and Body Composition in Patients with Type 2 Diabetes

    Directory of Open Access Journals (Sweden)

    Ji-Soo Yoo, PhD, RN

    2007-09-01

    Conclusion: CLMP is a useful program, and its multiple approaches by nurses as the leaders and coordinators appear to have positive and synergistic roles in improving and maintaining stable glucose level and body composition in patients with type 2 diabetes.

  2. A comprehensive worksite wellness program in Austin, Texas: partnership between Steps to a Healthier Austin and Capital Metropolitan Transportation Authority.

    Science.gov (United States)

    Davis, Lynn; Loyo, Karina; Glowka, Aerie; Schwertfeger, Rick; Danielson, Lisa; Brea, Cecily; Easton, Alyssa; Griffin-Blake, Shannon

    2009-04-01

    In 2003, Steps to a Healthier Austin was funded by the Centers for Disease Control and Prevention to implement chronic disease prevention and health promotion activities. We report Steps to a Healthier Austin's partnership with Health & Lifestyles Corporate Wellness, Inc (Health & Lifestyles), to provide a worksite wellness program for Capital Metropolitan Transportation Authority (Capital Metro), Austin's local transit authority. Capital Metro employs 1,282 people. In 2003, Health & Lifestyles was hired to help promote healthier lifestyles, increase employee morale, and combat rising health care costs and absenteeism rates. Health & Lifestyles provided consultations with wellness coaches and personal trainers, a 24-hour company fitness center, personalized health assessments, and preventive screenings. The program expanded to include healthier food options, cash incentives, health newsletters, workshops, dietary counseling, smoking cessation programs, and a second fitness center. Participants in the wellness program reported improvements in physical activity, healthy food consumption, weight loss, and blood pressure. Capital Metro's total health care costs increased by progressively smaller rates from 2003 to 2006 and then decreased from 2006 to 2007. Absenteeism has decreased by approximately 25% since the implementation of the program, and the overall return on the investment was calculated to be 2.43. Since the implementation of the wellness program in 2003, Capital Metro has seen a reduction in costs associated with employee health care and absenteeism.

  3. Implementation of the results of scientific investigations in the framework of the branch task comprehensive program called Health

    Energy Technology Data Exchange (ETDEWEB)

    Kochin, I.V.; Martynenko, O.N.; Berestizhevskii, S.I.; Eshchenko, N.E.

    1987-01-01

    A draft is evaluated for a research program on health hazards and occupational diseases in coking plants in the USSR. The research program would be a component of the Health program for 1986-1990 approved by the authorities. The following structure of the research program is recommended for the coking industry in the Ukrainian SSR: research on social and socio-economic factors which influence health of coking plant employees (development of standard survey, development of questionnaires), examinations of state of health of coking plant personnel on the basis of statistical data (determining most frequent disease in coking plant personnel, calculating indices which describe disease frequency, assessment of disease structure), investigations into disease dependence on social and socio-economic factors as well as safety conditions (development of mathematical models which describe effects of various social and economic factors on general state of health and diseases of coking plant personnel, classification of personnel in coking plant considering state of health and socio-economic factors (development of computer programs and algorithms), development of computer programs for health control in coking plants and reducing economic losses caused by absence associated with diseases and accidents.

  4. Teaching communication skills in clinical settings: comparing two applications of a comprehensive program with standardized and real patients.

    Science.gov (United States)

    Carvalho, Irene P; Pais, Vanessa G; Silva, Filipa R; Martins, Raquel; Figueiredo-Braga, Margarida; Pedrosa, Raquel; Almeida, Susana S; Correia, Luís; Ribeiro-Silva, Raquel; Castro-Vale, Ivone; Teles, Ana; Mota-Cardoso, Rui

    2014-05-09

    Communication is important for the quality of clinical practice, and programs have been implemented to improve healthcare providers' communication skills. However, the consistency of programs teaching communication skills has received little attention, and debate exists about the application of acquired skills to real patients. This study inspects whether (1) results from a communication program are replicated with different samples, and (2) results with standardized patients apply to interviews with real patients. A structured, nine-month communication program was applied in two consecutive years to two different samples of healthcare professionals (25 in the first year, 20 in the second year). Results were assessed at four different points in time, each year, regarding participants' confidence levels (self-rated), basic communication skills in interviews with standardized patients, and basic communication skills in interviews with real patients. Data were analyzed using GLM Repeated-Measures procedures. Improvements were statistically significant in both years in all measures except in simulated patients' assessment of the 2008 group. Differences between the two samples were non-significant. Differences between interviews with standardized and with real patients were also non-significant. The program's positive outcomes were replicated in different samples, and acquired skills were successfully applied to real-patient interviews. This reinforces this type of program structure as a valuable training tool, with results translating into real situations. It also adds to the reliability of the assessment instruments employed, though these may need adaptation in the case of real patients.

  5. SU-E-T-29: A Web Application for GPU-Based Monte Carlo IMRT/VMAT QA with Delivered Dose Verification

    International Nuclear Information System (INIS)

    Folkerts, M; Graves, Y; Tian, Z; Gu, X; Jia, X; Jiang, S

    2014-01-01

    Purpose: To enable an existing web application for GPU-based Monte Carlo (MC) 3D dosimetry quality assurance (QA) to compute “delivered dose” from linac logfile data. Methods: We added significant features to an IMRT/VMAT QA web application which is based on existing technologies (HTML5, Python, and Django). This tool interfaces with python, c-code libraries, and command line-based GPU applications to perform a MC-based IMRT/VMAT QA. The web app automates many complicated aspects of interfacing clinical DICOM and logfile data with cutting-edge GPU software to run a MC dose calculation. The resultant web app is powerful, easy to use, and is able to re-compute both plan dose (from DICOM data) and delivered dose (from logfile data). Both dynalog and trajectorylog file formats are supported. Users upload zipped DICOM RP, CT, and RD data and set the expected statistic uncertainty for the MC dose calculation. A 3D gamma index map, 3D dose distribution, gamma histogram, dosimetric statistics, and DVH curves are displayed to the user. Additional the user may upload the delivery logfile data from the linac to compute a 'delivered dose' calculation and corresponding gamma tests. A comprehensive PDF QA report summarizing the results can also be downloaded. Results: We successfully improved a web app for a GPU-based QA tool that consists of logfile parcing, fluence map generation, CT image processing, GPU based MC dose calculation, gamma index calculation, and DVH calculation. The result is an IMRT and VMAT QA tool that conducts an independent dose calculation for a given treatment plan and delivery log file. The system takes both DICOM data and logfile data to compute plan dose and delivered dose respectively. Conclusion: We sucessfully improved a GPU-based MC QA tool to allow for logfile dose calculation. The high efficiency and accessibility will greatly facilitate IMRT and VMAT QA

  6. SU-E-T-29: A Web Application for GPU-Based Monte Carlo IMRT/VMAT QA with Delivered Dose Verification

    Energy Technology Data Exchange (ETDEWEB)

    Folkerts, M [The University of Texas Southwestern Medical Ctr, Dallas, TX (United States); University of California, San Diego, La Jolla, CA (United States); Graves, Y [University of California, San Diego, La Jolla, CA (United States); Tian, Z; Gu, X; Jia, X; Jiang, S [The University of Texas Southwestern Medical Ctr, Dallas, TX (United States)

    2014-06-01

    Purpose: To enable an existing web application for GPU-based Monte Carlo (MC) 3D dosimetry quality assurance (QA) to compute “delivered dose” from linac logfile data. Methods: We added significant features to an IMRT/VMAT QA web application which is based on existing technologies (HTML5, Python, and Django). This tool interfaces with python, c-code libraries, and command line-based GPU applications to perform a MC-based IMRT/VMAT QA. The web app automates many complicated aspects of interfacing clinical DICOM and logfile data with cutting-edge GPU software to run a MC dose calculation. The resultant web app is powerful, easy to use, and is able to re-compute both plan dose (from DICOM data) and delivered dose (from logfile data). Both dynalog and trajectorylog file formats are supported. Users upload zipped DICOM RP, CT, and RD data and set the expected statistic uncertainty for the MC dose calculation. A 3D gamma index map, 3D dose distribution, gamma histogram, dosimetric statistics, and DVH curves are displayed to the user. Additional the user may upload the delivery logfile data from the linac to compute a 'delivered dose' calculation and corresponding gamma tests. A comprehensive PDF QA report summarizing the results can also be downloaded. Results: We successfully improved a web app for a GPU-based QA tool that consists of logfile parcing, fluence map generation, CT image processing, GPU based MC dose calculation, gamma index calculation, and DVH calculation. The result is an IMRT and VMAT QA tool that conducts an independent dose calculation for a given treatment plan and delivery log file. The system takes both DICOM data and logfile data to compute plan dose and delivered dose respectively. Conclusion: We sucessfully improved a GPU-based MC QA tool to allow for logfile dose calculation. The high efficiency and accessibility will greatly facilitate IMRT and VMAT QA.

  7. Impact of a Comprehensive Workplace Hand Hygiene Program on Employer Health Care Insurance Claims and Costs, Absenteeism, and Employee Perceptions and Practices.

    Science.gov (United States)

    Arbogast, James W; Moore-Schiltz, Laura; Jarvis, William R; Harpster-Hagen, Amanda; Hughes, Jillian; Parker, Albert

    2016-06-01

    The aim of this study was to determine the efficacy of a multimodal hand hygiene intervention program in reducing health care insurance claims for hygiene preventable infections (eg, cold and influenza), absenteeism, and subjective impact on employees. A 13.5-month prospective, randomized cluster controlled trial was executed with alcohol-based hand sanitizer in strategic workplace locations and personal use (intervention group) and brief hand hygiene education (both groups). Four years of retrospective data were collected for all participants. Hygiene-preventable health care claims were significantly reduced in the intervention group by over 20% (P Employee survey data showed significant improvements in hand hygiene behavior and perception of company concern for employee well-being. Providing a comprehensive, targeted, yet simple to execute hand hygiene program significantly reduced the incidence of health care claims and increased employee workplace satisfaction.

  8. A case study of IMRT planning (Plan B) subsequent to a previously treated IMRT plan (Plan A)

    International Nuclear Information System (INIS)

    2Department of Radiation Oncology, Fraser Valley Centre, BC Cancer Agency, Surrey, British Columbia (Canada))" data-affiliation=" (Department of Medical Physics and 2Department of Radiation Oncology, Fraser Valley Centre, BC Cancer Agency, Surrey, British Columbia (Canada))" >Cao, F; 2Department of Radiation Oncology, Fraser Valley Centre, BC Cancer Agency, Surrey, British Columbia (Canada))" data-affiliation=" (Department of Medical Physics and 2Department of Radiation Oncology, Fraser Valley Centre, BC Cancer Agency, Surrey, British Columbia (Canada))" >Leong, C; 2Department of Radiation Oncology, Fraser Valley Centre, BC Cancer Agency, Surrey, British Columbia (Canada))" data-affiliation=" (Department of Medical Physics and 2Department of Radiation Oncology, Fraser Valley Centre, BC Cancer Agency, Surrey, British Columbia (Canada))" >Schroeder, J; 2Department of Radiation Oncology, Fraser Valley Centre, BC Cancer Agency, Surrey, British Columbia (Canada))" data-affiliation=" (Department of Medical Physics and 2Department of Radiation Oncology, Fraser Valley Centre, BC Cancer Agency, Surrey, British Columbia (Canada))" >Lee, B

    2014-01-01

    Background and purpose: Treatment of the contralateral neck after previous ipsilateral intensity modulated radiation therapy (IMRT) for head and neck cancer is a challenging problem. We have developed a technique that limits the cumulative dose to the spinal cord and brainstem while maximizing coverage of a planning target volume (PTV) in the contralateral neck. Our case involves a patient with right tonsil carcinoma who was given ipsilateral IMRT with 70Gy in 35 fractions (Plan A). A left neck recurrence was detected 14 months later. The patient underwent a neck dissection followed by postoperative left neck radiation to a dose of 66 Gy in 33 fractions (Plan B). Materials and Methods: The spinal cord-brainstem margin (SCBM) was defined as the spinal cord and brainstem with a 1.0 cm margin. Plan A was recalculated on the postoperative CT scan but the fluence outside of SCBM was deleted. A further modification of Plan A resulted in a base plan that was summed with Plan B to evaluate the cumulative dose received by the spinal cord and brainstem. Plan B alone was used to evaluate for coverage of the contralateral neck PTV. Results: The maximum cumulative doses to the spinal cord with 0.5cm margin and brainstem with 0.5cm margin were 51.96 Gy and 45.60 Gy respectively. For Plan B, 100% of the prescribed dose covered 95% of PTVb1. Conclusion: The use of a modified ipsilateral IMRT plan as a base plan is an effective way to limit the cumulative dose to the spinal cord and brainstem while enabling coverage of a PTV in the contralateral neck.

  9. Comparison and Analysis of Evaluation System of Child Care Program in Primary Health Care System in the East Azerbaijan Province Based on Comprehensive Evaluation Model (CIPP

    Directory of Open Access Journals (Sweden)

    Yalda Mousa Zadeh

    2015-08-01

    Full Text Available Background and objectives: Planning plays an important role in improving children's health and an evaluation system is necessary to planning. The purpose of this study was comparing and analyzing evaluation system of child care program in primary health care system in the Eastern Azerbaijan province based on Comprehensive Evaluation Model (CIPP. Material and Methods : This is a cross sectional study. The process includes a review of current evaluation system, comparison and analysis of the system based on a comprehensive model and to assess and identify the strengths and weaknesses of the current systems. The quantitative methods (such as brainstorming, observation and interview and consensus of study group about the results of the study were used for analyzing and interpreting results. Results: It showed that not enough attention was paid to the context and performance and the content of evaluation just includes inputs and processes based on the finding. Specific criteria and impact were considered in four areas (context, input, process and outcome and all levels which were according to the proposal and based on the CIPP model. Conclusion: Evaluation is a control process tool by higher levels and self-assessment by service provider is not considered in the current system. Evaluation includes quantitative aspects and not the quality of process. So, it is recommended that forecasting system that utilizes evaluation will result in improving future planning and a scientific model to be used in designing evaluation program. ​

  10. Teaching communication skills in clinical settings: comparing two applications of a comprehensive program with standardized and real patients

    Science.gov (United States)

    2014-01-01

    Background Communication is important for the quality of clinical practice, and programs have been implemented to improve healthcare providers’ communication skills. However, the consistency of programs teaching communication skills has received little attention, and debate exists about the application of acquired skills to real patients. This study inspects whether (1) results from a communication program are replicated with different samples, and (2) results with standardized patients apply to interviews with real patients. Methods A structured, nine-month communication program was applied in two consecutive years to two different samples of healthcare professionals (25 in the first year, 20 in the second year). Results were assessed at four different points in time, each year, regarding participants’ confidence levels (self-rated), basic communication skills in interviews with standardized patients, and basic communication skills in interviews with real patients. Data were analyzed using GLM Repeated-Measures procedures. Results Improvements were statistically significant in both years in all measures except in simulated patients’ assessment of the 2008 group. Differences between the two samples were non-significant. Differences between interviews with standardized and with real patients were also non-significant. Conclusions The program’s positive outcomes were replicated in different samples, and acquired skills were successfully applied to real-patient interviews. This reinforces this type of program structure as a valuable training tool, with results translating into real situations. It also adds to the reliability of the assessment instruments employed, though these may need adaptation in the case of real patients. PMID:24886341

  11. The effect of a comprehensive injury audit program on injury incidence in ballet: a 3-year prospective study.

    Science.gov (United States)

    Allen, Nick; Nevill, Alan M; Brooks, John H M; Koutedakis, Yiannis; Wyon, Matthew A

    2013-09-01

    The aim of this study was to determine whether an intervention with individualized conditioning program based on injury history and functional movement screening would be effective in reducing ballet injury incidence. Prospective 3-year epidemiological study. Professional ballet company and its in-house medical facility. Dancers from a professional ballet company over the 3-year study period. Participant numbers ranged from 52 to 58 (year 1: 52; year 2: 58; year 3: 53). The intervention consisted of individual conditioning programs developed using injury history and functional movement screening. Analysis was undertaken of the all dancers who were present in the company during the study period. The significance of change in injuries over a 3-year period was determined using a Poisson distribution model. To determine whether individual conditioning programs resulted in a decrease in injury incidence over the study period. The injury count reduced significantly in years 2 and 3 (P ballet. The implementation of well-structured injury surveillance programs can impact on injury incidence through its influence on intervention programs.

  12. Virtual film technique used in 3d and step-shot IMRT planning check

    International Nuclear Information System (INIS)

    Wang, Y.; Zealey, W.; Deng, X.; Huang, S.; Qi, Z.

    2004-01-01

    Full text: A virtual film technique developed and used in segmented field dose reconstruction for IMRT planning dose distribution check. Film dosimetry analysis is commonly used for the isodose curve comparison but the result can be affected by film dosimetry technical problems, and the film processing also takes a significant amount of workload. This study is focused on using digital image technique to reconstruct dose distribution for a 3D plan by mapping water-scanning data on screen in black and white intensity value, and by simulating the film analysis process to plot equivalent Isodose curve for the planning Isodose comparison check. In-house developed software is used to select the TPR (Tissue-Phantom Ratio) and OCR (Off Central-Axis Ratio) data for different beam field types and sizes; each point dose of the field is interpolated and converted into the greyscale pixel value. The location of the pixel is calculated by the triangular function according to the beam entry position and gantry/collimator angles. After each segment field is processed, the program gathers all the segments and overlays the greyscale value pixel by pixel for all the segments into a combined map. The background value is calibrated to match the water scan curve background level. The penumbra slope is adjusted by an interpolated divergent angle according to the OAD (Off Central-Axis Distance) of the field. A normal film dosimetry analysis can then be performed to plot the Isodose curves. By comparing some typical fields with both single beam and segmented IMRT fields, with the point dose checked by ionization measurement, the central point dose discrepancy is within ±2% and the maximum 3-5% for a random point using TLD technique. Compare the Isodose overlaying result to planning curves for both perpendicular and lateral beam. Although the curve shape for the virtual film viewed is more artificial compared with real film, the results are easier to compare for the quantity analysis with

  13. IMRT optimization with pseudo-biologic objective function

    International Nuclear Information System (INIS)

    Yi, B. Y.; Ahn, S. D.; Kim, J. H.; Lee, S. W.; Choi, E. K.

    2002-01-01

    The pseudo-biologic objective function has been proposed for the IMRT optimization. It is similar to the biological objective function in mathematical shape, but uses physical parameters. The pseudo-biologic objective function concept is consisted of the target coverage index (TCI) and the organ score index (OSI), was introduced. The TCI was expressed as the sum of all of the weighted bins of target dose volume histogram (DVH). The weights were given as the normal distribution of which the average is 100 % and the standard deviation is ±. The OSI was expressed as similar way. The average of the normal distribution was 0% of the dose and that of standard deviation was selected as a function of limiting dose and its importance. The objective function could be calculated as the product of the TCI and OSI's. The RTP Tool Box (RTB) was used for this study. The constraints applied in the optimization was intuitively clinical experience based numbers, while the physical objective function asks just numbers which are not necessarily based on the clinic, and the parameters for the biologic objective functions are uncertain. The OSI's from the pseudo-biological function showed better results than from the physical functions, while TCI's showed similar tendency. We could show that the pseudo-biologic function can be used for an IMRT objective function on behalf of the biological objective function

  14. Patient specific 3D printed phantom for IMRT quality assurance

    International Nuclear Information System (INIS)

    Ehler, Eric D; Higgins, Patrick D; Dusenbery, Kathryn E; Barney, Brett M

    2014-01-01

    The purpose of this study was to test the feasibility of a patient specific phantom for patient specific dosimetric verification. Using the head and neck region of an anthropomorphic phantom as a substitute for an actual patient, a soft-tissue equivalent model was constructed with the use of a 3D printer. Calculated and measured dose in the anthropomorphic phantom and the 3D printed phantom was compared for a parallel-opposed head and neck field geometry to establish tissue equivalence. A nine-field IMRT plan was constructed and dose verification measurements were performed for the 3D printed phantom as well as traditional standard phantoms. The maximum difference in calculated dose was 1.8% for the parallel-opposed configuration. Passing rates of various dosimetric parameters were compared for the IMRT plan measurements; the 3D printed phantom results showed greater disagreement at superficial depths than other methods. A custom phantom was created using a 3D printer. It was determined that the use of patient specific phantoms to perform dosimetric verification and estimate the dose in the patient is feasible. In addition, end-to-end testing on a per-patient basis was possible with the 3D printed phantom. Further refinement of the phantom construction process is needed for routine use. (paper)

  15. Quantitative analysis of patient-specific dosimetric IMRT verification

    International Nuclear Information System (INIS)

    Budgell, G J; Perrin, B A; Mott, J H L; Fairfoul, J; Mackay, R I

    2005-01-01

    Patient-specific dosimetric verification methods for IMRT treatments are variable, time-consuming and frequently qualitative, preventing evidence-based reduction in the amount of verification performed. This paper addresses some of these issues by applying a quantitative analysis parameter to the dosimetric verification procedure. Film measurements in different planes were acquired for a series of ten IMRT prostate patients, analysed using the quantitative parameter, and compared to determine the most suitable verification plane. Film and ion chamber verification results for 61 patients were analysed to determine long-term accuracy, reproducibility and stability of the planning and delivery system. The reproducibility of the measurement and analysis system was also studied. The results show that verification results are strongly dependent on the plane chosen, with the coronal plane particularly insensitive to delivery error. Unexpectedly, no correlation could be found between the levels of error in different verification planes. Longer term verification results showed consistent patterns which suggest that the amount of patient-specific verification can be safely reduced, provided proper caution is exercised: an evidence-based model for such reduction is proposed. It is concluded that dose/distance to agreement (e.g., 3%/3 mm) should be used as a criterion of acceptability. Quantitative parameters calculated for a given criterion of acceptability should be adopted in conjunction with displays that show where discrepancies occur. Planning and delivery systems which cannot meet the required standards of accuracy, reproducibility and stability to reduce verification will not be accepted by the radiotherapy community

  16. Preliminary validation of a Monte Carlo model for IMRT fields

    International Nuclear Information System (INIS)

    Wright, Tracy; Lye, Jessica; Mohammadi, Mohammad

    2011-01-01

    Full text: A Monte Carlo model of an Elekta linac, validated for medium to large (10-30 cm) symmetric fields, has been investigated for small, irregular and asymmetric fields suitable for IMRT treatments. The model has been validated with field segments using radiochromic film in solid water. The modelled positions of the multileaf collimator (MLC) leaves have been validated using EBT film, In the model, electrons with a narrow energy spectrum are incident on the target and all components of the linac head are included. The MLC is modelled using the EGSnrc MLCE component module. For the validation, a number of single complex IMRT segments with dimensions approximately 1-8 cm were delivered to film in solid water (see Fig, I), The same segments were modelled using EGSnrc by adjusting the MLC leaf positions in the model validated for 10 cm symmetric fields. Dose distributions along the centre of each MLC leaf as determined by both methods were compared. A picket fence test was also performed to confirm the MLC leaf positions. 95% of the points in the modelled dose distribution along the leaf axis agree with the film measurement to within 1%/1 mm for dose difference and distance to agreement. Areas of most deviation occur in the penumbra region. A system has been developed to calculate the MLC leaf positions in the model for any planned field size.

  17. Simultaneous navigation of multiple Pareto surfaces, with an application to multicriteria IMRT planning with multiple beam angle configurations.

    Science.gov (United States)

    Craft, David; Monz, Michael

    2010-02-01

    To introduce a method to simultaneously explore a collection of Pareto surfaces. The method will allow radiotherapy treatment planners to interactively explore treatment plans for different beam angle configurations as well as different treatment modalities. The authors assume a convex optimization setting and represent the Pareto surface for each modality or given beam set by a set of discrete points on the surface. Weighted averages of these discrete points produce a continuous representation of each Pareto surface. The authors calculate a set of Pareto surfaces and use linear programming to navigate across the individual surfaces, allowing switches between surfaces. The switches are organized such that the plan profits in the requested way, while trying to keep the change in dose as small as possible. The system is demonstrated on a phantom pancreas IMRT case using 100 different five beam configurations and a multicriteria formulation with six objectives. The system has intuitive behavior and is easy to control. Also, because the underlying linear programs are small, the system is fast enough to offer real-time exploration for the Pareto surfaces of the given beam configurations. The system presented offers a sound starting point for building clinical systems for multicriteria exploration of different modalities and offers a controllable way to explore hundreds of beam angle configurations in IMRT planning, allowing the users to focus their attention on the dose distribution and treatment planning objectives instead of spending excessive time on the technicalities of delivery.

  18. The National Clinical Skills Competition Promotes the Construction of a Comprehensive Training Program for Chinese Medical Students

    Science.gov (United States)

    Yang, Jing; Huang, Si-min; Lu, Chun-ting; Feng, Lie

    2018-01-01

    To explore an efficient training program based on an analysis in organizing seven sessions for the National Clinical Skills Competition in China. Each year, 6-12 excellent medical students of our university are selected as an observation team. Comparisons of the teaching characteristics were performed in this study. An optimal curriculum…

  19. A planning and delivery study of a rotational IMRT technique with burst delivery

    International Nuclear Information System (INIS)

    Kainz, Kristofer; Chen, Guang-Pei; Chang, Yu-Wen; Prah, Douglas; Sharon Qi, X.; Shukla, Himanshu P.; Stahl, Johannes; Allen Li, X.

    2011-01-01

    Purpose: A novel rotational IMRT (rIMRT) technique using burst delivery (continuous gantry rotation with beam off during MLC repositioning) is investigated. The authors evaluate the plan quality and delivery efficiency and accuracy of this dynamic technique with a conventional flat 6 MV photon beam. Methods: Burst-delivery rIMRT was implemented in a planning system and delivered with a 160-MLC linac. Ten rIMRT plans were generated for five anonymized patient cases encompassing head and neck, brain, prostate, and prone breast. All plans were analyzed retrospectively and not used for treatment. Among the varied plan parameters were the number of optimization points, number of arcs, gantry speed, and gantry angle range (alpha) over which the beam is turned on at each optimization point. Combined rotational/step-and-shoot rIMRT plans were also created by superimposing multiple-segment static fields at several optimization points. The rIMRT trial plans were compared with each other and with plans generated using helical tomotherapy and VMAT. Burst-mode rotational IMRT plans were delivered and verified using a diode array, ionization chambers, thermoluminescent dosimeters, and film. Results: Burst-mode rIMRT can achieve plan quality comparable to helical tomotherapy, while the former may lead to slightly better OAR sparing for certain cases and the latter generally achieves slightly lower hot spots. Few instances were found in which increasing the number of optimization points above 36, or superimposing step-and-shoot IMRT segments, led to statistically significant improvements in OAR sparing. Using an additional rIMRT partial arc yielded substantial OAR dose improvements for the brain case. Measured doses from the rIMRT plan delivery were within 4% of the plan calculation in low dose gradient regions. Delivery time range was 228-375 s for single-arc rIMRT 200-cGy prescription with a 300 MU/min dose rate, comparable to tomotherapy and VMAT. Conclusions: Rotational IMRT

  20. Does IMRT increase the peripheral radiation dose? A comparison of treatment plans 2000 and 2010

    International Nuclear Information System (INIS)

    Salz, Henning; Eichner, Regina; Wiezorek, Tilo

    2012-01-01

    It has been reported in several papers and textbooks that IMRT treatments increase the peripheral dose in comparison with non-IMRT fields. But in clinical practice not only open fields have been used in the pre-IMRT era, but also fields with physical wedges or composed fields. The aim of this work is to test the hypothesis of increased peripheral dose when IMRT is used compared to standard conformal radiotherapy. Furthermore, the importance of the measured dose differences in clinical practice is discussed and compared with other new technologies for the cases where an increase of the peripheral dose was observed. For cancers of the head and neck, the cervix, the rectum and for the brain irradiation due to acute leukaemia, one to four plans have been calculated with IMRT or conformal standard technique (non-IMRT). In an anthropomorphic phantom the dose at a distance of 30 cm in cranio-caudal direction from the target edge was measured with TLDs using a linear accelerator Oncor registered (Siemens) for both techniques. IMRT was performed using step-and-shoot technique (7 to 11 beams), non-IMRT plans with different techniques. The results depended on the site of irradiation. For head and neck cancers IMRT resulted in an increase of 0.05 - 0.09% of the prescribed total dose (Dptv) or 40 - 70 mGy (Dptv = 65 Gy), compared to non-IMRT technique without wedges or a decrease of 0.16% (approx. 100 mGy) of the prescribed total dose compared to non-IMRT techniques with wedges. For the cervical cancer IMRT resulted in an increased dose in the periphery (+ 0.07% - 0.15% of Dptv or 30 - 70 mGy at Dptv = 45 Gy), for the rectal cancer in a dose reduction (0.21 - 0.26% of Dptv or 100 - 130 mGy at Dptv = 50 Gy) and for the brain irradiation in an increase dose (+ 0.05% of Dptv = 18 Gy or 9 mSv). In summary IMRT does not uniformly cause increased radiation dose in the periphery in the model used. It can be stated that these dose values are smaller than reported in earlier papers

  1. Human Papillomavirus Vaccine as an Anti-cancer Vaccine: Collaborative Efforts to Promote HPV Vaccine in the National Comprehensive Cancer Control Program

    Science.gov (United States)

    Townsend, Julie S.; Steele, C. Brooke; Hayes, Nikki; Bhatt, Achal; Moore, Angela R.

    2018-01-01

    Background Widespread use of the HPV vaccine has the potential to reduce incidence from HPV-associated cancers. However, vaccine uptake among adolescents remains well below the Healthy People 2020 targets. The Centers for Disease Control and Prevention (CDC)’s National Comprehensive Cancer Control Program awardees (NCCCP) are well positioned to work with immunization programs to increase vaccine uptake. Methods CDC’s chronic disease management information system was queried for objectives and activities associated with HPV vaccine that were reported by NCCCP awardees from 2013 – 2016 as part of program reporting requirements. A content analysis was conducted on the query results to categorize interventions according to strategies outlined in The Guide to Community Preventive Services and the 2014 President’s Cancer Panel report. Results Sixty-two percent of NCCCP awardees had planned or implemented at least one activity since 2013 to address low HPV vaccination coverage in their jurisdictions. Most NCCCP awardees (86%) reported community education activities, while 65% reported activities associated with provider education. Systems-based strategies such as client reminders or provider assessment and feedback were each reported by less than 25% of NCCCP awardees. Conclusion Many NCCCP awardees report planning or implementing activities to address low HPV vaccination coverage, often in conjunction with state immunization programs. NCCCP awardees can play a role in increasing HPV vaccination coverage through their cancer prevention and control expertise and access to partners in the health care community. PMID:28263672

  2. Content and face validity of a comprehensive robotic skills training program for general surgery, urology, and gynecology.

    Science.gov (United States)

    Dulan, Genevieve; Rege, Robert V; Hogg, Deborah C; Gilberg-Fisher, Kristine K; Tesfay, Seifu T; Scott, Daniel J

    2012-04-01

    The authors previously developed a comprehensive, proficiency-based robotic training curriculum that aimed to address 23 unique skills identified via task deconstruction of robotic operations. The purpose of this study was to determine the content and face validity of this curriculum. Expert robotic surgeons (n = 12) rated each deconstructed skill regarding relevance to robotic operations, were oriented to the curricular components, performed 3 to 5 repetitions on the 9 exercises, and rated each exercise. In terms of content validity, experts rated all 23 deconstructed skills as highly relevant (4.5 on a 5-point scale). Ratings for the 9 inanimate exercises indicated moderate to thorough measurement of designated skills. For face validity, experts indicated that each exercise effectively measured relevant skills (100% agreement) and was highly effective for training and assessment (4.5 on a 5-point scale). These data indicate that the 23 deconstructed skills accurately represent the appropriate content for robotic skills training and strongly support content and face validity for this curriculum. Copyright © 2012. Published by Elsevier Inc.

  3. Salud Para Su Corazon-NCLR: a comprehensive Promotora outreach program to promote heart-healthy behaviors among hispanics.

    Science.gov (United States)

    Balcazar, Hector; Alvarado, Matilde; Hollen, Mary Luna; Gonzalez-Cruz, Yanira; Hughes, Odelinda; Vazquez, Esperanza; Lykens, Kristine

    2006-01-01

    This article describes results of year-1 implementation of the Salud Para Su Corazón (Health For Your Heart)-National Council of la Raza (NCLR) promotora (lay health worker) program for promoting heart-healthy behaviors among Latinos. Findings of this community outreach initiative include data from promotora pledges and self-skill behaviors, cardiovascular disease risk factors of Latino families, family heart-health education delivery, and program costs associated with promotora time. Participation included 29 trained promotoras serving 188 families from three NCLR affiliates in Escondido, California; Chicago, Illinois; and Ojo Caliente, New Mexico. Using several evaluation tools, the results showed that the promotora approach worked based on evidence obtained from the following indicators: changes in promotora's pre-post knowledge and performance skills, progress toward their pledge goals following training, recruiting and teaching families, providing follow-up, and organizing or participating in community events. Strengths and limitations of the promotora model approach are also discussed.

  4. Evaluation of a comprehensive employee wellness program at an organization with a consumer-directed health plan.

    Science.gov (United States)

    Burton, Wayne N; Chen, Chin-Yu; Li, Xingquan; Schultz, Alyssa B; Kasiarz, David; Edington, Dee W

    2014-04-01

    Consumer-directed health plans (CDHPs) are popular among employers in the United States. This study examined an employee wellness program and its association with employee health in an organization that recently initiated a CDHP. This retrospective observational analysis compared the health risks, employer-paid health care costs, and short-term disability absences of employees of a large financial services corporation from 2009 to 2010. The two-time health risk appraisal participants had a significant improvement in the percentage of employees in the overall low-risk category. The average annual employer-paid medical and pharmacy costs did not significantly change. For employees who improved their health risk category, there was a commensurate change in costs and absences. In a difficult economic climate, this organization began a health promotion program for employees as well as a new CDHP benefit structure. No short-term reduction in health care usage or overall health status was observed.

  5. A Comprehensive Mathematical Programming Model for Minimizing Costs in A Multiple-Item Reverse Supply Chain with Sensitivity Analysis

    Directory of Open Access Journals (Sweden)

    Mahmoudi Hoda

    2014-09-01

    Full Text Available These instructions give you guidelines for preparing papers for IFAC conferences. A reverse supply chain is configured by a sequence of elements forming a continuous process to treat return-products until they are properly recovered or disposed. The activities in a reverse supply chain include collection, cleaning, disassembly, test and sorting, storage, transport, and recovery operations. This paper presents a mathematical programming model with the objective of minimizing the total costs of reverse supply chain including transportation, fixed opening, operation, maintenance and remanufacturing costs of centers. The proposed model considers the design of a multi-layer, multi-product reverse supply chain that consists of returning, disassembly, processing, recycling, remanufacturing, materials and distribution centers. This integer linear programming model is solved by using Lingo 9 software and the results are reported. Finally, a sensitivity analysis of the proposed model is also presented.

  6. Rotational IMRT techniques compared to fixed gantry IMRT and Tomotherapy: multi-institutional planning study for head-and-neck cases

    Directory of Open Access Journals (Sweden)

    Lutters Gerd

    2011-02-01

    Full Text Available Abstract Background Recent developments enable to deliver rotational IMRT with standard C-arm gantry based linear accelerators. This upcoming treatment technique was benchmarked in a multi-center treatment planning study against static gantry IMRT and rotational IMRT based on a ring gantry for a complex parotid gland sparing head-and-neck technique. Methods Treatment plans were created for 10 patients with head-and-neck tumours (oropharynx, hypopharynx, larynx using the following treatment planning systems (TPS for rotational IMRT: Monaco (ELEKTA VMAT solution, Eclipse (Varian RapidArc solution and HiArt for the helical tomotherapy (Tomotherapy. Planning of static gantry IMRT was performed with KonRad, Pinnacle and Panther DAO based on step&shoot IMRT delivery and Eclipse for sliding window IMRT. The prescribed doses for the high dose PTVs were 65.1Gy or 60.9Gy and for the low dose PTVs 55.8Gy or 52.5Gy dependend on resection status. Plan evaluation was based on target coverage, conformity and homogeneity, DVHs of OARs and the volume of normal tissue receiving more than 5Gy (V5Gy. Additionally, the cumulative monitor units (MUs and treatment times of the different technologies were compared. All evaluation parameters were averaged over all 10 patients for each technique and planning modality. Results Depending on IMRT technique and TPS, the mean CI values of all patients ranged from 1.17 to 2.82; and mean HI values varied from 0.05 to 0.10. The mean values of the median doses of the spared parotid were 26.5Gy for RapidArc and 23Gy for VMAT, 14.1Gy for Tomo. For fixed gantry techniques 21Gy was achieved for step&shoot+KonRad, 17.0Gy for step&shoot+Panther DAO, 23.3Gy for step&shoot+Pinnacle and 18.6Gy for sliding window. V5Gy values were lowest for the sliding window IMRT technique (3499 ccm and largest for RapidArc (5480 ccm. The lowest mean MU value of 408 was achieved by Panther DAO, compared to 1140 for sliding window IMRT. Conclusions All

  7. Rotational IMRT techniques compared to fixed gantry IMRT and Tomotherapy: multi-institutional planning study for head-and-neck cases

    International Nuclear Information System (INIS)

    Wiezorek, Tilo; Schubert, Kai; Wagner, Daniela; Wendt, Thomas G; Brachwitz, Tim; Georg, Dietmar; Blank, Eyck; Fotina, Irina; Habl, Gregor; Kretschmer, Matthias; Lutters, Gerd; Salz, Henning

    2011-01-01

    Recent developments enable to deliver rotational IMRT with standard C-arm gantry based linear accelerators. This upcoming treatment technique was benchmarked in a multi-center treatment planning study against static gantry IMRT and rotational IMRT based on a ring gantry for a complex parotid gland sparing head-and-neck technique. Treatment plans were created for 10 patients with head-and-neck tumours (oropharynx, hypopharynx, larynx) using the following treatment planning systems (TPS) for rotational IMRT: Monaco (ELEKTA VMAT solution), Eclipse (Varian RapidArc solution) and HiArt for the helical tomotherapy (Tomotherapy). Planning of static gantry IMRT was performed with KonRad, Pinnacle and Panther DAO based on step&shoot IMRT delivery and Eclipse for sliding window IMRT. The prescribed doses for the high dose PTVs were 65.1Gy or 60.9Gy and for the low dose PTVs 55.8Gy or 52.5Gy dependend on resection status. Plan evaluation was based on target coverage, conformity and homogeneity, DVHs of OARs and the volume of normal tissue receiving more than 5Gy (V 5Gy ). Additionally, the cumulative monitor units (MUs) and treatment times of the different technologies were compared. All evaluation parameters were averaged over all 10 patients for each technique and planning modality. Depending on IMRT technique and TPS, the mean CI values of all patients ranged from 1.17 to 2.82; and mean HI values varied from 0.05 to 0.10. The mean values of the median doses of the spared parotid were 26.5Gy for RapidArc and 23Gy for VMAT, 14.1Gy for Tomo. For fixed gantry techniques 21Gy was achieved for step&shoot+KonRad, 17.0Gy for step&shoot+Panther DAO, 23.3Gy for step&shoot+Pinnacle and 18.6Gy for sliding window. V 5Gy values were lowest for the sliding window IMRT technique (3499 ccm) and largest for RapidArc (5480 ccm). The lowest mean MU value of 408 was achieved by Panther DAO, compared to 1140 for sliding window IMRT. All IMRT delivery technologies with their associated TPS

  8. Make a Move: A Comprehensive Effect Evaluation of a Sexual Harassment Prevention Program in Dutch Residential Youth Care.

    Science.gov (United States)

    van Lieshout, Sanne; Mevissen, Fraukje E F; van Breukelen, Gerard; Jonker, Marianne; Ruiter, Robert A C

    2016-06-27

    Sexual harassment-unwanted sexual comments, advances, or behaviors-and sexual violence are still prevalent worldwide, leading to a variety of physical, cognitive, and emotional problems among those being harassed. In particular, youth in care are at risk of becoming perpetrators (and victims) of sexual harassment. However, in general, there are very few interventions targeting this at-risk group, and no such programs exist in the Netherlands. To this end, a group intervention program-Make a Move-targeting determinants of sexual harassment was developed. This program was implemented and evaluated among boys (N = 177) in Dutch residential youth care (20 institutions). A pre-test, post-test, and 6-month follow-up design including an intervention and a waiting list control group with randomized assignment of institutions (cluster randomized trial) was used to measure the effects of the intervention on determinants of sexual harassment. Multilevel (mixed) regression analysis with Bonferroni correction for multiple testing (α = .005) showed no significant effects of Make a Move on determinants of sexual harassment (ps > .03, Cohen's ds < .44). Results are discussed in light of a three-way explanatory model focusing on intervention content, evaluation, and implementation as potential explanations for not finding any measurable intervention effects. © The Author(s) 2016.

  9. Comparison of VMAT and IMRT strategies for cervical cancer patients using automated planning.

    Science.gov (United States)

    Sharfo, Abdul Wahab M; Voet, Peter W J; Breedveld, Sebastiaan; Mens, Jan Willem M; Hoogeman, Mischa S; Heijmen, Ben J M

    2015-03-01

    In a published study on cervical cancer, 5-beam IMRT was inferior to single arc VMAT. Here we compare 9, 12, and 20 beam IMRT with single and dual arc VMAT. For each of 10 patients, automated plan generation with the in-house Erasmus-iCycle optimizer was used to assist an expert planner in generating the five plans with the clinical TPS. For each patient, all plans were clinically acceptable with a high and similar PTV coverage. OAR sparing increased when going from 9 to 12 to 20 IMRT beams, and from single to dual arc VMAT. For all patients, 12 and 20 beam IMRT were superior to single and dual arc VMAT, with substantial variations in gain among the study patients. As expected, delivery of VMAT plans was significantly faster than delivery of IMRT plans. Often reported increased plan quality for VMAT compared to IMRT has not been observed for cervical cancer. Twenty and 12 beam IMRT plans had a higher quality than single and dual arc VMAT. For individual patients, the optimal delivery technique depends on a complex trade-off between plan quality and treatment time that may change with introduction of faster delivery systems. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  10. Comparison of VMAT and IMRT strategies for cervical cancer patients using automated planning

    International Nuclear Information System (INIS)

    Sharfo, Abdul Wahab M.; Voet, Peter W.J.; Breedveld, Sebastiaan; Mens, Jan Willem M.; Hoogeman, Mischa S.; Heijmen, Ben J.M.

    2015-01-01

    Background and purpose: In a published study on cervical cancer, 5-beam IMRT was inferior to single arc VMAT. Here we compare 9, 12, and 20 beam IMRT with single and dual arc VMAT. Material and methods: For each of 10 patients, automated plan generation with the in-house Erasmus-iCycle optimizer was used to assist an expert planner in generating the five plans with the clinical TPS. Results: For each patient, all plans were clinically acceptable with a high and similar PTV coverage. OAR sparing increased when going from 9 to 12 to 20 IMRT beams, and from single to dual arc VMAT. For all patients, 12 and 20 beam IMRT were superior to single and dual arc VMAT, with substantial variations in gain among the study patients. As expected, delivery of VMAT plans was significantly faster than delivery of IMRT plans. Conclusions: Often reported increased plan quality for VMAT compared to IMRT has not been observed for cervical cancer. Twenty and 12 beam IMRT plans had a higher quality than single and dual arc VMAT. For individual patients, the optimal delivery technique depends on a complex trade-off between plan quality and treatment time that may change with introduction of faster delivery systems

  11. Dose-volume based ranking of incident beam direction and its utility in facilitating IMRT beam placement

    International Nuclear Information System (INIS)

    Schreibmann, Eduard; Xing Lei

    2005-01-01

    Purpose: Beam orientation optimization in intensity-modulated radiation therapy (IMRT) is computationally intensive, and various single beam ranking techniques have been proposed to reduce the search space. Up to this point, none of the existing ranking techniques considers the clinically important dose-volume effects of the involved structures, which may lead to clinically irrelevant angular ranking. The purpose of this work is to develop a clinically sensible angular ranking model with incorporation of dose-volume effects and to show its utility for IMRT beam placement. Methods and Materials: The general consideration in constructing this angular ranking function is that a beamlet/beam is preferable if it can deliver a higher dose to the target without exceeding the tolerance of the sensitive structures located on the path of the beamlet/beam. In the previously proposed dose-based approach, the beamlets are treated independently and, to compute the maximally deliverable dose to the target volume, the intensity of each beamlet is pushed to its maximum intensity without considering the values of other beamlets. When volumetric structures are involved, the complication arises from the fact that there are numerous dose distributions corresponding to the same dose-volume tolerance. In this situation, the beamlets are not independent and an optimization algorithm is required to find the intensity profile that delivers the maximum target dose while satisfying the volumetric constraints. In this study, the behavior of a volumetric organ was modeled by using the equivalent uniform dose (EUD). A constrained sequential quadratic programming algorithm (CFSQP) was used to find the beam profile that delivers the maximum dose to the target volume without violating the EUD constraint or constraints. To assess the utility of the proposed technique, we planned a head-and-neck and abdominal case with and without the guidance of the angular ranking information. The qualities of the

  12. Intensity-modulated radiotherapy (IMRT) and conventional three-dimensional conformal radiotherapy for high-grade gliomas: Does IMRT increase the integral dose to normal brain?

    International Nuclear Information System (INIS)

    Hermanto, Ulrich; Frija, Erik K.; Lii, MingFwu J.; Chang, Eric L.; Mahajan, Anita; Woo, Shiao Y.

    2007-01-01

    Purpose: To determine whether intensity-modulated radiotherapy (IMRT) treatment increases the total integral dose of nontarget tissue relative to the conventional three-dimensional conformal radiotherapy (3D-CRT) technique for high-grade gliomas. Methods and Materials: Twenty patients treated with 3D-CRT for glioblastoma multiforme were selected for a comparative dosimetric evaluation with IMRT. Original target volumes, organs at risk (OAR), and dose-volume constraints were used for replanning with IMRT. Predicted isodose distributions, cumulative dose-volume histograms of target volumes and OAR, normal tissue integral dose, target coverage, dose conformity, and normal tissue sparing with 3D-CRT and IMRT planning were compared. Statistical analyses were performed to determine differences. Results: In all 20 patients, IMRT maintained equivalent target coverage, improved target conformity (conformity index [CI] 95% 1.52 vs. 1.38, p mean by 19.8% and D max by 10.7%), optic chiasm (D mean by 25.3% and D max by 22.6%), right optic nerve (D mean by 37.3% and D max by 28.5%), and left optic nerve (D mean by 40.6% and D max by 36.7%), p ≤ 0.01. This was achieved without increasing the total nontarget integral dose by greater than 0.5%. Overall, total integral dose was reduced by 7-10% with IMRT, p < 0.001, without significantly increasing the 0.5-5 Gy low-dose volume. Conclusions: These results indicate that IMRT treatment for high-grade gliomas allows for improved target conformity, better critical tissue sparing, and importantly does so without increasing integral dose and the volume of normal tissue exposed to low doses of radiation

  13. SU-F-T-315: Comparative Studies of Planar Dose with Different Spatial Resolution for Head and Neck IMRT QA

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, T; Koo, T [Hallym University Medical Center, Chuncheon, Gangwon (Korea, Republic of)

    2016-06-15

    bicubic interpolation for head and neck IMRT delivery. This work was supported by Radiation Technology R&D program through the National Research Foundation of Korea funded by the Ministry of Science, ICT & Future Planning (No. 2013M2A2A7038291)

  14. PARETO: A novel evolutionary optimization approach to multiobjective IMRT planning

    International Nuclear Information System (INIS)

    Fiege, Jason; McCurdy, Boyd; Potrebko, Peter; Champion, Heather; Cull, Andrew

    2011-01-01

    Purpose: In radiation therapy treatment planning, the clinical objectives of uniform high dose to the planning target volume (PTV) and low dose to the organs-at-risk (OARs) are invariably in conflict, often requiring compromises to be made between them when selecting the best treatment plan for a particular patient. In this work, the authors introduce Pareto-Aware Radiotherapy Evolutionary Treatment Optimization (pareto), a multiobjective optimization tool to solve for beam angles and fluence patterns in intensity-modulated radiation therapy (IMRT) treatment planning. Methods: pareto is built around a powerful multiobjective genetic algorithm (GA), which allows us to treat the problem of IMRT treatment plan optimization as a combined monolithic problem, where all beam fluence and angle parameters are treated equally during the optimization. We have employed a simple parameterized beam fluence representation with a realistic dose calculation approach, incorporating patient scatter effects, to demonstrate feasibility of the proposed approach on two phantoms. The first phantom is a simple cylindrical phantom containing a target surrounded by three OARs, while the second phantom is more complex and represents a paraspinal patient. Results: pareto results in a large database of Pareto nondominated solutions that represent the necessary trade-offs between objectives. The solution quality was examined for several PTV and OAR fitness functions. The combination of a conformity-based PTV fitness function and a dose-volume histogram (DVH) or equivalent uniform dose (EUD) -based fitness function for the OAR produced relatively uniform and conformal PTV doses, with well-spaced beams. A penalty function added to the fitness functions eliminates hotspots. Comparison of resulting DVHs to those from treatment plans developed with a single-objective fluence optimizer (from a commercial treatment planning system) showed good correlation. Results also indicated that pareto shows

  15. First application of quantum annealing to IMRT beamlet intensity optimization

    International Nuclear Information System (INIS)

    Nazareth, Daryl P; Spaans, Jason D

    2015-01-01

    Optimization methods are critical to radiation therapy. A new technology, quantum annealing (QA), employs novel hardware and software techniques to address various discrete optimization problems in many fields. We report on the first application of quantum annealing to the process of beamlet intensity optimization for IMRT.We apply recently-developed hardware which natively exploits quantum mechanical effects for improved optimization. The new algorithm, called QA, is most similar to simulated annealing, but relies on natural processes to directly minimize a system’s free energy. A simple quantum system is slowly evolved into a classical system representing the objective function. If the evolution is sufficiently slow, there are probabilistic guarantees that a global minimum will be located.To apply QA to IMRT-type optimization, two prostate cases were considered. A reduced number of beamlets were employed, due to the current QA hardware limitations. The beamlet dose matrices were computed using CERR and an objective function was defined based on typical clinical constraints, including dose-volume objectives, which result in a complex non-convex search space. The objective function was discretized and the QA method was compared to two standard optimization methods, simulated annealing and Tabu search, run on a conventional computing cluster.Based on several runs, the average final objective function value achieved by the QA was 16.9 for the first patient, compared with 10.0 for Tabu and 6.7 for the simulated annealing (SA) method. For the second patient, the values were 70.7 for the QA, 120.0 for Tabu and 22.9 for the SA. The QA algorithm required 27–38% of the time required by the other two methods.In this first application of hardware-enabled QA to IMRT optimization, its performance is comparable to Tabu search, but less effective than the SA in terms of final objective function values. However, its speed was 3–4 times faster than the other two methods

  16. PARETO: A novel evolutionary optimization approach to multiobjective IMRT planning.

    Science.gov (United States)

    Fiege, Jason; McCurdy, Boyd; Potrebko, Peter; Champion, Heather; Cull, Andrew

    2011-09-01

    In radiation therapy treatment planning, the clinical objectives of uniform high dose to the planning target volume (PTV) and low dose to the organs-at-risk (OARs) are invariably in conflict, often requiring compromises to be made between them when selecting the best treatment plan for a particular patient. In this work, the authors introduce Pareto-Aware Radiotherapy Evolutionary Treatment Optimization (pareto), a multiobjective optimization tool to solve for beam angles and fluence patterns in intensity-modulated radiation therapy (IMRT) treatment planning. pareto is built around a powerful multiobjective genetic algorithm (GA), which allows us to treat the problem of IMRT treatment plan optimization as a combined monolithic problem, where all beam fluence and angle parameters are treated equally during the optimization. We have employed a simple parameterized beam fluence representation with a realistic dose calculation approach, incorporating patient scatter effects, to demonstrate feasibility of the proposed approach on two phantoms. The first phantom is a simple cylindrical phantom containing a target surrounded by three OARs, while the second phantom is more complex and represents a paraspinal patient. pareto results in a large database of Pareto nondominated solutions that represent the necessary trade-offs between objectives. The solution quality was examined for several PTV and OAR fitness functions. The combination of a conformity-based PTV fitness function and a dose-volume histogram (DVH) or equivalent uniform dose (EUD) -based fitness function for the OAR produced relatively uniform and conformal PTV doses, with well-spaced beams. A penalty function added to the fitness functions eliminates hotspots. Comparison of resulting DVHs to those from treatment plans developed with a single-objective fluence optimizer (from a commercial treatment planning system) showed good correlation. Results also indicated that pareto shows promise in optimizing the number

  17. Fast IMRT with narrow high energy scanned photon beams

    Energy Technology Data Exchange (ETDEWEB)

    Andreassen, Bjoern; Straaring t, Sara Janek; Holmberg, Rickard; Naefstadius, Peder; Brahme, Anders [Department of Medical Radiation Physics, Karolinska Institutet and Stockholm University, P.O. Box 260, SE-171 76 Stockholm (Sweden); Department of Hospital Physics, Karolinska University Hospital, SE-171 76 Stockholm (Sweden); Department of Medical Radiation Physics, Karolinska Institutet and Stockholm University, P.O. Box 260, SE-171 76 Stockholm, Sweden and Department of Hospital Physics, Karolinska University Hospital, SE-171 76 Stockholm (Sweden)

    2011-08-15

    Purpose: Since the first publications on intensity modulated radiation therapy (IMRT) in the early 1980s almost all efforts have been focused on fairly time consuming dynamic or segmental multileaf collimation. With narrow fast scanned photon beams, the flexibility and accuracy in beam shaping increases, not least in combination with fast penumbra trimming multileaf collimators. Previously, experiments have been performed with full range targets, generating a broad bremsstrahlung beam, in combination with multileaf collimators or material compensators. In the present publication, the first measurements with fast narrow high energy (50 MV) scanned photon beams are presented indicating an interesting performance increase even though some of the hardware used were suboptimal. Methods: Inverse therapy planning was used to calculate optimal scanning patterns to generate dose distributions with interesting properties for fast IMRT. To fully utilize the dose distributional advantages with scanned beams, it is necessary to use narrow high energy beams from a thin bremsstrahlung target and a powerful purging magnet capable of deflecting the transmitted electron beam away from the generated photons onto a dedicated electron collector. During the present measurements the scanning system, purging magnet, and electron collimator in the treatment head of the MM50 racetrack accelerator was used with 3-6 mm thick bremsstrahlung targets of beryllium. The dose distributions were measured with diodes in water and with EDR2 film in PMMA. Monte Carlo simulations with geant4 were used to study the influence of the electrons transmitted through the target on the photon pencil beam kernel. Results: The full width at half-maximum (FWHM) of the scanned photon beam was 34 mm measured at isocenter, below 9.5 cm of water, 1 m from the 3 mm Be bremsstrahlung target. To generate a homogeneous dose distribution in a 10 x 10 cm{sup 2} field, the authors used a spot matrix of 100 equal intensity

  18. Developing Needs Analysis Based-Reading Comprehension Learning Materials: A Study on the Indonesian Language Study Program Students

    Directory of Open Access Journals (Sweden)

    S. Salam

    2017-08-01

    Full Text Available The purpose of this research was to describe the need of development of 'Reading Comprehension' teaching materials to students and lecturers of Indonesian Language and Literature Education Department, Gorontalo. This research is included in the research and development to develop educational products in the form of teaching materials. Mixed research design was used in this study to explore the data needs of the development of reading materials learning. Quantitative data was obtained from the responses of 36 respondents and 2 lecturers of the Reading subjects on the questionnaire needs analysis and questionnaire of teaching material analysis that is being used today. Likert Scale was used in questionnaire of needs analysis seen from 7 aspects, namely: content of teaching material, reading strategy, text type, text genre, text topic, learning activity, and evaluation of learning (81 items and questionnaire of teaching material analysis that was being used that amounted to 5 aspects, namely: the content of teaching materials, organization of teaching materials, language, layout, and completeness of teaching material support (31 items. Qualitative data were obtained from open questions about the experiences of students and lecturers in reading learning in the same questionnaire, as well as content analysis of the material being used. The results showed that the requirement of development of teaching materials, students and lecturers assessed 63 items (77.78% in the required category, and 18 items (22.22% with the required categories. Then, the teaching materials currently in use still lack the aspects of the content, the text type, the text genre, the text topic, and the evaluation of each learning unit. Details of the results obtained 4 items (12.90% as low category, 22 items (70.97% as enough category, and 5 items (16.13% as high category.

  19. Management of a comprehensive radiation safety program in a major American University and affiliated academic medical center

    International Nuclear Information System (INIS)

    Yoshizumi, T.T.; Reiman, R.E.; Vylet, V.; Clapp, J.R.; Thomann, W.R.; Lyles, K.W.

    2000-01-01

    Duke University, which operates under eight radiation licenses issued by the State of North Carolina, consists of a leading medical center including extensive inpatient and outpatient facilities, a medical school, biomedical research labs, and an academic campus including two major accelerator facilities. The Nuclear Medicine and Radiation Oncology departments handle over 40,000 diagnostic and therapeutic procedures annually, including approximately 160 radioiodine therapeutic cases. In biomedical research labs, about 300 professors are authorized to use radioactive materials. Over 2,000 radiation workers are identified on campus. Over the past two years, we have transformed the existing radiation safety program into a more responsive and more accountable one. Simultaneously, the institutional 'culture' changed, and the Radiation Safety Division came to be viewed as a helpful ally by investigators. The purpose of this paper is to present our experiences that have made this transformation possible. Our initiatives included; (a) defining short-term and long-term goals; (b) establishing a definitive chain of authority; (c) obtaining an external review by a consultant Health Physicist; (d) improving existing radiation safety programs; (e) reorganizing the Radiation Safety Division, with creation of multidisciplinary professional staff positions; (f) implementing campus-wide radiation safety training, (g) increasing technician positions; (h) establishing monthly medical center radiation safety executive meeting. As a result progress made at the Divisional level includes; (a) culture change by recruiting professionals with academic credentials and recent college graduates; (b) implementing weekly staff meetings and monthly quality assurance meetings; (c) achieving academic prominence by publishing and presenting papers in national meetings; (d) senior staff achieving faculty appointments with academic departments; (e) senior staff participating in graduate student

  20. SU-E-T-521: Feasibility Study of a Rotational Step-And-Shoot IMRT Treatment Planning Approach

    International Nuclear Information System (INIS)

    Zhu, X; Chang, S; Cullip, T; Yuan, L; Zhang, X; Lian, J; Tang, X; Tracton, G; Dooley, J

    2014-01-01

    Purpose: Rotational step-and-shot IMRT (r-IMRT) could improve delivery efficiency with good dose conformity, especially if it can leverage the burst mode of the accelerator where radiation is turned on/off momentarily while the gantry rotates continuously. The challenge for the r-IMRT planning is to minimize the number of beams to achieve a fast and smooth rotational delivery. Methods: Treatment plans for r-IMRT were created using an in-house treatment planning system. To generate the plan using a very few beams, gantry angle was optimized by weighting the beam monitoring unit (MU), and beam shape optimization was a combination of column search with k-means clustering. A prostate case and a head and neck case were planned using r-IMRT. The dosimetry is compared to s-IMRT planned with Varian Eclipse treatment planning system. Results: With the same PTV dose coverage D95=100%, the r-IMRT plans shows comparable sparing as the s-IMRT plans in the prostate for the rectum D10cc and the bladder Dmean, and in the head and neck for the spinal cord Dmax, the brain stem Dmax, the left/right parotid Dmean, the larynx Dmean, and the mandible Dmean. Both plans meet the established institutional clinical dosimetric criteria. The r-IMRT plan uses 19 beam/405 MU for the prostate, and 68 beam/880 MU for the head and neck, while the s-IMRT uses 7 beam/724 MU and 9 beam/1812 MU, respectively. Compared to the corresponding s-IMRT, r-IMRT has a reduction of MUs of 44% for the prostate case and 41% for the head and neck case. Conclusions: We have demonstrated the feasibility of a rotational step and shoot IMRT treatment planning approach that significantly shortens the conventional IMRT treatment beam-on time without degrading the dose comformity

  1. SU-E-T-521: Feasibility Study of a Rotational Step-And-Shoot IMRT Treatment Planning Approach

    Energy Technology Data Exchange (ETDEWEB)

    Zhu, X [Univ. of North Carolina at Chapel Hill, Chapel Hill, NC (United States); Chang, S [UNC School of Medicine, Chapel Hill, NC (United States); Cullip, T [UNC Hospitals, Chapel Hill, NC (United States); Yuan, L; Zhang, X [Duke University, Durham, NC (United States); Lian, J; Tang, X [UniversityNorth Carolina, Chapel Hill, NC (United States); Tracton, G; Dooley, J [University of North Carolina, Chapel Hill, NC (United States)

    2014-06-01

    Purpose: Rotational step-and-shot IMRT (r-IMRT) could improve delivery efficiency with good dose conformity, especially if it can leverage the burst mode of the accelerator where radiation is turned on/off momentarily while the gantry rotates continuously. The challenge for the r-IMRT planning is to minimize the number of beams to achieve a fast and smooth rotational delivery. Methods: Treatment plans for r-IMRT were created using an in-house treatment planning system. To generate the plan using a very few beams, gantry angle was optimized by weighting the beam monitoring unit (MU), and beam shape optimization was a combination of column search with k-means clustering. A prostate case and a head and neck case were planned using r-IMRT. The dosimetry is compared to s-IMRT planned with Varian Eclipse treatment planning system. Results: With the same PTV dose coverage D95=100%, the r-IMRT plans shows comparable sparing as the s-IMRT plans in the prostate for the rectum D10cc and the bladder Dmean, and in the head and neck for the spinal cord Dmax, the brain stem Dmax, the left/right parotid Dmean, the larynx Dmean, and the mandible Dmean. Both plans meet the established institutional clinical dosimetric criteria. The r-IMRT plan uses 19 beam/405 MU for the prostate, and 68 beam/880 MU for the head and neck, while the s-IMRT uses 7 beam/724 MU and 9 beam/1812 MU, respectively. Compared to the corresponding s-IMRT, r-IMRT has a reduction of MUs of 44% for the prostate case and 41% for the head and neck case. Conclusions: We have demonstrated the feasibility of a rotational step and shoot IMRT treatment planning approach that significantly shortens the conventional IMRT treatment beam-on time without degrading the dose comformity.

  2. A Comprehensive Program to Reduce Rates of Hospital-Acquired Pressure Ulcers in a System of Community Hospitals.

    Science.gov (United States)

    Englebright, Jane; Westcott, Ruth; McManus, Kathryn; Kleja, Kacie; Helm, Colleen; Korwek, Kimberly M; Perlin, Jonathan B

    2018-03-01

    The prevention of hospital-acquired pressure ulcers (PrUs) has significant consequences for patient outcomes and the cost of care. Providers are challenged with evaluating available evidence and best practices, then implementing programs and motivating change in various facility environments. In a large system of community hospitals, the Reducing Hospital Acquired-PrUs Program was developed to provide a toolkit of best practices, timely and appropriate data for focusing efforts, and continuous implementation support. Baseline data on PrU rates helped focus efforts on the most vulnerable patients and care situations. Facilities were empowered to use and adapt available resources to meet local needs and to share best practices for implementation across the system. Outcomes were measured by the rate of hospital-acquired PrUs, as gathered from patient discharge records. The rate of hospital-acquired stage III and IV PrUs decreased 66.3% between 2011 and 2013. Of the 149 participating facilities, 40 (27%) had zero hospital-acquired stage III and IV PrUs and 77 (52%) had a reduction in their PrU rate. Rates of all PrUs documented as present on admission did not change during this period. A comparison of different strategies used by the most successful facilities illustrated the necessity of facility-level flexibility and recognition of local workflows and patient demographics. Driven by the combination of a repository of evidence-based tools and best practices, readily available data on PrU rates, and local flexibility with processes, the Reducing Hospital Acquired-PrUs Program represents the successful operationalization of improvement in a wide variety of facilities.

  3. rFRET: A comprehensive, Matlab-based program for analyzing intensity-based ratiometric microscopic FRET experiments.

    Science.gov (United States)

    Nagy, Peter; Szabó, Ágnes; Váradi, Tímea; Kovács, Tamás; Batta, Gyula; Szöllősi, János

    2016-04-01

    Fluorescence or Förster resonance energy transfer (FRET) remains one of the most widely used methods for assessing protein clustering and conformation. Although it is a method with solid physical foundations, many applications of FRET fall short of providing quantitative results due to inappropriate calibration and controls. This shortcoming is especially valid for microscopy where currently available tools have limited or no capability at all to display parameter distributions or to perform gating. Since users of multiparameter flow cytometry usually apply these tools, the absence of these features in applications developed for microscopic FRET analysis is a significant limitation. Therefore, we developed a graphical user interface-controlled Matlab application for the evaluation of ratiometric, intensity-based microscopic FRET measurements. The program can calculate all the necessary overspill and spectroscopic correction factors and the FRET efficiency and it displays the results on histograms and dot plots. Gating on plots and mask images can be used to limit the calculation to certain parts of the image. It is an important feature of the program that the calculated parameters can be determined by regression methods, maximum likelihood estimation (MLE) and from summed intensities in addition to pixel-by-pixel evaluation. The confidence interval of calculated parameters can be estimated using parameter simulations if the approximate average number of detected photons is known. The program is not only user-friendly, but it provides rich output, it gives the user freedom to choose from different calculation modes and it gives insight into the reliability and distribution of the calculated parameters. © 2016 International Society for Advancement of Cytometry. © 2016 International Society for Advancement of Cytometry.

  4. Cost-benefit and extended cost-effectiveness analysis of a comprehensive adolescent pregnancy prevention program in Zambia: study protocol for a cluster randomized controlled trial.

    Science.gov (United States)

    Mori, Amani Thomas; Kampata, Linda; Musonda, Patrick; Johansson, Kjell Arne; Robberstad, Bjarne; Sandøy, Ingvild

    2017-12-19

    Early marriages, pregnancies and births are the major cause of school drop-out among adolescent girls in sub-Saharan Africa. Birth complications are also one of the leading causes of death among adolescent girls. This paper outlines a protocol for a cost-benefit analysis (CBA) and an extended cost-effectiveness analysis (ECEA) of a comprehensive adolescent pregnancy prevention program in Zambia. It aims to estimate the expected costs, monetary and non-monetary benefits associated with health-related and non-health outcomes, as well as their distribution across populations with different standards of living. The study will be conducted alongside a cluster-randomized controlled trial, which is testing the hypothesis that economic support with or without community dialogue is an effective strategy for reducing adolescent childbearing rates. The CBA will estimate net benefits by comparing total costs with monetary benefits of health-related and non-health outcomes for each intervention package. The ECEA will estimate the costs of the intervention packages per unit health and non-health gain stratified by the standards of living. Cost data include program implementation costs, healthcare costs (i.e. costs associated with adolescent pregnancy and birth complications such as low birth weight, pre-term birth, eclampsia, medical abortion procedures and post-abortion complications) and costs of education and participation in community and youth club meetings. Monetary benefits are returns to education and averted healthcare costs. For the ECEA, health gains include reduced rate of adolescent childbirths and non-health gains include averted out-of-pocket expenditure and financial risk protection. The economic evaluations will be conducted from program and societal perspectives. While the planned intervention is both comprehensive and expensive, it has the potential to produce substantial short-term and long-term health and non-health benefits. These benefits should be

  5. SU-E-T-16: A Hybrid VMAT/IMRT Technique for the Treatment of Nasopharyngeal Carcinoma

    International Nuclear Information System (INIS)

    Zhao, N; Yang, R; Wang, J

    2014-01-01

    Purpose: To investigate a Hybrid VMAT/IMRT technique which combines volumetric modulated arc therapy (VMAT) and intensity modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC). Methods: 2 full arcs VMAT, 9-field IMRT and Hybrid VMAT/IMRT plans were created for 10 patients with NPC. The Hybrid VMAT/IMRT technique consisted of 1 full VMAT arc and 7 IMRT fields. The dose distribution of planning target volume (PTV) and organs at risk (OARs) for Hybrid VMAT/IMRT was compared with IMRT and VMAT. The monitor units (MUs) were also evaluated. Results: The Hybrid VMAT/IMRT technique significantly improved target dose homogeneity compared with IMRT and VMAT for PTV70 and PTV54. For PTV70 and PTV60, the Hybrid VMAT/IMRT technique significantly improved target dose conformity compared with IMRT (0.62 vs 0.47; p<0.05 and 0.64 vs 0.58; p<0.05, respectively) and VMAT (0.62 vs 0.43; p<0.05 and 0.64 vs 0.6; p<0.05, respectively). The near maximum dose (D2%) of temporomandibular joint (TMJ), temporal lobe and mandible for Hybrid plans were 5.5%, 7.9% and 5.2% lower than IMRT plans (p<0.05). The mean dose of TMJ, temporal lobe, mandible and unspecified tissue for Hybrid plans were 12.8%, 11.4%, 4.2% and 4.1% lower than IMRT plans (p<0.05). The mean dose of right parotid, mandible and unspecified tissue for Hybrid plans were 3.3%, 2.4% and 3.1% lower than VMAT plans (p<0.05). The mean MUs needed for IMRT, VMAT and Hybrid plans were 2256, 507 and 1394, respectively. Conclusion: Hybrid VMAT/IMRT technique significantly improved the target dose homogeneity and conformity compared with IMRT and VMAT and reduced the dose of OARs and unspecified tissue compared with IMRT with fewer MUs. Compared with VMAT, Hybrid VMAT/IMRT technique can better protect parotid gland, mandible and unspecified tissue. Ruijie Yang was funded by the grant project: National Natural Science Foundation of China (No. 81071237). Other authors have no competing interest for this work

  6. SU-E-T-16: A Hybrid VMAT/IMRT Technique for the Treatment of Nasopharyngeal Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Zhao, N; Yang, R; Wang, J [Peking University Third Hospital, Beijing, Beijing (China)

    2014-06-01

    Purpose: To investigate a Hybrid VMAT/IMRT technique which combines volumetric modulated arc therapy (VMAT) and intensity modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC). Methods: 2 full arcs VMAT, 9-field IMRT and Hybrid VMAT/IMRT plans were created for 10 patients with NPC. The Hybrid VMAT/IMRT technique consisted of 1 full VMAT arc and 7 IMRT fields. The dose distribution of planning target volume (PTV) and organs at risk (OARs) for Hybrid VMAT/IMRT was compared with IMRT and VMAT. The monitor units (MUs) were also evaluated. Results: The Hybrid VMAT/IMRT technique significantly improved target dose homogeneity compared with IMRT and VMAT for PTV70 and PTV54. For PTV70 and PTV60, the Hybrid VMAT/IMRT technique significantly improved target dose conformity compared with IMRT (0.62 vs 0.47; p<0.05 and 0.64 vs 0.58; p<0.05, respectively) and VMAT (0.62 vs 0.43; p<0.05 and 0.64 vs 0.6; p<0.05, respectively). The near maximum dose (D2%) of temporomandibular joint (TMJ), temporal lobe and mandible for Hybrid plans were 5.5%, 7.9% and 5.2% lower than IMRT plans (p<0.05). The mean dose of TMJ, temporal lobe, mandible and unspecified tissue for Hybrid plans were 12.8%, 11.4%, 4.2% and 4.1% lower than IMRT plans (p<0.05). The mean dose of right parotid, mandible and unspecified tissue for Hybrid plans were 3.3%, 2.4% and 3.1% lower than VMAT plans (p<0.05). The mean MUs needed for IMRT, VMAT and Hybrid plans were 2256, 507 and 1394, respectively. Conclusion: Hybrid VMAT/IMRT technique significantly improved the target dose homogeneity and conformity compared with IMRT and VMAT and reduced the dose of OARs and unspecified tissue compared with IMRT with fewer MUs. Compared with VMAT, Hybrid VMAT/IMRT technique can better protect parotid gland, mandible and unspecified tissue. Ruijie Yang was funded by the grant project: National Natural Science Foundation of China (No. 81071237). Other authors have no competing interest for this work.

  7. Enhancing the effectiveness of biological control programs of invasive species through a more comprehensive pest management approach.

    Science.gov (United States)

    DiTomaso, Joseph M; Van Steenwyk, Robert A; Nowierski, Robert M; Vollmer, Jennifer L; Lane, Eric; Chilton, Earl; Burch, Patrick L; Cowan, Phil E; Zimmerman, Kenneth; Dionigi, Christopher P

    2017-01-01

    Invasive species are one of the greatest economic and ecological threats to agriculture and natural areas in the US and the world. Among the available management tools, biological control provides one of the most economical and long-term effective strategies for managing widespread and damaging invasive species populations of nearly all taxa. However, integrating biological control programs